Introduction

The Supreme Court of Hawaii, in the landmark case Robin Carr, indi v. Straub Clinic Hospital, Inc. (79 Haw. 475, 1995), addressed critical issues surrounding the doctrine of informed consent in medical malpractice. This case marked a significant shift from the traditional "physician-oriented" standard to the "patient-oriented" standard, fundamentally altering the legal landscape for informed consent in Hawaii.

Summary of the Judgment

The plaintiffs, Robin Carr and Donna Sorrell, sued Dr. Walter S. Strode and Straub Clinic Hospital for failing to obtain informed consent prior to performing a vasectomy on Carr. This failure allegedly resulted in the unplanned birth of their child, Ellen. Initially, a jury found in favor of the plaintiffs, awarding them $75,000 in general damages for lack of informed consent. However, the trial court granted a Judgment Notwithstanding the Verdict (JNOV) in favor of the defendants, citing the absence of expert medical evidence from the plaintiffs.

Upon appeal, the Supreme Court of Hawaii reversed the trial court's decision, emphasizing the necessity of adopting the patient-oriented standard for informed consent. The court remanded the case for a new trial, focusing solely on the issue of informed consent.

Analysis

Precedents Cited

The judgment extensively reviewed prior cases that shaped the doctrine of informed consent:

• NISHI v. HARTWELL (52 Haw. 188, 1970): Established the "physician-oriented" standard, requiring plaintiffs to provide expert testimony to prove deviations from medical standards.
• CANTERBURY v. SPENCE (464 F.2d 772, D.C. Cir., 1972): Introduced the "patient-oriented" standard, focusing on what a reasonable patient needs to know to make an informed decision.
• LEYSON v. STEUERMANN (5 Haw. App. 504, 1985) and Mroczkowski v. Straub Clinic Hospital (6 Haw. App. 563, 1987): Clarified and codified Hawaii's statutes on informed consent, aligning more closely with the patient-oriented approach.
• BERNARD v. CHAR (79 Haw. App. 371, 1995): Cemented the patient-oriented standard within Hawaii's legal framework.

Legal Reasoning

The court's primary legal innovation was the explicit adoption of the patient-oriented standard for informed consent, thereby overruling the longstanding physician-oriented approach established in NISHI v. HARTWELL. This shift mandates physicians to disclose information based on what a reasonable patient would consider material to their decision-making process, rather than solely adhering to professional medical standards.

The court reasoned that the patient-oriented standard better respects the patient's autonomy and right to self-determination. It ensures that patients receive all pertinent information necessary to make informed decisions about their medical treatments, thereby enhancing transparency and accountability in medical practices.

Additionally, the court clarified that while expert medical testimony remains essential to establish the materiality of risks, it is no longer required to define the standard of disclosure itself. This nuanced understanding balances the need for expert input with the patient's perspective.

Impact

The adoption of the patient-oriented standard has profound implications for future medical malpractice cases in Hawaii:

• Enhanced Patient Protection: Patients are now better protected as the standard directly addresses their informational needs, ensuring that consent is truly informed.
• Shift in Burden of Proof: While plaintiffs still need to establish the materiality of risks with expert testimony, they are no longer burdened with proving deviations from medical practice.
• Legal Precedent: This ruling sets a clear precedent, guiding lower courts in assessing informed consent claims and shaping how medical practices communicate risks to patients.
• Healthcare Practices: Medical professionals may revise consent procedures to align with the patient-oriented standard, ensuring comprehensive communication of risks and alternatives.

Complex Concepts Simplified

Informed Consent

Informed Consent is a fundamental principle in healthcare, requiring that patients are adequately informed about the risks, benefits, and alternatives of a medical procedure before agreeing to it. This ensures that patients make voluntary and educated decisions regarding their treatment.

Physician-Oriented vs. Patient-Oriented Standards

Physician-Oriented Standard: Focuses on what the medical community deems necessary to disclose. It relies on professional judgment to determine what information is critical for patient consent.

Patient-Oriented Standard: Centers on what a reasonable patient would need to know to make an informed decision. It emphasizes the patient's perspective and informational needs over professional discretion.

Judgment Notwithstanding the Verdict (JNOV)

JNOV occurs when a judge overturns the jury's decision because it finds that no reasonable jury could have reached such a verdict based on the evidence presented. In this case, the trial court granted a JNOV in favor of the defendants, which was later reversed by the Supreme Court.

Materiality of Risk

Materiality of Risk refers to the significance of potential risks associated with a medical procedure that would influence a patient's decision to undergo or refuse the treatment. It is crucial in determining whether consent was truly informed.

Conclusion

The Supreme Court of Hawaii's decision in Robin Carr, indi v. Straub Clinic Hospital, Inc. represents a pivotal moment in the evolution of informed consent law within the state. By embracing the patient-oriented standard, the court has reinforced the importance of patient autonomy and the necessity for transparent communication in medical practices. This ruling not only aligns Hawaii with broader national trends favoring patient-centered care but also ensures that patients are adequately informed, thereby fostering trust and accountability in the patient-physician relationship.