Master New Jersey's high court held that informed consent requires disclosure of all medically reasonable alternatives—including surgery and no treatment—even when a physician recommends conservative care, and that nondisclosure sounds in negligence rather than battery. with this comprehensive case brief.
Matthies v. Mastromonaco is a leading informed-consent decision from the New Jersey Supreme Court that clarifies both the scope of a physician's disclosure obligations and the proper doctrinal home for claims based on nondisclosure. Building on the patient-centered standard from Largey v. Rothman and Canterbury v. Spence, the Court held that a physician must disclose not only the risks and benefits of the recommended course, but also the medically reasonable alternatives—including the option of no treatment—so that the patient can make a meaningful, autonomous choice. That duty exists even if the physician recommends against an alternative or would not personally perform it.
The case is significant because it rejects a cramped view of informed consent limited to surgical or invasive procedures and cabins battery to instances of unauthorized touching. It refocuses the doctrine on patient self-determination and clarifies proof requirements: plaintiffs must establish (1) that an undisclosed alternative was medically reasonable, (2) that a reasonably prudent patient in the plaintiff's position would have chosen differently if informed, and (3) that the different choice would have resulted in a better outcome. For law students, Matthies is a touchstone for the elements, evidentiary burdens, and policy underpinnings of informed consent.
Matthies v. Mastromonaco, 160 N.J. 26, 733 A.2d 456 (N.J. 1999)
Plaintiff Matthies, an approximately 81-year-old nursing home resident, sustained a hip fracture (femoral neck) after a fall. Defendant Dr. Mastromonaco, an internist serving as her attending physician, recommended and instituted conservative, non-surgical management—bed rest, immobilization, and supportive care—aimed at permitting the fracture to heal without operative intervention. He did not meaningfully discuss with Matthies or her family the medically plausible surgical alternatives, such as internal fixation (pinning) or hemiarthroplasty, which could have facilitated earlier mobilization and potentially preserved her ability to walk. Nor did he document a disclosure of the comparative risks and benefits of conservative versus surgical management, or of the option of no treatment. Over time, Matthies remained immobilized, developed complications associated with prolonged bed rest, and ultimately lost the ability to ambulate. She sued for medical negligence and lack of informed consent, alleging that the physician failed to disclose reasonable alternatives and thereby deprived her of the opportunity to choose a course—surgery—that she would have selected to preserve mobility. The trial court rejected or limited the informed-consent claim on the ground that no invasive procedure had been performed; the matter ultimately reached the New Jersey Supreme Court.
Does the doctrine of informed consent require a physician who recommends conservative, non-surgical treatment to disclose medically reasonable alternative treatments—including surgery and the option of no treatment—and, if so, is the failure to do so actionable in negligence even when no unauthorized touching occurred?
New Jersey applies a patient-oriented standard for informed consent. A physician must disclose to the patient all information that a reasonably prudent patient in the plaintiff's position would deem material to an informed decision, including: (1) the nature of the recommended course of treatment; (2) the material risks and benefits of that course; (3) the medically reasonable alternatives (including no treatment), with their material risks and benefits; and (4) the probable outcome of foregoing treatment. Failure to make these disclosures is negligence, not battery (which is reserved for unauthorized touching). To prevail, a plaintiff must prove: (a) breach—non-disclosure of material information regarding medically reasonable alternatives; (b) causation—an objective test that a reasonably prudent patient in the plaintiff's position would have chosen a different course if properly informed; and (c) injury—that the different choice would have yielded a better outcome. Expert testimony is ordinarily required to establish which alternatives were medically reasonable and to explain their comparative risks and benefits.
Yes. The doctrine of informed consent requires disclosure of medically reasonable alternatives to the recommended treatment, including surgery and no treatment, even when the physician advocates conservative care. The failure to disclose such alternatives sounds in negligence rather than battery. The court reversed and remanded for a new trial on the informed-consent claim under the proper legal standard.
