What are the facts?
Plaintiff Irene Largey consulted Dr. Rothman about an enlarged lymph node in her left axilla. To rule out malignancy, Dr. Rothman recommended an excisional biopsy (surgical removal of the node). Largey consented to the procedure but testified that Dr. Rothman did not advise her of a risk of lymphedema—a potentially serious, permanent swelling of the arm due to lymphatic disruption—nor did he discuss alternative diagnostic approaches or the comparative risks of foregoing immediate surgery. After the biopsy, Largey developed chronic lymphedema in her left arm, resulting in enduring pain, swelling, and functional limitation. She sued, alleging negligent failure to obtain informed consent. At trial, the court instructed the jury using a professional disclosure standard—i.e., that a physician's duty to disclose is defined by what a reasonably prudent physician in the same or similar circumstances would reveal. The jury returned a defense verdict. The Appellate Division reversed, adopting a patient-oriented materiality standard and remanding for a new trial. The New Jersey Supreme Court granted certification to determine the proper standard for informed consent and the appropriate causation test.
What is the legal issue?
In an informed consent action, is a physician's duty to disclose governed by the professional (physician-centered) standard or by the patient-oriented materiality standard; and, for causation, must the plaintiff prove subjectively that she would have declined the procedure if informed, or objectively that a reasonably prudent patient in her position would have decided differently?
What rule applies?
New Jersey adopts the patient-oriented standard: a physician must disclose all material information that a reasonably prudent patient would consider significant in deciding whether to undergo a proposed procedure, including the nature of the condition, the nature and probability of risks, the alternatives (including no treatment), and the risks of those alternatives. Materiality turns on the frequency and severity of potential outcomes, not on medical custom. Expert testimony is not required to establish the disclosure standard but may be necessary to explain the nature, extent, probability, and gravity of medical risks and alternatives. Causation is evaluated objectively: the plaintiff must show that a reasonably prudent patient in the plaintiff's position would have declined the procedure or chosen a different course had the material information been disclosed. Recognized exceptions include emergencies, risks commonly known, risk information already known or reasonably expected to be known by the patient, and therapeutic privilege (a narrow exception when disclosure would pose a serious threat to the patient's well-being).
What did the court hold?
The Supreme Court of New Jersey adopted the patient-oriented materiality standard for informed consent and an objective test for causation, rejected the professional disclosure standard, and affirmed the Appellate Division's remand for a new trial with proper instructions.
What is the reasoning?
The court grounded its analysis in patient autonomy: informed consent protects a patient's right to self-determination over bodily integrity. Tying the duty of disclosure to medical custom subordinates that right to professional practice patterns and undermines patient-centered decision-making. Following Canterbury v. Spence, the court held that the standard for disclosure is a legal, not purely medical, norm—what risks and alternatives a reasonable patient would deem significant to the decision—so the measure should not be defined by physician custom. While medical expertise is essential to describe risks, probabilities, alternatives, and consequences, the ultimate question of what a reasonable patient would want to know is within the competence of courts and juries. On causation, the court adopted an objective test to avoid the unreliability of self-serving, hindsight testimony by plaintiffs who have suffered adverse outcomes. The appropriate inquiry is whether a reasonably prudent patient in the plaintiff's position, informed of material risks and alternatives, would have refused the procedure or chosen an alternative. This test still permits consideration of the plaintiff's particular circumstances (e.g., age, health, risk aversion) if known to the physician and relevant to a reasonable patient in that position, but it resists purely subjective reconstruction. The court acknowledged narrow exceptions—emergencies and therapeutic privilege—while cautioning that therapeutic privilege cannot be used to withhold information simply to secure consent. Applying these principles, the trial court's professional-standard instruction was erroneous, requiring a new trial under the patient-oriented standard.
Why is this case significant?
Largey is New Jersey's leading case on informed consent. It (1) aligns the duty of disclosure with patient autonomy by adopting a materiality standard, (2) clarifies that expert testimony goes to risk description and probabilities, not to defining the disclosure duty, (3) adopts an objective causation test, and (4) distinguishes informed consent (negligence) from unauthorized touching (battery). For students, it is a model opinion linking doctrine and policy, frequently appearing in torts and professional-responsibility contexts and shaping jury instructions and litigation strategy in medical malpractice cases.
What standard for disclosure does Largey adopt for informed consent?
Largey adopts the patient-oriented materiality standard: a physician must disclose information a reasonably prudent patient would deem significant to deciding whether to undergo the procedure, including material risks, probabilities, alternatives (including no treatment), and their comparative risks.
Is an informed consent claim in New Jersey based on negligence or battery?
Negligence. Largey treats informed consent as a negligence-based claim premised on a breach of the duty to disclose material information. Battery is reserved for unauthorized procedures or materially different procedures than those consented to.
What causation test applies under Largey?
An objective test: the plaintiff must prove that a reasonably prudent patient in the plaintiff's position would have declined the recommended procedure or chosen a different course if fully informed. This avoids reliance on the plaintiff's subjective, hindsight assertion that she personally would have refused.
Is expert testimony required to prove an informed consent claim after Largey?
Expert testimony is not required to establish the standard of disclosure (because it is legal, not medical), but is typically necessary to explain the nature of the condition, the risks and their probabilities, the consequences of those risks, available alternatives, and the risks of declining treatment—facts a jury needs to assess materiality and causation.
How does Largey treat low-probability but high-severity risks?
Such risks can be material and must be disclosed if a reasonable patient would consider them significant. Materiality depends on both the likelihood and the gravity of the potential harm; a rare but catastrophic outcome may require disclosure.
What are the recognized exceptions to disclosure under Largey?
Exceptions include emergencies, situations where the risk is commonly known or already known to the patient, cases in which the patient indicates a preference not to receive information, and a narrow therapeutic privilege where disclosure would seriously harm the patient's well-being. These exceptions are construed narrowly and cannot be used to withhold information merely to secure consent.