Facts
- Jean Matthies, age 81, fell in her senior-housing apartment and fractured her right hip; she was not found for two days and arrived at the hospital dehydrated, confused, and medically compromised.
- Matthies had osteoporosis and long-standing right-side impairment from a prior stroke.
- Dr. Edward D. Mastromonaco, an orthopedic surgeon, chose non-surgical treatment (bed rest) rather than internal fixation (pinning), citing surgical risk, porous bone, and limited expected functional gain.
- He did not inform Matthies or her family about surgery as an alternative or discuss comparative risks and outcomes of surgery versus bed rest.
- After bed rest began, the femoral head displaced, causing leg shortening and persistent inability to walk; Matthies later underwent hip replacement surgeries but remained unable to walk and became nursing-home dependent.
- Matthies alleged that, if told about surgery and its implications for future mobility, she would have chosen surgery instead of bed rest.
Issues
- Whether a physician must obtain informed consent before implementing a noninvasive (nonsurgical) course of treatment when medically reasonable alternatives exist.
- Whether informed consent requires disclosure of medically reasonable alternatives that the physician does not recommend, including their risks and likely outcomes.
- Whether lack of informed consent is properly analyzed as negligence rather than battery.
Decision
- The Supreme Court of New Jersey affirmed the Appellate Division’s reversal of the trial court’s limitation of the case and remanded for further proceedings.
- The court held that informed consent is required even when the chosen treatment is noninvasive.
- The court held that informed consent requires disclosure of medically reasonable invasive and noninvasive alternatives, with their risks and likely outcomes, even if the physician does not recommend the alternative.
Legal Principles
- Informed consent protects the patient’s right to decide among medically reasonable treatment options; the focus is the adequacy of information, not whether the selected treatment involves physical invasion.
- A physician must disclose medically reasonable alternatives—recommended or not—when alternatives present materially different risks or outcomes a prudent patient would consider significant.
- Informed-consent claims are governed by a negligence framework (duty to disclose material information, breach, causation, and damages), rather than a battery theory premised on unconsented touching.
- Causation may be shown by evidence that proper disclosure would have led a reasonable patient in the plaintiff’s position to choose a different course, avoiding the asserted harm.
Conclusion
The court required that patients be informed of medically reasonable treatment alternatives and their comparative risks and outcomes even when a physician selects noninvasive care, and it treated the failure to disclose as a negligence-based informed-consent claim warranting trial consideration.