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.
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?
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).
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.
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.
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.
Largey v. Rothman reorients informed consent around patient autonomy. By adopting the patient-oriented materiality standard and an objective causation test, the New Jersey Supreme Court ensures that the law protects a patient's right to make informed choices about medical care, rather than deferring to variable professional disclosure customs.