## Facts

- Patricia P. Ashe was treated for breast cancer and later developed a left-lung mass that could have been metastatic breast cancer or a primary lung cancer.
- After lung surgery and chemotherapy, Ashe was referred to radiation oncologist Steven L. Stroup, M.D., to consider radiation therapy.
- Dr. Stroup testified radiation therapy would be indicated if the cancer were primary, but chemotherapy alone would be indicated if the tumor were metastatic breast cancer.
- Dr. Stroup prescribed radiation (200 centigray daily for 25 days).
- Ashe developed radiation myelitis from permanent spinal-cord injury and became paraplegic.
- Dr. Stroup did not tell Ashe that radiation could cause permanent spinal-cord injury; he estimated the risk at under 1%.
- Ashe’s expert testified the risk was 1–2% and that the standard of care required warning patients of the risk of spinal-cord injury.
- Ashe sued Dr. Stroup and Radiation Oncology Associates for medical malpractice, including lack of informed consent.
- Ashe testified inconsistently about whether she would have consented if warned (uncertain in deposition; at trial said she would not have consented).

## Issues

1. What standard governs causation in an informed-consent medical malpractice claim: whether the plaintiff must prove, under a subjective or objective test, that adequate disclosure would have changed the decision to undergo treatment.
2. Whether the causation question may be removed from the jury based on the plaintiff’s inconsistent testimony about what she would have decided if properly informed.

## Decision

- The Tennessee Supreme Court held that causation in informed-consent cases is governed by an objective standard.
- The test is whether a reasonable person in the patient’s position would have consented to the procedure if adequately informed of all significant perils.
- The court affirmed the appellate court’s reversal of the directed verdict on the informed-consent claim.
- The case was remanded for a new trial on the informed-consent claim because the causation question should have been submitted to the jury under the objective standard.

## Legal Principles

- In informed-consent malpractice claims, causation is measured objectively: whether a reasonable person in the patient’s position would have declined or accepted treatment if properly informed of significant risks.
- A purely subjective approach risks hindsight bias and can make causation largely dependent on post-injury testimony.
- The patient’s own testimony about what they would have done is relevant evidence but is not controlling under the objective standard.
- The trier of fact may consider, among other factors, the seriousness and probability of the risk, the patient’s medical condition, and patient-specific circumstances bearing on decision-making when applying the reasonable-person test.
- Directed verdicts are improper when the evidence permits a jury to decide whether adequate disclosure would have affected a reasonable patient’s decision.

## Conclusion

The court required an objective, reasonable-patient causation standard for informed-consent claims and held that the jury—not the judge—must decide whether adequate disclosure of the paralysis risk would have altered a reasonable patient’s decision, warranting a new trial on informed consent.


Ashe v. Radiation Oncology Assocs., 9 S.W.3d 119 (Tenn. 1999)