## Facts

- Rena Truman was a longtime patient of Dr. Claude R. Thomas, who served as her primary physician from 1963 to 1969.
- Expert testimony indicated that if Mrs. Truman had received a Pap smear at any time between 1964 and 1969, her cervical cancer likely would have been detected early enough to be curable.
- In April 1969, another physician observed abnormal cervical conditions and urged Mrs. Truman to see a gynecologist; she did not promptly do so.
- In October 1969, a gynecologist diagnosed advanced cervical cancer; the tumor was not surgically removable and treatment was unsuccessful.
- Mrs. Truman died in July 1970 at age 30.
- Her children sued Dr. Thomas for wrongful death, alleging he negligently failed to perform a Pap smear and failed to inform Mrs. Truman of the material risks of not undergoing the test.

## Issues

1. Whether a physician’s duty of disclosure includes informing a patient of the material risks of refusing a recommended diagnostic test (i.e., “informed refusal”).
2. Whether the trial court committed reversible error by refusing a jury instruction on liability for failing to disclose the material risks of declining the recommended test.

## Decision

- The California Supreme Court reversed the defense verdict and ordered a new trial.
- The Court held that a physician’s duty of due care includes a duty to inform the patient of the material risks of not undergoing a recommended diagnostic test.
- The trial court prejudicially erred by refusing to instruct the jury on this theory, which was supported by evidence and central to plaintiffs’ case.

## Legal Principles

- The disclosure obligation associated with informed consent extends to material risks of non-treatment or non-testing when a physician recommends a diagnostic procedure.
- Materiality is judged by what a reasonable patient would consider significant in deciding whether to accept or refuse the recommended procedure.
- The scope of disclosure is not defined solely by medical custom; it is driven by the patient’s right to make an informed choice.
- When supported by the evidence, a party is entitled to jury instructions that permit the jury to decide a properly framed negligence theory; refusal may be reversible error if it prevents consideration of a central claim.

## Conclusion

A physician may be negligent for failing to explain the material risks of declining a recommended diagnostic test, and a jury must be instructed so it can determine whether that failure caused harm; because the jury was not instructed on this theory, a new trial was required.


Truman v. Thomas, 611 P.2d 902 (Cal. 1980)