Miller v. Kennedy
11 Wash. App. 272, 522 P.2d 852 (1974)
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Rule of Law:
A physician has a legal duty to disclose all material risks of a proposed treatment to a patient, with materiality being defined by what a reasonable person in the patient's position would consider significant in making a decision, rather than by the customary practice of the medical community.
Facts:
- Richard R. Miller consulted Dr. Kennedy for symptoms including fatigue and shortness of breath.
- Dr. Kennedy diagnosed Miller with a severe heart block condition and hospitalized him for intensive care.
- While investigating the cause of the heart condition, tests suggested a potential kidney problem.
- Dr. Kennedy recommended a kidney biopsy to diagnose the kidney issue.
- Miller alleged Dr. Kennedy never informed him of the risk of losing the kidney as a result of the biopsy, while Dr. Kennedy testified that he did provide this information.
- During the biopsy procedure, the biopsy needle was inserted slightly above the intended site.
- Following the procedure, Miller suffered from continuous bleeding from his kidney and considerable pain.
- Due to uncontrollable hemorrhaging that proximately resulted from the biopsy, Miller's previously healthy kidney had to be surgically removed.
Procedural Posture:
- Richard R. Miller sued Dr. Kennedy for medical malpractice in a state trial court.
- A jury returned a verdict in favor of the defendant, Dr. Kennedy.
- The plaintiff, Miller, filed a motion for a new trial or judgment notwithstanding the verdict (n.o.v.), which the trial court denied.
- Miller, as the appellant, appealed the judgment to the Court of Appeals of Washington.
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Issue:
Does the doctrine of informed consent require a physician to disclose all material risks that a reasonable patient would find significant in making a treatment decision, with this duty being defined by law rather than by the professional custom of other physicians?
Opinions:
Majority - Callow, J.
Yes, the doctrine of informed consent requires a physician to disclose all material risks that a reasonable patient would find significant in making a treatment decision, and this duty is defined by law, not medical custom. The court held that the relationship between a doctor and patient is a fiduciary one, grounded in trust. A patient has a fundamental right to self-determination, which can only be exercised if they possess adequate information. Therefore, the scope of a physician's duty to disclose is measured by the patient's need to know. A risk is material if a reasonable person in the patient's position would likely attach significance to it when deciding on a course of treatment. Expert medical testimony is necessary to establish the existence of a risk, but not to establish the legal duty to disclose that risk. The court also held that the trial court erred in refusing to give a jury instruction on res ipsa loquitur, as there was expert testimony from which the jury could have inferred that Miller's injury would not have occurred without negligence. Due to the incorrect jury instructions on informed consent and res ipsa loquitur, the case was reversed and remanded for a new trial.
Analysis:
This decision significantly shifts the standard for informed consent in Washington from a physician-centric standard to a patient-centric one. By rejecting the 'professional custom' standard, the court aligned with a modern trend exemplified by cases like Canterbury v. Spence. The ruling empowers patients by establishing that the duty to disclose material risks is a matter of law based on a patient's right to self-determination, not a standard set by the medical community. This precedent makes it more difficult for physicians to defend nondisclosure by arguing that their peers would have done the same; the focus is now on what a reasonable patient would need to know.