The Court grounded its analysis in the principle of patient self-determination: the core purpose of informed consent is to enable patients to make autonomous medical choices, not to ratify a physician's preference. Limiting disclosure obligations to the risks of the recommended course, or to invasive procedures alone, would deprive patients of the ability to weigh material alternatives that could better align with their values—here, the critical difference between lifelong immobility and the possibility of ambulation. The Court emphasized that whether an alternative is "medically reasonable" does not mean it must be the physician's preferred or even the majority-supported option; rather, it must be an accepted, plausible course that a reasonable patient would want to consider. A physician may still decline to perform an alternative he or she deems unwise, but must disclose it and, if appropriate, facilitate referral so the patient can seek it elsewhere. On doctrinal framing, the Court clarified that lack-of-informed-consent claims are a species of negligence based on nondisclosure, not intentional torts. Battery is reserved for unauthorized touching or procedures performed without any consent. Here, although no surgery was performed, the physician undertook a course of treatment (conservative management) without adequately informing the patient of viable alternatives; that omission is actionable as negligence. Regarding proof, the Court adopted the objective, reasonable-patient causation test from Largey/Canterbury, requiring plaintiffs to show that a prudent patient in their position would have chosen differently if informed, and that the different choice would likely have produced a better outcome. Because jurors generally require medical context to evaluate what alternatives are medically reasonable and what risks are material, expert testimony is typically necessary on those points. Applying those principles, the record contained evidence from which a jury could find that surgical options were medically reasonable, that the risks and benefits materially differed, and that a reasonable patient seeking to preserve ambulation would have chosen surgery if fully informed. The trial court erred by foreclosing or mischaracterizing the informed-consent theory simply because no invasive procedure occurred.
Matthies broadens informed-consent doctrine to require disclosure of medically reasonable alternatives regardless of whether the physician recommends or will perform them, firmly situates nondisclosure as negligence rather than battery, and articulates clear elements and evidentiary needs. For students and practitioners, it is a key case on: the patient-centered materiality standard; the duty to discuss alternatives and the option of no treatment; the objective causation test; the role of expert testimony; and the distinction between lack of consent (battery) and lack of informed consent (negligence).
Yes, if the alternatives are medically reasonable. Matthies holds that disclosure turns on what a reasonably prudent patient would find material, not solely on the physician's preference. A doctor may still refuse to perform an option he or she deems unwise, but must disclose it and, when appropriate, refer the patient so the patient can pursue that alternative elsewhere.
No. Matthies rejects that limitation. The duty to disclose extends to all courses of treatment, including conservative management and the option of no treatment. The touchstone is the patient's right to make an informed, autonomous decision, not whether the recommended course is invasive.
New Jersey applies an objective, reasonable-patient standard. The plaintiff must show that a reasonably prudent patient in the plaintiff's position would have declined the recommended course or chosen a different, medically reasonable alternative if fully informed, and that the different choice would likely have led to a better outcome.
Expert testimony is ordinarily required to establish which alternatives were medically reasonable, to explain the comparative risks, benefits, and probabilities of outcomes, and to assist the jury in assessing materiality. Experts also inform the analysis of whether a different choice would likely have produced a better result. Jurors then decide materiality and causation.
Battery addresses unauthorized touching or procedures performed without any consent. In contrast, informed consent is a negligence theory based on the failure to disclose material information needed for an informed choice. Even where some consent exists (or the course is noninvasive), a physician may be liable in negligence for not disclosing medically reasonable alternatives.
Matthies v. Mastromonaco is a cornerstone of modern informed-consent jurisprudence. It centers the doctrine on patient autonomy, requiring physicians to disclose not just the risks of a recommended path, but also the medically reasonable alternatives and the option of no treatment. By doing so, it ensures that medical decision-making remains the patient's prerogative, guided by full and material information.
Doctrinally, the case clarifies that nondisclosure is negligence—not battery—and articulates the proof structure students must master: a medically reasonable alternative, materiality to a prudent patient, objective causation, and a better-outcome link, typically established through expert testimony. Matthies thus provides a clear analytical roadmap for evaluating informed-consent claims across a broad range of treatment contexts.
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