ÿWPC*# ŠD–‚…%ìá5½ ™ÐúÚ°YÆÑW?÷`àô š‘rÉM©5b7`G€>»ÕYù@2xz鎮¦8+ˆ(p˜ ÑÈ›™©vº\ùɹ÷5qÔO;ÒfD®I ɾÁ›š£Âtºãíì 딈„ÙRÂ/ÕÌ\£v~)lÒ¥ƒ.oµJPV•ôÇR|÷š;î;‘²ÛrÄel‰M¡»=µlætXz½xm*þ†t¨×¦=ív³²».q¤£wO"$høò®2…‘' å…ƒ‚ÀüïA¥8vçòozŒ²7_µŸ¼ˆ«¢å\rÒÙ:Á¾bùç\H‰ÙÔˆ´[N9¦£>.Bîårc0¿šô¿I˜aŠNrÀ*µµ}!¦BM²b&‡¥{dgŽÜ²d‚ dPm©ºäÍhxáGéé{9AaÄ6Úi*}'ÎTó ÈÍtqªDŽ%z•ç`‹“dV©Ê«ÔÆPq…dW”ˆà¥t¨ÎO,§øØºÕ×lî¾%­æe‹§ÕbüûvòÕ ŠJð©cîΡžë ¨-æô{H„7®ZfX6EwÈŒö\ì Ž¾[uu{š×•÷P®‡^÷Ò6u“1:¶¼¹Fã[Ëú`[ÿd#!xU:™ %Ó 0ˆÙwa 4e y 0ˆ  0c— 0Dú N> > ^ @ L mN 1ue 72Ú 0w  0Šƒ 0   0´­ 0Ça 0Û( 0ï 0Dò 1‰6 72¿ñ?ô^3 B‘ 0¤®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®®® 0¤R D5ööööö AQ+ Æ| 0¤B! 0Dæ"˜HP LaserJet 8000 DN PSØÚØÚÚØØÚ0, øð AZ‹"Arial RegularX(`zZ$¡¡ÑTRY,3Ø'ÿ Letter3Ø'3Ø'ÿ Letterÿ3Ø'TÑÔ  ÔtpO'ÔüÔô3|x(·(2mÔ$¤¤Ý ƒzZ!ÝÑTRXà3Ø'ÿ Letter3Ø'3Ø' Letterÿ3Ø'TÑÔ  ÔÝ  ÝÒ4°ÒÒ„°ÒÔ€ôd®õXXÔà Œ àòòÚ  Ú0Ú  Úóó (;3£$´´Ô2#ÔÚ  Ú0Ú  Ú.Ô3  Ôà0  à(#Ã$òòÚ  Ú0Ú  Úóóc|›'L ÿU‹ÿÀÀÀ##37=CIQYag­­1.a.i.(1)(a)(i)1)a)i)(Oé;$µµà0  àÔ2#ÔÚ  ÚaÚ  Ú.Ô3  Ôà0` (#(#à(b·¤$¶¶à0  àà0` (#(#àÔ2#ÔÚ  ÚÚ  Ú.Ô3  Ôà0¸ ` (#` (#à(xir$··à0  àà0` (#(#àà0¸ ` (#` (#àÔ2#Ô(Ú  Ú0Ú  Ú)Ô3  Ôà0¸ (#¸ (#à(ŒÜ$¸¸à0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àÔ2#Ô(Ú  ÚaÚ  Ú)Ô3  Ôà0h(#(#à(ŸF$¹¹à0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àÔ2#Ô(Ú  ÚÚ  Ú)Ô3  Ôà0Àh(#h(#à(³Àô$ººà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àà0Àh(#h(#àÔ2#ÔÚ  Ú0Ú  Ú)Ô3  Ôà0À(#À(#à(ǵ{$»»à0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àà0Àh(#h(#àà0À(#À(#àÔ2#ÔÚ  ÚaÚ  Ú)Ô3  Ôà0p(#(#à(F$ïïà0  àà0` (#(#àà0¸ ` (#` (#àà0¸ (#¸ (#àà0h(#(#àà0Àh(#h(#àà0À(#À(#àà0p(#(#àÔ2#ÔÙ ÙÚ  ÚÚ  ÚÙ Ù)Ô3  Ôà0Èp(#p(#àÙ Ù xšAGaeimquy}Bullet ListBullets List ùÝ ƒb]"ÝÔ  ÔÝ  ÝÔ_ÔÔ€ŸRXXÔÓ  Óò òÔ Ad ÔFILEDÔ€X†XŸRÔÐ  ÐÌDecember€27,€1999ÌÌCecil€Crowson,€Jr.ÌAppellate€Court€ClerkÔdAeÔó ó 5Ô_ÔÔ_ÔÝ ƒ>˜$ÝÔ  ÔÒ4°ÒÒ„°ÒÔ€ôÇXòXXÔà Œ àòòÚ  Ú1Ú  ÚóóÝ  ÝÔ_ÔJurisdictions€applying€the€objective€standard€include:€€òòFain€v.€Smithóó,€479€So.2d€1150Ð  Ð(Ala.€1985);€òòÔ_ÔAronsonÔ_Ô€v.€Harrimanóó,€901€S.W.2d€832€(Ark.€1995);€òòHamilton€v.€Hardyóó,€549€P.2d€1099Рƾ Ð(Colo.€App.€1976);€òòHammer€v.€Mount€Sinai€Hosp.óó,€596€A.2d€1318€(Conn.€App.€1991);€òòBernard€v.Ð „| ÐCharóó,€903€P.2d€667€(Haw.€1995);€òòSherwood€v.€Carteróó,€805€P.2d€452€(Idaho€1990);€òòÔ_ÔFunkeÔ_Ô€v.Ð B : ÐÔ_ÔFieldmanÔ_Ôóó,€512€P.2d€539€(Ô_ÔKanÔ_Ô.€1973);€òòSard€v.€Hardyóó,€379€A.2d€1014€(Md.€1977);€òòWoolleyÔ_Ô€v.Ð  ø ÐHendersonóó,€418€A.2d€1123€(Me.€1980);€òòPhillips€v.