Takeaway
In short, this case made informed consent a patient-centered negligence doctrine: physicians must reasonably disclose material risks and alternatives, and juries—not medical custom alone—decide whether that duty was breached.
Nineteen-year-old Jerry Canterbury suffered severe pain between his shoulder blades and consulted neurosurgeon Dr. William Spence. After a myelogram showed a possible abnormality near the fourth thoracic vertebra, Spence recommended a laminectomy to investigate and treat what he suspected was a ruptured disc. Canterbury testified that Spence never told him the operation carried a risk of paralysis. When Canterbury’s mother asked whether the procedure was serious, Spence allegedly responded that it was no more serious than any other operation.
After the February 1959 surgery, Canterbury initially recovered normally. Hospital personnel allegedly changed an order requiring him to remain in bed while voiding. While unattended and without a side rail, Canterbury slipped from his bed. Within hours, he developed near-total paralysis below the waist and breathing difficulties. Spence performed a second operation, but Canterbury was left with serious and lasting impairments, including difficulty walking, bowel paralysis, and urinary incontinence.
Canterbury sued Spence for negligent performance of the laminectomy and negligent failure to disclose the risk of paralysis. He sued Washington Hospital Center for negligent postoperative care. At the close of Canterbury’s case, the district court directed verdicts for both defendants, reasoning that Canterbury had not supplied sufficient medical proof of negligent treatment or causation. The court of appeals reversed and remanded for a new trial.
Issue #1
Whether a physician’s duty to disclose treatment risks and alternatives is defined exclusively by prevailing medical custom.
Holding
No. A physician has a legal duty to make reasonable disclosures necessary for the patient to make an intelligent treatment decision; medical custom is relevant only insofar as medical judgment is genuinely involved.
Reasoning
The court grounded disclosure in the patient’s fundamental right to decide what will be done to his or her own body. Because patients ordinarily lack medical knowledge and rely heavily on their physicians, meaningful consent requires a reasonable explanation of the proposed treatment, its alternatives, and its dangers.
The court rejected the prevailing rule that made disclosure depend wholly on what doctors customarily reveal. That approach lets the medical profession set the limits of the patient’s right to know, even though the decision whether to undergo treatment belongs to the patient rather than the physician.
Professional standards remain important when the disputed question requires medical expertise, such as identifying risks or assessing a claimed therapeutic reason not to disclose. But the ultimate legal standard for disclosure is ordinary reasonableness under the circumstances, set by law rather than by professional custom alone.
Issue #2
What information must a physician disclose to satisfy the duty of reasonable disclosure.
Holding
A physician must disclose material risks, reasonable alternatives, and the likely consequences of declining treatment, measured by what a reasonable person in the patient’s position would consider significant to the treatment decision.
Reasoning
The court declined to require literal “full disclosure,” which would unrealistically compel doctors to list every remote or trivial risk. The duty instead concerns information material to an intelligent choice.
A risk is material when a reasonable person in the position the physician knows or should know the patient occupies would likely attach significance to it in deciding whether to accept or reject the proposed therapy. Materiality depends on both the probability of harm and the seriousness of the threatened injury.
The standard is objective but patient-centered. It considers the informational needs of a reasonable patient in this patient’s circumstances, while allowing the physician reasonable judgment about what information is important and capable of being conveyed. Common, obvious, previously known, or plainly immaterial risks generally need not be discussed.
Issue #3
Whether Dr. Spence was entitled, as a matter of law, to withhold the risk of paralysis because disclosure might discourage patients from accepting beneficial surgery.
Holding
No. The evidence permitted a jury to find that Spence unreasonably failed to disclose a material risk, and no recognized privilege to withhold the information was established as a matter of law.
Reasoning
The court recognized narrow privileges not to disclose: a genuine emergency in which consent cannot practicably be obtained, and a therapeutic situation in which disclosure itself would foreseeably threaten the patient’s well-being. These exceptions reflect exceptional circumstances, not a general physician power to decide that a patient should remain uninformed.
A therapeutic privilege cannot rest on the paternalistic belief that patients might irrationally refuse treatment their doctor believes they need. The privilege requires a medically sound, patient-specific judgment that disclosure would itself pose a serious threat, such as rendering the patient incapable of rational choice or substantially harming treatment.
Canterbury and his mother testified that Spence did not disclose the risk of paralysis, while Spence acknowledged that paralysis occurred in roughly one percent of laminectomies. A small risk of grave disability may be material. There was no emergency and no evidence that Canterbury’s particular emotional condition made disclosure medically unsafe; a jury therefore had to decide whether nondisclosure was reasonable.
Issue #4
How causation is determined in an informed-disclosure claim.
