The plaintiff, Ms. Harnish, underwent surgery at Children's Hospital Medical Center to address a serious condition in her neck region. According to her evidence, the physician did not disclose certain significant risks associated with the procedure—specifically, potential injury to nerves affecting tongue function and related sensory or motor deficits—nor did he adequately discuss non-surgical alternatives or the comparative risks and benefits of different options. After the operation, Harnish experienced complications consistent with the undisclosed risks (including impairments affecting the tongue and related functions). She brought suit alleging negligence based on lack of informed consent. At trial, the judge instructed the jury that the physician's disclosure obligations were governed by what the medical profession customarily disclosed (a physician-oriented standard) and suggested that expert testimony on professional custom was required to establish the scope of the duty. The jury returned a verdict for the defendants. Harnish appealed, arguing that the trial court applied the wrong legal standard and that the jury should have been instructed on a patient-oriented, materiality standard for disclosure.
Does a physician's duty to disclose information for informed consent in Massachusetts depend on the professional standard of disclosure (what physicians customarily reveal) or on a patient-oriented standard of materiality (what a reasonable patient would consider important), and how should causation be assessed in such claims?
In Massachusetts, the duty to disclose in informed consent cases is measured by what information a reasonable patient in the physician's position would consider material to making a decision about treatment. A risk (or alternative) is material if a reasonable patient, in what the physician knows or should know to be the patient's position, would be likely to attach significance to it in deciding whether to undergo the proposed therapy. The physician must disclose material risks, benefits, and reasonable alternatives, subject to recognized exceptions (e.g., emergencies, incompetence, and a narrow therapeutic privilege). To prevail, the plaintiff must prove: (1) the physician failed to disclose a material risk or alternative; (2) the undisclosed risk materialized and caused injury; and (3) causation under an objective standard—i.e., that a reasonable person in the patient's position would have declined or chosen differently if properly informed. Expert testimony is generally required to establish the existence, nature, and probability of medical risks and alternatives, but not to establish the legal standard or the materiality determination, which is for the factfinder.
The Supreme Judicial Court adopted the patient-oriented, materiality standard for informed consent and an objective reasonable-patient test for causation. Because the trial court instructed the jury under a physician-centered professional disclosure standard, the judgment for the defendants was reversed and the case remanded for a new trial under the proper legal framework.
The court grounded its analysis in the principle of patient autonomy: medical decision-making ultimately belongs to the patient, not the profession. A disclosure standard based on professional custom risks perpetuating medical paternalism by allowing physicians—rather than patients—to define what information is important. By contrast, a materiality standard, focused on the informational needs of a reasonable patient, best vindicates the right of self-determination and aligns with the broader tort goal of reasonable care under the circumstances. Relying on Canterbury v. Spence, the court defined material risks as those a reasonable patient would likely consider significant when deciding among medical options. The court emphasized that disclosure includes not only the risks of the proposed treatment, but also its benefits and reasonable alternatives, as well as the risks of foregoing treatment, to the extent those matters are material. The court recognized narrow exceptions: (1) emergencies that preclude disclosure; (2) patient incapacity; and (3) therapeutic privilege, applicable only when disclosure itself poses a serious threat to the patient's well-being and must be carefully circumscribed. On proof, the court clarified that while jurors can evaluate materiality without professional custom evidence, expert medical testimony is generally needed to establish the medical facts—the nature of the condition, available alternatives, and the frequency and severity of pertinent risks—because such matters are beyond common knowledge. As to causation, the court adopted an objective test: whether a reasonable person in the patient's position would have declined the procedure or chosen differently if properly informed. This standard avoids the reliability issues inherent in a purely subjective, hindsight statement by the plaintiff and provides a predictable, administrable rule. Applying these principles, the court found the trial judge's physician-centered instruction erroneous and ordered a new trial with proper patient-centered instructions.
Harnish is the leading Massachusetts case on informed consent. It cements the patient-oriented, materiality standard for disclosure; clarifies that the action sounds in negligence; adopts an objective reasonable-patient test for causation; and explains the role of expert testimony. Doctrinally, it aligns Massachusetts with modern tort theory, prioritizing patient autonomy over professional custom. Practically, it provides a clear checklist for evaluating informed consent claims and informs model jury instructions across the state.
Harnish v. Children's Hospital Medical Center marks a decisive shift to patient autonomy in Massachusetts tort law. By embracing a materiality-based disclosure duty and an objective test for causation, the court creates a principled, administrable framework that aligns medical malpractice doctrine with modern ethical norms and the core tort concept of reasonable care.