€Hullóó,€516€So.2d€488€(Miss.€1987);€òòÔ_ÔBacklundÔ_Ô€v.Ð ¾ ¶ ÐUniversity€of€Washingtonóó,€975€P.2d€950€(Wash.€1999);€òòÔ_ÔScariaÔ_Ô€v.€St.€Paul€Fire€&€Marine€Ins.€Co.óó,Ð | t Ð227€N.W.2d€647€(Wis.€1975);€òòDixon€v.€Petersóó,€306€S.E.2d€477€(N.C.€Ct.€App.€1983). TÑTR[ð AØ'ÿ Legal[ð AØ' Legal  AØ'ÿ Legal  AØ'ÿ LegalTÑ d(|3]$©©Ý ƒzZ!ÝÑTRXà3Ø'ÿ Letter3Ø'3Ø' Letterÿ3Ø'TÑÔ  ÔÝ  Ý(|3]$££Ý ƒzZ!ÝÑTRXà3Ø'ÿ Letter3Ø'3Ø' Letterÿ3Ø'TÑÔ  ÔÝ  Ý )ÿÿ!dxdxabZc[Cþÿ<<CÿÿƒLevel 1Level 2Level 3Level 4Level 5(|3]$¢¢Ý ƒzZ!ÝÑTRXà3Ø'ÿ Letter3Ø'3Ø' Letterÿ3Ø'TÑÔ  ÔÝ  Ý($$””ò òÚ  Ú1Ú  Úó óÝ ƒzZ!ÝÑTRXà3Ø'ÿ Letter3Ø'3Ø' Letterÿ3Ø'TÑÔ  ÔÝ  ÝÔ_ÔÑܰњѰÑÒ4°ÒÒ„°ÒÑTR[° AØ' LegalXà3Ø'ÿ Letter AØ'ÿ Legal3Ø' LetterTÑÑ  ÑÑ8€†XXdædÈ8ÑÑ  ÑÑ  ÑÔ"*US ú\ú\ú (ú:!ú&ú)*Ôò òÑ€îqÑà@PPDàIN€THE€SUPREME€COURT€OF€TENNESSEEˆÐ  Ðà@rr)DàAT€NASHVILLEˆÌÌÌßx€`[B2.jz„Ð`  `€€@ÿEžˆ ` 8ttxPÖÀ ( È xßÌÌà Œ àà ä àà < àà ” àà ì àà D àà œ àFOR€PUBLICATIONÌÌó óà Œ àà ä àà < àà ” àà ì àà D àà œ àò òFiled:ó ó€òò€€€€€December€27,€1999à€T$T$MT$àóóˆÐ h` ÐÌÌÌPATRICIA€P.€Ô_ÔASHEÔ_Ô,à@##/Dà)ˆÐ þ  Ðà@##/Dà)ˆÌà Œ àPLAINTIFF/APPELLANT,à@##/Dà)ˆà œ àDavidson€Circuit€No.€95C„58Ð ÒÊ  Ðà@##/Dà)ˆÌv.à@##/Dà)ˆà œ àHon.€Hamilton€V.€Ô_ÔGaydenÔ_Ô,€Jr.,Ð ž– Ðà@##/Dà)ˆà0 œ àà0ôœT$œT$àJudgeЄ|ôT$ôT$ ÐRADIATION€ONCOLOGYà@##/Dà)ˆÐ jb ÐASSOCIATES€and€STEVEN€L.à@##/Dà)ˆà œ àNo.€M1997„00036„SC„R11„CVÐ PH ÐÔ_ÔSTROUPÔ_Ô,€M.D.,à@##/Dà)ˆÐ 6. Ðà@##/Dà)ˆÌà Œ àDEFENDANTS/APPELLEES.à@##/Dà)ˆÐ ú ÐÌÌÌÌÌÌÌòòFOR€APPELLANTóó:à < àà ” àà ì àà D àà0 œ àòòFOR€APPELLEEóó:Ð2"*œT$œT$ ÐÌÌDAVID€RANDOLPH€SMITHà0 ì àà0DìT$ìT$àà0œDT$DT$àTHOMAS€A.€Ô_ÔWISEMANÔ_Ô€IIIÐä$Ü!œT$œT$ ÐROBERT€BLAKE€Ô_ÔMENZELÔ_Ôà0 ì àà0DìT$ìT$àà0œDT$DT$àNashvilleÐÊ%Â"œT$œT$ ÐNashvilleÌÌÌÌÌÌÌÌÌÌÌÌÌÌà@oo)Dàò òÔ‡è„(çXXÔO€P€I€N€I€O€Nó óÔ#†X†Xçè„(  #ԈРD3<,1 ÐÌÌÌÌÌCOURT€OF€APPEALS€AFFIRMEDÌCASE€REMANDED€à€  CT$àHOLDER,€J.ˆÐ  .:&38 ÐÑîqÑâ âÑTR[° AØ'ÿ Legal[° AØ' Legal AØ'ÿ Legal AØ'ÿ LegalTÑâ âÑ  ÑÔ_ÔÔ  ÔÓÓà Œ àà@,Dàò òOPINIONó óˆÐ  ÐÌà Œ àWe€granted€this€appeal€to€address€the€appropriate€standard€to€beÐ ¬ ¤ Ðemployed€when€assessing€the€issue€of€causation€in€a€medical€malpracticeÐ x p Ðinformed€consent€case.€€We€find€that€the€objective€standard€as€set€forth€in€thisÐ D< Ðopinion€best€balances€a€patientððs€right€to€self„determination€with€the€need€for€aÐ   Ðrealistic€framework€for€rational€resolution€of€the€issue€of€causation.