Reibl v Hughes

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Reibl v Hughes

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Hearing: June 5, 1980
Judgment: October 7, 1980
Full case nameJohn Reibl v Robert A. Hughes
Citations [1980] 2 SCR 880
Holding
In order to obtain medical consent, physicians must provide the patient with enough information so that an objective, reasonable person in the patient's position could make an informed decision.
Court Membership
Chief Justice: Bora Laskin
Puisne Justices: Ronald Martland, Roland Ritchie, Brian Dickson, Jean Beetz, Willard Estey, William McIntyre, Julien Chouinard, Antonio Lamer
Reasons given
Unanimous reasons by The Court
Ritchie and Estey JJ. took no part in the consideration or decision of the case.

Reibl v Hughes [1980] 2 S.C.R. 880 is a leading decision of the Supreme Court of Canada on negligence, medical malpractice, informed consent, the duty to warn, and causation.

Supreme Court of Canada highest court of Canada

The Supreme Court of Canada is the highest court of Canada, the final court of appeals in the Canadian justice system. The court grants permission to between 40 and 75 litigants each year to appeal decisions rendered by provincial, territorial and federal appellate courts. Its decisions are the ultimate expression and application of Canadian law and binding upon all lower courts of Canada, except to the extent that they are overridden or otherwise made ineffective by an Act of Parliament or the Act of a provincial legislative assembly pursuant to section 33 of the Canadian Charter of Rights and Freedoms.

Informed consent process by means of which a research participant agrees to be the subject of research

Informed consent is a process for getting permission before conducting a healthcare intervention on a person, or for disclosing personal information. A health care provider may ask a patient to consent to receive therapy before providing it, or a clinical researcher may ask a research participant before enrolling that person into a clinical trial. Informed consent is collected according to guidelines from the fields of medical ethics and research ethics.

Contents

The case settled the issue of when a physician may be sued for battery and when it is more appropriate to sue the doctor in negligence. The Court wrote unanimously that "unless there has been misrepresentation or fraud to secure consent to the treatment, a failure to disclose the attendant risks, however serious, should go to negligence rather than to battery." The case also marked the creation of a standard whereby a physician must give the patient sufficient information so that an objective, reasonable person in the patient's position would be able to make an informed choice about a medical procedure.

Battery is a criminal offense involving the unlawful physical acting upon a threat, distinct from assault which is the act of creating apprehension of such contact.

Background

Robert A. Hughes, a physician, was in the process of competently performing an endarterectomy on his patient, John Reibl, when Reibl suffered a massive stroke. Paralysis and impotence resulted. Reibl alleged that he had not truly given informed consent, and as such the surgery constituted battery. [1] Although Reibl was aware that the surgery was not without risks, he felt that Hughes had implied that the risks of not having the surgery were greater. Reibl was eighteen months away from obtaining a lifetime pension, and the stroke prevented him from earning that pension. He stated that if he had been aware of the risks in the surgery, he would have waited the year and a half to earn his pension before undergoing the procedure, even if it meant a shortened life.

Endarterectomy

Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of deposits. It is carried out by separating the plaque from the arterial wall.

In the original trial, Reibl was awarded monetary damages for negligence and battery, irrespective of his having signed a formal consent form. On appeal to the Ontario Court of Appeal, the court directed that a new trial be held, but that the charge of battery be disallowed from the new proceedings.

Ruling

It is a general principle in tort law that a defendant is not liable for damages unless their negligence was the cause of the injury to the plaintiff.

A tort, in common law jurisdictions, is a civil wrong that causes a claimant to suffer loss or harm resulting in legal liability for the person who commits the tortious act. It can include the intentional infliction of emotional distress, negligence, financial losses, injuries, invasion of privacy, and many other things.

In the context of a medical malpractice claim where it is alleged the doctor failed to inform the patient of a risk, the doctor will not be held liable if the patient would have had the procedure anyway (even if they knew of the risk).

Medical malpractice is a legal cause of action that occurs when a medical or health care professional deviates from standards in his or her profession, thereby causing injury to a patient.

Reibl v. Hughes the Supreme Court outlined a "modified objective test" for causation in medical malpractice. It is well established in Canadian law that a doctor cannot be sued for not disclosing information if the patient would have consented to the operation irrespective of whether or not the information was disclosed.

Consider this example: your doctor knows that a surgery has a 5% chance of causing complete paralysis but does not tell you. Without the operation, however, you will very likely die within 12 months.

The court looked at two approaches: an objective test ("what would a reasonable person do?") and a subjective ("what would this plaintiff have done?"). There was concern that an objective test favors the doctor while a subjective test favors the plaintiff.

In an objective test, the Court would accept medical evidence that the chance of paralysis was 5% and the chance of death was high. A reasonable person, thinking rationally, would take the risk of paralysis over death.

If it were a subjective test, the Court would ask the plaintiff. Logically, the plaintiff, who is paralysed will say "no." Logically, if the plaintiff said they would have had the operation anyway, they would not be suing the doctor.

In Reibl, The Court created a "modified objective test" which starts with the "reasonable person" and adds some of the characteristics of the plaintiff, such as age, sex, and family circumstances but will not allow "irrational beliefs" to be taken into account.

The test has been frequently used to determine many medical malpractice and negligence cases, including Arndt v. Smith. [2]

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Negligence is a failure to exercise appropriate and or ethical ruled care expected to be exercised amongst specified circumstances. The area of tort law known as negligence involves harm caused by failing to act as a form of carelessness possibly with extenuating circumstances. The core concept of negligence is that people should exercise reasonable care in their actions, by taking account of the potential harm that they might foreseeably cause to other people or property.

In the common law of torts, res ipsa loquitur is a doctrine that infers negligence from the very nature of an accident or injury in the absence of direct evidence on how any defendant behaved. Although modern formulations differ by jurisdiction, common law originally stated that the accident must satisfy the necessary elements of negligence: duty, breach of duty, causation, and injury. In res ipsa loquitur, the elements of duty of care, breach, and causation are inferred from an injury that does not ordinarily occur without negligence.

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Defensive medicine, also called defensive medical decision making, refers to the practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against the patient as potential plaintiff. Defensive medicine is a reaction to the rising costs of malpractice insurance premiums and patients’ biases on suing for missed or delayed diagnosis or treatment but not for being overdiagnosed. U.S. physicians are at highest risk of being sued, and overtreatment is common. The number of lawsuits against physicians in the USA has increased within the last decades and has had a substantial impact on the behavior of physicians and medical practice. Physicians order tests and avoid treating high-risk patients to reduce their exposure to lawsuits, or are forced to discontinue practicing because of overly high insurance premiums. This behavior has become known as defensive medicine, "a deviation from sound medical practice that is indicated primarily by a threat of liability".

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<i>F v R</i>

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References

  1. , Reibl v. Hughes Court Ruling
  2. Arndt v. Smith, [1997] 2 SCR 539