Truman v. Thomas
611 P.2d 902, 27 Cal. 3d 285, 165 Cal. Rptr. 308 (1980)
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Rule of Law:
A physician's duty of care under the doctrine of informed consent includes the duty to disclose all material information that would enable a patient to make an informed decision, which encompasses advising the patient of the material risks of refusing to undergo a recommended diagnostic test.
Facts:
- From April 1963 to March 1969, Dr. Claude R. Thomas served as the primary physician for Rena Truman and her children.
- Throughout this six-year period, Dr. Thomas frequently saw Mrs. Truman but never performed a Pap smear test on her.
- Dr. Thomas testified that he often recommended a Pap smear, but Mrs. Truman refused, citing reasons such as cost or that she "just didn’t feel like it."
- Dr. Thomas admitted that he never specifically informed Mrs. Truman of the potentially fatal consequences of failing to undergo a Pap smear and allowing cervical cancer to develop undetected.
- In April 1969, a different physician discovered that Mrs. Truman's cervix was extremely rough and advised her to see a gynecologist.
- In October 1969, a gynecologist diagnosed Mrs. Truman with a large, inoperable cancerous tumor on her cervix.
- Rena Truman died from cervical cancer in July 1970 at the age of 30.
- Expert testimony at trial indicated that if Mrs. Truman had undergone a Pap smear between 1964 and 1969, the cancer likely would have been discovered in time to save her life.
Procedural Posture:
- Rena Truman's children (appellants) filed a wrongful death action against Dr. Thomas (respondent) in the trial court.
- At trial, the appellants requested a jury instruction stating that a physician has a duty to disclose the risks to a patient if a recommended test is refused.
- The trial court refused to give the requested instruction to the jury.
- The jury returned a special verdict finding Dr. Thomas free of any negligence that proximately caused Mrs. Truman’s death.
- A judgment was entered in favor of Dr. Thomas, and Mrs. Truman's children appealed to the Supreme Court of California.
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Issue:
Does a physician's duty to disclose material information to a patient include the duty to inform the patient of the risks of refusing to undergo a recommended diagnostic test?
Opinions:
Majority - Bird, C. J.
Yes. A physician's duty of due care requires the disclosure of all material information a patient needs to make an informed choice, and this duty includes advising a patient of the material risks associated with a decision to refuse a recommended procedure. The court reasoned that the right of a patient to control their own body is paramount, and this right can only be meaningfully exercised if the patient is aware of the consequences of their decisions, including the decision to reject a physician's advice. Extending the principles from Cobbs v. Grant, the court held that the fiduciary nature of the physician-patient relationship is not diminished when a patient declines a procedure. Therefore, the physician remains obligated to provide information about the risks of that refusal, especially when the risk is death, which is the principal reason for recommending the test in the first place.
Dissenting - Clark, J.
No. A physician should not have a duty to disclose the risks of refusing a diagnostic test because it imposes an intolerable burden on doctors and the healthcare system. The dissent argued that this new rule would require physicians to spend an unreasonable amount of time providing 'mini-courses in medical science' for every routine test, driving up costs and reducing time for actual patient care. It distinguished this case from Cobbs v. Grant, asserting that the informed consent doctrine applies only when there is a bodily intrusion requiring consent, not when a patient refuses a procedure. The proper standard of care should be determined by the medical community, not by the court as a matter of law.
Analysis:
This decision significantly expands the doctrine of informed consent from merely covering the risks of an accepted procedure to also covering the risks of a refused one. It establishes the principle of 'informed refusal,' shifting the onus onto the physician to ensure a patient's refusal of a recommended test is based on a clear understanding of the potential consequences. This holding strengthens patient autonomy by providing more information but also increases the potential scope of medical malpractice liability for physicians who fail to adequately document warnings about refused procedures. The case underscores that a physician's duty to inform is not extinguished by a patient's initial refusal.