€€We€hold€thatÐ ÜÔ  Ðthe€standard€to€be€applied€in€informed€consent€cases€is€whether€a€reasonableÐ ¨   Ðperson€in€the€patientððs€position€would€have€consented€to€the€procedure€orÐ tl Ðtreatment€in€question€if€adequately€informed€of€all€significant€perils.€€The€decisionÐ @8 Ðof€the€Court€of€Appeals€is€affirmed,€and€the€case€is€remanded€to€the€trial€courtÐ   Ðfor€a€new€trial.Ð ØÐ ÐÌÔ  ÔÓÓò òBACKGROUNDó óÐ ph ÐÓÓÌà Œ àThe€plaintiff,€Patricia€P.€Ashe,€was€diagnosed€with€breast€cancer€in€1988.€Ð "  ÐShe€ultimately€underwent€a€double€mastectomy€and€chemotherapy€as€treatmentÐ à#Ø  Ðfor€her€breast€cancer.€€In€1993,€she€began€experiencing€problems€with€a€coughÐ ¬%¤" Ðand€a€fever.€€She€returned€to€her€oncologist,€Dr.€Michael€Kuzu,€where€sheÐ x'p $ Ðpresented€symptoms€of€fever,€cough,€pain€in€the€abdomen,€weight€loss,Ð D)<"& Ðdecreased€appetite,€and€irritability.€€A€chest€x„ray€and€a€CT€scan€revealed€theÐ +$( Ðpresence€of€a€mass€in€the€medial€left€apex€of€her€left€lung.Ð Ü,Ô%* ÐÌà Œ àThe€record€indicates€that€the€lung€tumor€could€possibly€have€beenÐ t0l). Ðmetastatic€cancer€from€the€breast.€€Ms.€Ashe€underwent€surgery,€and€the€upperÐ @28+0 Ðportion€of€her€left€lung€was€removed.€€She€underwent€chemotherapy€and€wasÐ  4-2 Ðreferred€to€the€defendant,€Dr.€Steven€L.€Stroup,€for€consideration€of€radiationÐ Ø5Ð.4 Ðtherapy.€€Dr.€Stroup€testified€that€chemotherapy€alone€would€be€indicated€if€theÐ ¤7œ06 Ðlung€tumor€were€metastasized€breast€cancer.€€He,€however,€opined€that€radiationÐ  Ðtherapy€would€be€indicated€if€the€lung€cancer€were€primary€as€opposed€toÐ ÔÌ Ðsecondary€cancer.Ð   ˜ ÐÌà Œ àDr.€Stroup€prescribed€radiation€treatment€for€Ms.€Ashe.€€She€received€aÐ 80 Ðdaily€dose€of€200€centigray€for€twenty„five€days.€€He€described€the€dose€as€aÐ ü  Ðð ðmidplane€dose.ðð€€Ms.€Ashe€sustained€ð ðradiation€myelitisðð€caused€by€a€permanentÐ ÐÈ  Ðradiation€injury€to€her€spinal€cord.€€She€is€now€a€paraplegic.Ð œ”  ÐÌà Œ àDr.€Stroup€did€not€inform€Ms.€Ashe€that€the€radiation€treatment€mightÐ 4, Ðresult€in€a€permanent€injury€to€her€spinal€cord.€€According€to€Dr.€Stroup,€the€riskÐ ø Ðthat€she€would€sustain€a€spinal€cord€injury€was€less€than€one€percent.€€Mrs.€AsheÐ ÌÄ Ðproffered€the€testimony€of€her€expert,€Dr.€Carlos€Perez.€€Dr.€Perez€opined€thatÐ ˜ Ðthe€risk€of€spinal€cord€injury€was€one€to€two€percent.€€Dr.€Perez€testified€that€theÐ d\ Ðapplicable€standard€of€care€required€physicians€to€warn€patients€about€the€risk€ofÐ 0 ( Ðradiation€injury€to€the€spinal€cord.