California Civil Jury Instructions (CACI) (2017)

532. Informed Consent—Definition

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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 adequately 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, June 2014
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. If a
medical practitioner knows or should know of a patient’s unique concerns or lack
of familiarity with medical procedures, this knowledge may expand the scope of
required disclosures and require additional instructional language. (See Truman v.
Thomas (1980) 27 Cal.3d 285, 291 [165 Cal.Rptr. 308, 611 P.2d 902].)
Also, see CACI No. 531, Consent on Behalf of Another.
Sources and Authority
• “From the foregoing axiomatic ingredients emerges a necessity, and a resultant
requirement, for divulgence by the physician to his patient of 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].)
• “ ‘[A] physician has a fiduciary duty to disclose all information material to the
patient’s decision,’ when soliciting a patient’s consent to a medical procedure. A
cause of action premised on a physician’s breach of this fiduciary duty may
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alternatively be referred to as a claim for lack of informed consent.” (Jameson
v. Desta (2013) 215 Cal.App.4th 1144, 1164 [155 Cal.Rptr.3d 755], internal
citations omitted.)
• “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].)
• “First, a physician must disclose to the patient the potential of death, serious
harm, and other complications associated with a proposed procedure. 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.’ ” (Cobbs, supra, 8 Cal.3d at p.
244, internal citations omitted.)
• “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, supra, 27 Cal.3d at p. 291, 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.)
• “Where a shoulder is injured in an appendectomy, or a clamp is left in the
abdomen, expert testimony is not required since the jury is capable of
appreciating and evaluating the significance of such events. However, when a
doctor relates the facts he has relied upon in support of his decision to operate,
and where the facts are not commonly susceptible of comprehension by a lay
juror, medical expert opinion is necessary to enable the trier of fact to
determine if the circumstances indicated a need for surgery.” (Cobbs, supra, 8
Cal.3d at p. 236, internal citations omitted.)
• “We underline the limited and essentially subsidiary role of expert testimony in
informed consent litigation. . . . [A] rule that filters the scope of patient
disclosure entirely through the standards of the medical community
‘ “arrogate[s] the decision [of what to disclose] . . . to the physician alone.” ’
We explicitly rejected such an absolute rule as inimical to the rationale and
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objectives of the informed consent doctrine; we reaffirm that position.
Nevertheless, . . . there may be a limited number of occasions in the trial of
informed consent claims where the adequacy of disclosure in a given case may
turn on the standard of practice within the relevant medical community. In such
instances, expert testimony will usually be appropriate.” (Arato v. Avedon
(1993) 5 Cal.4th 1172, 1191 [23 Cal.Rptr.2d 131, 858 P.2d 598], internal
citation omitted.)
• “[A] physician must disclose personal interests unrelated to the patient’s health,
whether research or economic, that may affect the physician’s professional
judgment.” (Moore v. Regents of Univ. of Cal. (1990) 51 Cal.3d 120, 129 [271
Cal.Rptr. 146, 793 P.2d 479], cert. denied, 499 U.S. 936 (1991).)
• “While . . . there is no general duty of disclosure with respect to
nonrecommended procedures, we do not conclude . . . that there can never be
such a duty. In an appropriate case 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.)
Secondary Sources
5 Witkin, Summary of California Law (10th ed. 2005) Torts, §§ 395, 400
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)
CACI No. 532 MEDICAL NEGLIGENCE
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