## Facts

- Becky Gay Pauscher, age 26, was hospitalized at Iowa Methodist Medical Center in August 1982 for childbirth and was scheduled for discharge a few days later.
- On the planned discharge date, she developed fever, right flank pain, and gross hematuria; her obstetrician delayed discharge and prescribed an antibiotic.
- The next day her symptoms persisted; a consulting urologist feared a potentially life-threatening urinary tract obstruction and ordered stronger antibiotics, laboratory testing, and an intravenous pyelogram (IVP) to assess obstruction.
- The IVP required injection of an iodine-based contrast dye and X-rays; minor reactions were known to occur in a small percentage of patients, and severe reactions (including death) were rare.
- During the IVP supervised by a radiologist, Pauscher suffered a severe allergic-type reaction shortly after dye injection and died.
- Her estate alleged she had not been adequately warned of the risk of death and therefore had not given informed consent.

## Issues

1. What standard governs a physician’s duty to disclose risks for informed consent in Iowa: professional custom or a reasonable-patient material-risk standard?
2. Under the applicable standard, did the estate present sufficient evidence that nondisclosure occurred and proximately caused Pauscher’s death?

## Decision

- The Iowa Supreme Court adopted a patient-oriented, reasonable-patient “material risk” standard for informed consent, rejecting a purely physician-custom disclosure rule.
- The court affirmed the directed verdict for the hospital and physicians, but on different reasoning than the trial court.
- The court held the estate failed to generate a jury question that the remote risk of death from the IVP was material under the circumstances.
- The court also held the estate failed to present sufficient evidence of causation under an objective test—i.e., that a reasonable person in Pauscher’s position would have declined the IVP if warned of the small risk of death.

## Legal Principles

- A physician must disclose information a reasonable patient would consider significant in deciding whether to undergo a proposed procedure, including material risks and reasonable alternatives.
- A risk is material if a reasonable person in the patient’s position would attach significance to it in making the decision.
- An informed-consent claim requires proof of: (1) duty to disclose material risks/alternatives, (2) breach by nondisclosure, (3) causation shown by an objective reasonable-patient decision test, and (4) injury from the undisclosed risk.
- Expert testimony remains necessary on matters outside lay competence (e.g., nature of the procedure, likelihood and severity of complications, and feasible alternatives), even though materiality and causation are evaluated by the factfinder under the reasonable-patient standard.
- Extremely low-probability risks may be deemed nonmaterial in context, particularly where the procedure addresses a suspected serious condition and provides significant diagnostic benefit.

## Conclusion

Iowa’s high court reframed informed consent around what a reasonable patient would want to know, while affirming judgment for defendants because the record did not support that the IVP’s remote fatal-risk disclosure was required or that disclosure would have led a reasonable patient to refuse the test.


Pauscher v. Iowa Methodist Med. Ctr., 408 N.W.2d 355 (Iowa 1987)