Ð ü!ô ÐÌà Œ àMs.€Ashe€filed€the€present€action€alleging€claims€for€medical€malpracticeÐ ”%Œ" Ðand€lack€of€informed€consent.€€At€trial,€she€testified€that€she€would€not€haveÐ `'X $ Ðconsented€to€the€radiation€therapy€had€she€been€informed€of€the€risk€ofÐ ,)$"& Ðparalysis.€€Defense€counsel€on€cross„examination€pointed€out€that€the€plaintiffÐ ø*ð#( Ðdid€equivocate€in€her€deposition€on€the€issue€of€consent.€€Her€depositionÐ Ä,¼%* Ðtestimony€indicated€that€she€did€not€know€what€she€would€have€done€had€sheÐ .ˆ', Ðbeen€warned€about€the€risk€of€spinal€cord€injury.€€She€then€testified€on€redirectÐ \0T). Ðexamination€as€follows:Ð (2 +0 ÐÌÓÓà8 Œ àTrue,€but€the€risk€of€being€paralyzed€and€put€in€a€wheelchair€for€theÐ À5¸.4 Ðrest€of€your€life€was€not€one€of€the€items,€if€there€was€anyÐ ¦6ž/5 Ðdiscussed,€because€had€he€said€that€within€a€six„monthÐ Œ7„06 Ðperiodð!ðwhich€they€said€that€would€be€the€time€frame€for€it€toÐ r8j17 Ðhappenð!ðhad€he€said,€ððPatty,€if€you€do€this€there€is€a€risk€that€youÐ  Ðwill€be€in€a€wheelchair€six€months€from€now,ðð€I€would€have€told€him,Ð îæ ÐððI€will€take€my€chances.ðð€€I€would€not€have€it€done.ÓØÓÐÔÌŒ ü!Œ ü! ÐÌThe€trial€court€found€that€the€plaintiffððs€trial€testimony€conflicted€with€herÐ l d Ðdeposition€testimony€regarding€whether€she€would€have€consented€to€theÐ 80 Ðprocedure€had€she€been€warned€of€the€risk€of€spinal€cord€injury.€€The€trial€court,Ð ü  Ðtherefore,€struck€the€trial€testimony€and€granted€the€defendant€a€directed€verdictÐ ÐÈ  Ðon€the€informed€consent€claim.€€The€plaintiffððs€malpractice€claim€went€to€the€jury.€Ð œ”  ÐThe€jury€was€unable€to€reach€a€verdict,€and€a€mistrial€was€declared.Ð h` ÐÌà Œ àThe€plaintiff€appealed€to€the€Court€of€Appeals.€€The€Court€of€Appeals€heldÐ ø Ðthat€as€part€of€the€plaintiffððs€informed€consent€claim€she€was€required€to€proveÐ ÌÄ Ðthat€a€reasonable€person€knowing€of€the€risk€for€spinal€cord€injury€would€haveÐ ˜ Ðdecided€not€to€have€had€the€procedure€performed.€€The€Court€held€that€theÐ d\ Ðdiscrepancy€between€the€trial€testimony€and€deposition€testimony€went€to€theÐ 0 ( Ðissue€of€credibility€and€that€the€trial€testimony€should€not€have€been€stricken.€Ð ü!ô ÐThe€Court€of€Appeals€reversed€the€trial€courtððs€grant€of€a€directed€verdict€on€theÐ È#À  Ðinformed€consent€claim€and€remanded€the€case€for€a€new€trial.