Canterbury v. Spence

United States Court of Appeals for the District of Columbia Circuit · 1972 · Torts

TortsMedical malpracticeInformed consentNegligenceCausationExpert testimonyStatute of limitationsinformed consent

Facts

Nineteen-year-old Canterbury underwent a laminectomy performed by Dr. Spence after being told surgery was needed for a suspected ruptured disc, but Canterbury testified that Spence did not disclose any risk of paralysis, and his mother testified Spence described the operation as no more serious than any other operation. After the surgery, hospital personnel allegedly changed Spence's order that Canterbury remain in bed while voiding, left him unattended without a side rail, and he fell from the bed. Within hours he developed paralysis from the waist down and underwent a second operation, after which he was left with major lasting disabilities. At trial, Spence testified paralysis can be anticipated in about one percent of laminectomies and that trauma can cause paralysis, but the district judge directed verdicts for both defendants.

Issue

Whether the evidence was sufficient to require jury submission of Canterbury's claims that Dr. Spence negligently failed to disclose the material risk of paralysis, negligently performed the laminectomy, and that the hospital negligently provided post-operative care causing or aggravating his injuries. The case also raised what standard governs a physician's duty to disclose, what role causation and expert testimony play in nondisclosure claims, and whether the informed-consent claim was time-barred.

Rule

A physician has a duty to make a reasonable disclosure of information material to the patient's decision whether to undergo proposed therapy, including material risks, alternatives, and likely results of no treatment. The standard is not controlled by medical custom but by what a reasonable person in what the physician knows or should know to be the patient's position would likely consider significant; disclosure is excused only in true emergencies or when sound medical judgment shows disclosure would threaten the patient's well-being. Causation in nondisclosure cases is judged objectively: whether a prudent person in the patient's position, if adequately informed, would have declined the treatment. Expert testimony is required on medical matters such as risks, causation, and asserted privileges, but not on nonmedical matters such as whether disclosure occurred or whether a risk would be material to a patient's decision.

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One of 10 multiple-choice questions for this case. Pick an answer to see why.

In Seattle, Dr. Nina Patel recommended a nonemergency vascular procedure to Omar Reyes to relieve chronic leg pain. At trial, three surgeons testified that doctors in the area usually do not mention a 2% risk of permanent kidney failure unless the patient asks, and Dr. Patel followed that custom; Omar was never told of the risk and suffered kidney failure.

If Omar sues for negligent failure to obtain informed consent, which is the best statement of the governing standard for whether Dr. Patel had to disclose the risk?

Explanation. The majority held that the physician's duty of disclosure is governed by a legal standard of reasonableness focused on patient self-determination, not by medical custom alone. Custom may have evidentiary value when medical judgment is involved, but it does not define the legal duty. The question is whether a reasonable person in what the physician knows or should know to be the patient's position would likely attach significance to the risk in deciding whether to undergo treatment.