California Civil Jury Instructions (CACI)
532. Informed Consent—Definition
A patient’s consent to a medical procedure must be “informed.” A patient gives an “informed consent” only after the [insert type of medical practitioner] has fully explained the proposed treatment or procedure.
[A/An] [insert type of medical practitioner] must explain the likelihood of success and the risks of agreeing to a medical procedure in language that the patient can understand. [A/An] [insert type of medical practitioner] must give the patient as much information as [he/she] needs to make an informed decision, including any risk that a reasonable person would consider important in deciding to have the proposed treatment or procedure, and any other information skilled practitioners would disclose to the patient under the same or similar circumstances. The patient must be told about any risk of death or serious injury or significant potential complications that may occur if the procedure is performed. [A/An] [insert type of medical practitioner] is not required to explain minor risks that are not likely to occur.
New September 2003; Revised December 2005, October 2008
Directions for Use
This instruction should be read in conjunction with CACI No. 533, Failure to Obtain Informed Consent—Essential Factual Elements. Do not give this instruction with CACI No. 530A, Medical Battery, or CACI No. 530B, Medical Battery—Conditional Consent. (See Saxena v. Goffney (2008) 159 Cal.App.4th 316, 324 [71 Cal.Rptr.3d 469].)
If the patient is a minor or is incapacitated, tailor the instruction accordingly.
Also, see CACI No. 531, Consent on Behalf of Another.
Sources and Authority
- A physician is required to disclose “all information relevant to a meaningful decisional process.” (Cobbs v. Grant (1972) 8 Cal.3d 229, 242 [104 Cal.Rptr. 505, 502 P.2d 1].)
- “When a doctor recommends a particular procedure then he or she must disclose to the patient all material information necessary to the decision to undergo the procedure, including a reasonable explanation of the procedure, its likelihood of success, the risks involved in accepting or rejecting the proposed procedure, and any other information a skilled practitioner in good standing would disclose to the patient under the same or similar circumstances.” (Mathis v. Morrissey (1992) 11 Cal.App.4th 332, 343 [13 Cal.Rptr.2d 819].)
- “A physician has a duty to inform a patient in lay terms of the dangers inherently and potentially involved in a proposed treatment.” (McKinney v. Nash (1981) 120 Cal.App.3d 428, 440 [174 Cal.Rptr. 642].)
- Courts have observed that Cobbs created a two-part test for disclosure. “First, a physician must disclose to the patient the potential of death, serious harm, and other complications associated with a proposed procedure.” (Daum v. SpineCare Medical Group, Inc. (1997) 52 Cal.App.4th 1285, 1301 [61 Cal.Rptr.2d 260].) “Second, ‘[b]eyond the foregoing minimal disclosure, a doctor must also reveal to his patient such additional information as a skilled practitioner of good standing would provide under similar circumstances.’ ” (Id. at p. 1302, citation omitted.) The doctor has no duty to discuss minor risks inherent in common procedures when it is common knowledge that such risks are of very low incidence. (Cobbs, supra, 8 Cal.3d at p. 244.)
- The courts have defined “material information” as follows: “Material information is that which the physician knows or should know would be regarded as significant by a reasonable person in the patient’s position when deciding to accept or reject the recommended medical procedure. To be material, a fact must also be one which is not commonly appreciated. If the physician knows or should know of a patient’s unique concerns or lack of familiarity with medical procedures, this may expand the scope of required disclosure.” (Truman v. Thomas (1980) 27 Cal.3d 285, 291 [165 Cal.Rptr. 308, 611 P.2d 902], internal citations omitted.)
- “Obviously involved in the equation of materiality are countervailing factors of the seriousness and remoteness of the dangers involved in the medical procedure as well as the risks of a decision not to undergo the procedure.” (McKinney, supra, 120 Cal.App.3d at p. 441.)
- Expert testimony is not required to establish the duty to disclose the potential of death, serious harm, and other complications. (Cobbs, supra, 8 Cal.3d at p. 244.) Expert testimony is admissible to show what other information a skilled practitioner would have given under the circumstances. (Arato v. Avedon (1993) 5 Cal.4th 1172, 1191–1192 [23 Cal.Rptr.2d 131, 858 P.2d 598].)
- A physician must also disclose personal interests unrelated to the patient’s health, whether research or economic, that may affect his or her medical judgment. (Moore v. Regents of Univ. of Cal. (1990) 51 Cal.3d 120, 129–132 [271 Cal.Rptr. 146, 793 P.2d 479], cert. denied, 499 U.S. 936 (1991).)
- Appellate courts have rejected a general duty of disclosure concerning a treatment or procedure a physician does not recommend. However, in some cases, “there may be evidence that would support the conclusion that a doctor should have disclosed information concerning a nonrecommended procedure.” (Vandi v. Permanente Medical Group, Inc. (1992) 7 Cal.App.4th 1064, 1071 [9 Cal.Rptr.2d 463].)
- “Our high court has made it clear that battery and lack of informed consent are separate causes of action. A claim based on lack of informed consent—which sounds in negligence—arises when the doctor performs a procedure without first adequately disclosing the risks and alternatives. In contrast, a battery is an intentional tort that occurs when a doctor performs a procedure without obtaining any consent.” (Saxena, supra, 159 Cal.App.4th at p. 324.)
5 Witkin, Summary of California Law (10th ed. 2005) Torts, §§ 395, 400–507
California Tort Guide (Cont.Ed.Bar 3d ed.) § 9.11
3 Levy et al., California Torts, Ch. 31, Liability of Physicians and Other Medical Practitioners, § 31.41 (Matthew Bender)
6 California Forms of Pleading and Practice, Ch. 58, Assault and Battery, § 58.14 (Matthew Bender)
36 California Forms of Pleading and Practice, Ch. 415, Physicians: Medical Malpractice, §§ 415.13, 415.20 (Matthew Bender)
2 California Points and Authorities, Ch. 21, Assault and Battery, § 21.20 (Matthew Bender)
17 California Points and Authorities, Ch. 175, Physicians and Surgeons: Medical Malpractice, § 175.28 (Matthew Bender)
33 California Legal Forms, Ch. 104, Health Care Transactions, Consents, and Directives, § 104.11 (Matthew Bender)