Ð ”%Œ" ÐÌÔ  Ôò òÓ  ÓANALYSISó óÐ ,)$"& ÐÓæ%ÓÌà Œ àThe€burden€of€proof€on€the€standard€of€care€element€in€medicalÐ Ð,È%* Ðmalpractice€informed€consent€cases€is€controlled€by€Tenn.€Code€Ann.Ð œ.”', Ððð29-26-118.€€Pursuant€to€ðð€29„26„118,€a€plaintiff€must€prove€by€expert€testimonyÐ h0`). ÐthatÐ 42,+0 ÐÌÓÓà8 Œ àthe€defendant€did€not€supply€appropriate€information€to€the€patientÐ Ì5Ä.4 Ðin€obtaining€his€informed€consent€to€the€procedure€out€of€whichÐ ²6ª/5 Ðplaintiff's€claim€allegedly€arose€in€accordance€with€the€recognizedÐ ˜706 Ðstandard€of€acceptable€professional€practice€in€the€profession€andÐ ~8v17 Ðin€the€specialty,€if€any,€that€the€defendant€practices€in€theÐ  Ðcommunity€in€which€he€practices€or€in€similar€communities.Ó`'ÓÐîæŒ ü!Œ ü! ÐÌòòId.óó€€In€addition,€Tenn.€Code€Ann.€ðð€29„26„115€requires€that€the€plaintiff€prove€theÐ † ~ Ðrecognized€standard€of€acceptable€professional€practice,€that€the€defendantÐ R J Ðacted€with€less€than€ordinary€and€reasonable€care€in€accordance€with€thatÐ   Ðstandard,€and€that€the€plaintiff€sustained€injuries€as€a€result€of€the€defendantððsÐ êâ  Ðnegligent€act€or€omission.€€Accordingly,€the€plaintiff€in€an€informed€consentÐ ¶®  Ðmedical€malpractice€case€has€the€burden€of€proving:€€(1)€what€a€reasonableÐ ‚z  Ðmedical€practitioner€in€the€same€or€similar€community€would€have€disclosed€toÐ NF Ðthe€patient€about€the€risk€posed€by€the€proposed€procedure€or€treatment;€and€(2)Ð  Ðthat€the€defendant€departed€from€the€norm.€€òòGerman€v.€Nichopoulosóó,€577Ð æÞ ÐS.W.2d€197,€204€(Tenn.€Ct.€App.1978).Ð ²ª ÐÌà Œ àThis€Court€recently€enunciated€a€distinction€between€a€lack€of€informedÐ JB Ðconsent€case€and€a€pure€medical€battery€case.€€In€òòBlanchard€v.€Kellumóó,€975Ð ! ÐS.W.2d€522€(Tenn.€1998),€this€Court€defined€a€medical€battery€as€a€case€inÐ â"Ú Ðwhich€a€doctor€performs€an€unauthorized€procedure.€€òòId.óó€at€524.€€A€medicalÐ ®$¦! Ðbattery€may€typically€occur€when:€€(1)€€a€professional€performs€a€procedure€thatÐ z&r# Ðthe€patient€was€unaware€the€doctor€was€going€to€perform;€or€(2)€the€procedureÐ F(>!% Ðwas€performed€on€a€part€of€the€body€other€than€that€part€explained€to€the€patientÐ * #' Ð(i.e.,€amputation€of€the€wrong€leg).€€òòId.óó€€A€lack€of€informed€consent€claim€typicallyÐ Þ+Ö$) Ðoccurs€when€the€patient€was€aware€that€the€procedure€was€going€to€beÐ ª-¢&+ Ðperformed€but€the€patient€was€unaware€of€the€risk€associated€with€the€procedure.€Ð v/n(- ÐòòId.óóÐ B1:*/ ÐÌà Œ àThe€case€now€before€us€is€not€a€medical€battery€case.