Arena v. Gingrich

733 P.2d 75, 84 Or. App. 25
CourtCourt of Appeals of Oregon
DecidedFebruary 25, 1987
DocketA8306-03487; CA A36593
StatusPublished
Cited by4 cases

This text of 733 P.2d 75 (Arena v. Gingrich) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Arena v. Gingrich, 733 P.2d 75, 84 Or. App. 25 (Or. Ct. App. 1987).

Opinions

[27]*27RICHARDSON, P. J.

Plaintiff appeals from a judgment entered on a jury verdict for defendant Gingrich1 in this medical malpractice action. Defendant performed surgery on plaintiff for a hiatal hernia. There are three standard surgical procedures for that condition, two of which entail wrapping and suturing a portion of the stomach to the esophagus. The third involves implacement of an artificial device, known as an Anchelchik ring, at the base of the esophagus. Defendant used the third procedure; however, he advised plaintiff only about the first two before the surgery and before she gave her consent to it. Plaintiff contends that defendant proceeded without her informed consent and was professionally negligent and committed a battery by so doing. Plaintiff maintains that she suffered psychological damage and felt “violated” and that she had been used as a “guinea pig.”

The principal issue in connection with the negligence claim is whether the proper test for determining if a patient would have consented to a procedure, notwithstanding a physician’s nondisclosure of material alternatives or risks, is subjective, i.e., whether the particular patient would in fact have consented, or objective, i.e.,whether a prudent person in the patient’s position would do so. Plaintiff takes the former view; defendant takes, and the trial court took, the latter, and plaintiff assigns error, inter alia, to the court’s instruction reflecting that view. We do not agree fully with either party’s argument, but we do agree that the instruction was incorrect, and we reverse and remand on the negligence claim.2

Two of the questions which arise in cases where a patient alleges that a physician or other health practitioner [28]*28failed to obtain the patient’s informed consent to a diagnostic or therapeutic procedure are what information the practitioner must disclose to the patient and whether failure to make a necessary disclosure “caused” the patient’s consent, in the sense that the patient in fact consented but would not have had the disclosure been made. The Oregon Supreme Court has answered the first question, holding that the duty to disclose a risk of or an alternative to a mode of treatment depends on its materiality. Getchell v. Mansfield, 260 Or 174, 181, 489 P2d 953 (1971). Materiality is to be ascertained by reference to whether

“ ‘a reasonable person, in what the physician knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding whether or not to undergo the proposed therapy.’ ” Holland v. Srs. of St. Joseph, Seeley, 270 Or 129, 137, 522 P2d 208, 526 P2d 577 (1974), quoting Waltz & Scheuneman, “Informed Consent to Therapy,” 64 NW L Rev 638, 640 (1969).3

No issue is presented in this appeal about whether defendant’s nondisclosure was material or whether a reasonable patient would be likely to attach significance to the undisclosed information. The parties’ concern here is with the [29]*29second question which we have described, and that question has not heen answered by Oregon’s appellate courts. Both parties rely on cases from other jurisdictions to support their positions. Canterbury v. Spence, 464 F2d 772 (DC Cir), cert den 409 US 1064 (1972), and Cobbs v. Grant, 8 Cal 3d 229, 104 Cal Rptr 505, 502 P2d 1 (1972), are representative of the cases on which defendant relies. The court said in Cobbs:

“There must be a causal relationship between the physician’s failure to inform and the injury to the plaintiff. Such causal connection arises only if it is established that had revelation been made consent to treatment would not have been given. Here the record discloses no testimony that had plaintiff been informed of the risks of surgery he would not have consented to the operation. * * *
“The patient-plaintiff may testify on this subject but the issue extends beyond his credibility. Since at the time of trial the uncommunicated hazard has materialized, it would be surprising if the patient-plaintiff did not claim that had he been informed of the dangers he would have declined treatment. Subjectively he may believe so, with the 20/20 vision of hindsight, but we doubt that justice will be served by placing the physician in jeopardy of the patient’s bitterness and disillusionment. Thus an objective test is preferable: i.e., what would a prudent person in the patient’s position have decided if adequately informed of all significant perils.” 8 Cal 3d at 245. (Citations omitted.)4

Scott v. Bradford, 606 P2d 554 (Okla 1979), exemplifies plaintiffs authority:

“The court in Canterbury v. Spence, supra, although emphasizing principles of self-determination permits liability only if non-disclosure would have affected the decision of a fictitious ‘reasonable patient,’ even though actual patient testifies he would have elected to forego therapy had he been fully informed.
“Decisions discussing informed consent have emphasized the disclosure element but paid scant attention, to the consent element of the concept, although this is the root of causation. Language in some decisions suggest the standard to be applied is a subjective one, i. e., whether that particular patient would [30]*30still have consented to the treatment, reasonable choice or otherwise. * * *
“Although the Canterbury rule is probably that of the majority, its ‘reasonable man’ approach has been criticized by some commentators as backtracking on its own theory of self-determination. The Canterbury view certainly severely limits the protection granted an injured patient. To the extent the plaintiff, given an adequate disclosure, would have declined the proposed treatment, and a reasonable person in similar circumstances would have consented, a patient’s right of self-determination is irrevocably lost. This basic right to know and decide is the reason for the full-disclosure rule. Accordingly, we decline to jeopardize this right by the imposition of the ‘reasonable man’ standard.
“If a plaintiff testifies he would have continued with the proposed treatment had he been adequately informed, the trial is over under either the subjective or objective approach. If he testifies he would not, then the causation problem must be resolved by examining the credibility of plaintiffs testimony. The jury must be instructed that it must find plaintiff would have refused the treatment if he is to prevail.
“Although it might be said this approach places a physician at the mercy of a patient’s hindsight, a careful practitioner can always protect himself by insuring that he had adequately informed each patient he treats. If he does not breach this duty, a causation problem will not arise.” 606 P2d at 558-59. (Citations and footnotes omitted; emphasis in original.)

There are several difficulties with the “objective” or “reasonable person” test of causation.

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Related

Sherwood v. Carter
805 P.2d 452 (Idaho Supreme Court, 1991)
Arena v. Gingrich
748 P.2d 547 (Oregon Supreme Court, 1988)
Arena v. Gingrich
733 P.2d 75 (Court of Appeals of Oregon, 1987)

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733 P.2d 75, 84 Or. App. 25, Counsel Stack Legal Research, https://law.counselstack.com/opinion/arena-v-gingrich-orctapp-1987.