## Facts

- Melissa Canesi consulted Dr. James A. Wilson in July 1991 after a missed period; office testing was negative and Wilson diagnosed her as not pregnant.
- Wilson prescribed Provera to induce menstruation without disclosing warnings that, if taken during pregnancy, it posed fetal risks including congenital abnormalities (including limb reduction) and risk of retaining a defective ovum rather than spontaneous abortion.
- A later blood test confirmed pregnancy with twins; when Melissa asked whether Provera could harm the fetuses, Wilson told her not to worry.
- Melissa transferred prenatal care to Dr. Ronald Loewe, told him she had taken Provera before pregnancy confirmation, and he also reassured her.
- Pregnancy complications followed, including the in utero death of one twin and findings suggesting possible fetal abnormality in the surviving fetus.
- Brandon Canesi was born March 18, 1992 with bilateral limb reduction affecting both upper limbs.
- The parents sued Wilson and Loewe for medical negligence and wrongful birth, alleging failure to warn of fetal risks, failure to perform diagnostic measures that would have disclosed defects earlier, and that proper disclosure would have led them to terminate the pregnancy.
- Plaintiffs also asserted that Provera caused the limb reduction; defendants argued the claims failed absent proof of that medical causation.
- The trial court granted summary judgment to defendants, and the intermediate appellate court affirmed, treating medical causation as essential to the action.

## Issues

1. In a wrongful birth action involving failure to warn about fetal risks of a prescribed drug, must plaintiffs prove medical causation that the drug caused the congenital defect?
2. May a wrongful birth claim proceed on an informed-consent/failure-to-warn theory based on proof that adequate disclosure would have led the parents to terminate the pregnancy (decision causation), even if drug-to-defect causation is not established?
3. What causation and materiality showings govern when the alleged injury is loss of informed reproductive choice rather than physical causation of the impairment?

## Decision

- The New Jersey Supreme Court reversed the summary judgment in part and remanded.
- The Court held that plaintiffs must prove traditional medical causation only to the extent they pursue a theory that Provera caused the limb reduction.
- The Court held that a wrongful birth claim based on negligent nondisclosure of material fetal risks may proceed without proof that Provera caused the defect, provided plaintiffs can prove that adequate disclosure would have led them to terminate the pregnancy.
- The lower courts erred by treating the entire case as dependent on proof of drug-to-defect causation when plaintiffs also asserted failure-to-warn and diagnostic-omission theories tied to informed choice.

## Legal Principles

- Wrongful birth is conceptually distinct from ordinary malpractice for physical injury; the actionable harm may be the parents’ loss of the opportunity to avoid birth of a child with serious impairments.
- Informed-consent principles apply: physicians must disclose material risks that a reasonably prudent patient would consider significant in deciding whether to accept or reject treatment.
- Causation in wrongful birth may turn on “decision causation” (whether nondisclosure caused continuation of the pregnancy) rather than “medical causation” (whether treatment caused the defect), depending on the theory of liability.
- When plaintiffs claim a physician’s act or prescription physically caused the child’s impairment, medical causation must be established with appropriate expert proof.
- Evidence that authoritative warnings identified specific congenital risks can support materiality and breach of the duty to disclose, and can ground a wrongful birth claim even where the teratogenic mechanism is disputed.

## Conclusion

The court held that lack of proof that Provera caused the child’s limb reduction did not, by itself, defeat a wrongful birth claim premised on negligent failure to disclose material fetal risks and related diagnostic omissions; on remand, plaintiffs could pursue liability by proving material nondisclosure and that adequate information would have led them to terminate the pregnancy.


Canesi ex rel. Canesi v. Wilson, 730 A.2d 805 (N.J. 1999)