Canterbury v. Spence

464 F.2d 772 (D.C. Cir. 1972)

Quick Summary

Jerry W. Canterbury (plaintiff) filed a lawsuit against Dr. William Thornton Spence (defendant) and Washington Hospital Center (defendant) after a laminectomy resulted in Canterbury’s paralysis, claiming negligence in failing to disclose surgical risks and in post-operative care.

The case questioned whether Dr. Spence was obligated to inform Canterbury about the paralysis risk and whether the hospital was negligent in its care.

The appellate court determined that these issues should be decided by a jury and not directed verdicts.

Facts of the Case

At the age of 19, Jerry W. Canterbury (plaintiff) experienced severe upper back pain and sought medical attention from Dr. William Thornton Spence (defendant), a neurosurgeon. After diagnostic procedures, Dr. Spence recommended a laminectomy to repair a suspected ruptured disc.

Canterbury consented to the surgery without being informed of the risk of paralysis. Post-operation, Canterbury fell from his hospital bed, resulting in paralysis from the waist down. He underwent a second surgery but continued to suffer long-term incontinence and bladder paralysis.

Canterbury filed a medical malpractice action against Dr. Spence and Washington Hospital Center (defendant), alleging negligence in surgery, failure to disclose risks, and negligent post-operative care. Dr. Spence had informed Canterbury’s mother about the surgery but downplayed its seriousness, and she signed a consent form post-procedure.

Procedural Posture and History

  1. Canterbury experienced severe back pain and consulted Dr. Spence.
  2. Dr. Spence recommended and performed a laminectomy without informing Canterbury of the risk of paralysis.
  3. Canterbury became paralyzed after a fall in the hospital.
  4. Canterbury brought a medical malpractice action against Dr. Spence and the hospital.
  5. The federal district court granted directed verdicts for the defendants, stating Canterbury failed to produce medical evidence of negligence.
  6. Canterbury appealed to the court of appeals.

I.R.A.C. Format

Issue

  • Whether Dr. Spence was negligent in failing to disclose the risk of paralysis associated with the laminectomy.
  • Whether the hospital provided negligent post-operative care resulting in Canterbury’s injuries.

Rule of Law

A physician has a duty to inform a patient of the risks associated with a medical procedure, allowing the patient to make an informed decision regarding their treatment. This duty is part of the physician’s overall obligation to exercise reasonable care towards their patients.

Reasoning and Analysis

The court reversed the lower court’s decision, finding that evidence was presented which should have been considered by a jury. The court emphasized that every adult has the right to decide what happens to their body, which necessitates being adequately informed of medical risks and alternatives by their physician.

The court rejected the idea that medical practice custom determines the duty to disclose, asserting instead that the law should set this standard. The court also introduced an objective standard for determining causation: whether a reasonable person, with proper risk disclosure, would have declined the treatment that resulted in harm.

Conclusion

The court reversed the judgment for both Dr. Spence and Washington Hospital Center and remanded the case for a new trial, as there were jury issues regarding whether Dr. Spence’s nondisclosure of risk and alleged negligent performance of surgery, as well as the hospital’s post-operative care, caused Canterbury’s injuries.

Key Takeaways

  1. A physician must inform a patient of risks associated with medical procedures, allowing for informed consent.
  2. The standard for what risks need to be disclosed is based on what a reasonable person would need to know to make an informed decision.
  3. Causation in nondisclosure cases should be determined objectively, based on what a reasonable person would have decided if properly informed.

Relevant FAQs of this case

What legal obligations do professionals have to inform clients of risks in their services?

Professionals have a legal duty of care to disclose all material risks associated with their services that might affect the client’s decision-making process. This obligation is crucial for informed consent and varies based on the profession’s standards, the complexity of the service, and the client’s ability to understand the risks. The goal is to ensure that clients can give voluntary and informed consent based on the full appreciation of potential consequences.

  • For example: An investment advisor must inform an investor of the potential for loss when recommending a high-risk stock, allowing the client to understand and weigh the risk before consenting to invest.

How does a 'reasonable person standard' influence legal decision-making in informed consent cases?

The ‘reasonable person standard’ provides an objective measure in informed consent cases, determining whether a prudent individual would have made a different decision if properly informed of all significant risks. This benchmark serves as a guide for both professionals to disclose information and courts to assess whether nondisclosure likely affected the client’s choice.

  • For example: In prescribing medication, a doctor must explain common side effects and severe risks because a reasonable person would likely consider these factors when deciding whether to take a prescription.

In what scenarios does the failure to disclose constitute negligence?

Negligence due to nondisclosure occurs when a professional breaches their duty by failing to communicate critical information that affects a client’s decisions, consequently leading to harm that would have been avoidable had the client been properly informed. The severity of negligence hinges on the likelihood and magnitude of the risk not disclosed.

  • For example: An architect designing a house must alert the homeowner if there is a significant risk that part of the design does not comply with building codes, potentially leading to future structural issues or legal penalties.

References

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