Holding
Causation turns on an objective test: whether a prudent person in the patient’s position would have declined the treatment if adequately informed of the material risk that materialized.
Reasoning
Nondisclosure alone does not establish liability. The undisclosed risk must materialize, cause injury, and bear a causal relationship to the physician’s failure to inform. If adequate disclosure would not have changed the decision to undergo treatment, the omission did not cause the injury in the legal sense.
The court rejected a purely subjective test based solely on Canterbury’s later assertion that he personally would have refused surgery. Such testimony is inevitably hypothetical and may be affected by hindsight after the feared injury has occurred.
The patient’s own testimony remains relevant, but the factfinder must decide what a prudent person in the patient’s position would have chosen if told of the material risks, alternatives, and consequences of no treatment.
Issue #5
Whether expert medical testimony is required to prove every element of a claim based on inadequate disclosure.
Holding
No. Expert evidence is necessary for medical matters, but lay evidence may establish nondisclosure, the patient’s lack of knowledge, materiality to a reasonable patient’s decision, and other nonmedical facts.
Reasoning
Medical experts ordinarily are needed to identify and explain the risks of treatment, available medical alternatives, the likely consequences of foregoing treatment, medical causation, and any asserted emergency or therapeutic privilege. Those matters generally lie beyond ordinary experience.
But the central legal question of whether disclosure was adequate is not wholly medical. A patient or other lay witness may testify to what the physician did or did not say, what the patient knew, and what happened after treatment.
Likewise, jurors can assess whether a risk would be material to a reasonable patient’s choice without medical-custom testimony. Requiring expert proof of professional disclosure customs would improperly reintroduce the physician-centered standard the court had rejected.
Issue #6
Whether Canterbury’s nondisclosure claim was barred by the statute of limitations applicable to battery actions.
Holding
No. Although an unauthorized operation can support a battery theory subject to a one-year limitations period, Canterbury also alleged negligent breach of a physician’s duty to disclose, which is governed by the three-year negligence period and was timely filed after his minority ended.
Reasoning
Canterbury was a minor when the surgery occurred, so the limitations period did not begin until he reached majority. His claims for negligent surgery and negligent hospital care plainly fell within the three-year negligence period.
The court acknowledged that treatment without effective consent may amount to battery. Had Canterbury sought recovery only on a battery theory, the one-year statute would have barred the claim.
But the complaint also asserted a distinct negligence theory: that Spence breached his professional duty to provide reasonable disclosure before surgery. That claim protected Canterbury’s interest against negligent invasion of bodily integrity and remained timely under the three-year statute.
Issue #7
Whether the evidence required submission to the jury of Canterbury’s negligent-surgery claim against Dr. Spence.
Holding
Yes. The evidence permitted reasonable jurors to find negligent surgical performance and causation, including aggravation of a preexisting condition.
Reasoning
A post-second-operation report prepared by Spence indicated that he then believed overly tight sutures at the laminectomy site might have caused the paralysis. Although he later denied that explanation at trial, the earlier report and surrounding facts created a jury question.
Before surgery, Canterbury had back pain but none of the disabling paralysis, bowel dysfunction, or urinary problems he later suffered. His condition appeared soon after the procedure, and his symptoms improved somewhat when Spence reopened the wound and created additional room for the spinal cord to pulsate.
The jury was not required to accept Spence’s opinion that Canterbury’s preexisting spinal condition alone caused the disability. Even if that condition contributed, a negligent defendant is liable for aggravating a preexisting vulnerability. Medical uncertainty did not eliminate the jury’s authority to draw reasonable causal inferences from all the evidence.
Issue #8
Whether the evidence required submission to the jury of Canterbury’s negligent-postoperative-care claim against Washington Hospital Center.
Holding
Yes. Evidence that Canterbury was left unattended while voiding after serious spinal surgery, without a side rail and contrary to an earlier bed-rest order, supported jury findings of negligence and causation.
Reasoning
A jury could find that hospital personnel changed the instruction that Canterbury remain in bed while voiding, failed to provide assistance, and left him without a side rail while he attempted to relieve himself. Those circumstances could establish a failure to exercise reasonable care for a recently operated patient’s safety.
The evidence showed that Canterbury’s condition was progressing normally after the first surgery, that he fell while unattended, and that he developed severe paralysis and respiratory trouble only hours later. Jurors could rely on ordinary experience that a fall may cause or worsen injury, reinforced by Spence’s testimony that trauma can produce paralysis.
Canterbury was not required to identify conclusively whether Spence’s surgery, the hospital’s care, or both caused his disabilities before the case could go to the jury. Once evidence supported negligence by multiple defendants and uncertainty remained about which caused the harm, the defendants could be required to offer proof that they did not cause it.