€€Ms.€Ashe€hadÐ Ú4Ò-3 Ðâ âauthorized€the€radiation€treatment.€€Ms.€Ashe,€however,€contends€that€she€wasÐ ¦6ž/5 Ðnot€apprised€of€certain€risks€inherent€in€the€treatment.€€Her€claim,€therefore,€isÐ  Ðpremised€on€the€lack€of€informed€consent.Ð ÔÌ Ðâ âÌà Œ àThe€issue€with€which€we€are€now€confronted€is€whether€an€objective,Ð l d Ðsubjective,€or€a€hybrid€subjective/objective€test€shall€be€employed€whenÐ 80 Ðassessing€causation€in€medical€malpractice€informed€consent€cases.€€The€issueÐ ü  Ðis€one€of€first€impression€in€Tennessee.€€The€majority€of€jurisdictions€havingÐ ÐÈ  Ðaddressed€this€issue€follow€an€objective€standard.€€A€minority€of€jurisdictionsÐ œ”  Ðhaving€addressed€the€issue€follow€the€subjective€approach.€€One€jurisdiction,Ð h` ÐHawaii,€employed€a€ð ðmodified€objective€standardðð€for€informed€consent€cases€forÐ 4, Ðapproximately€ten€years.€€Hawaii€has€now€abandoned€the€modified€approach€inÐ ø Ðfavor€of€the€objective€standard.€€We€shall€now€examine€the€various€approachesÐ ÌÄ Ðand€the€rationales€behind€these€approaches.Ð ˜ ÐÌÔ  ÔÓ  Óò òSubjective€Standardó óÐ 0 ( ÐÓ¨6ÓÌà Œ àThe€plaintiff€urges€this€Court€to€follow€the€minority€rule€or€adopt€aÐ Ô#Ì  Ðsubjective€standard€when€evaluating€causation€in€an€informed€consent€case.€Ð  %˜" ÐCausation€under€the€subjective€standard€is€established€solely€by€patientÐ l'd $ Ðtestimony.€€Patients€must€testify€and€prove€that€they€would€not€have€consentedÐ 8)0"& Ðto€the€procedures€had€they€been€advised€of€the€particular€risk€in€question.€€òòSeeóóÐ +ü#( Ðòòe.g.óó,€òòScott€v.€Bradfordóó,€606€P.2d€554€(Okla.€1979);€òòWilkinson€v.€Vesseyóó,€295Ð Ð,È%* ÐA.2d€676€(R.I.€1972).€€Accordingly,€resolution€of€causation€under€a€subjectiveÐ œ.”', Ðstandard€is€premised€elusively€on€the€credibility€of€a€patientððs€testimony.Ð h0`). ÐÌà Œ àThe€subjective€standard€engages€in€an€abstract€analysis.€€The€abstractÐ 4ø,2 Ðanalysis€not€only€poses€a€purely€hypothetical€question€but€seeks€to€answer€theÐ Ì5Ä.4 Ðhypothetical€question.€€One€commentator€has€framed€this€hypothetical€questionÐ ˜706 Ðas€follows:€€ð ðViewed€from€the€point€at€which€[the€patient]€had€to€decide,€would€theÐ  Ðpatient€have€decided€differently€had€he€known€something€he€did€not€know?ðð€Ð ÔÌ ÐCanterbury€v.€Spence,€464€F.2d€772,€790€(D.C.€Cir.€1972)€òòquotingóó€Waltz€&Ð   ˜ ÐScheuneman,€òòInformed€Consent€to€Therapyóó,€64€Nw.U.L.Rev.€628,€647€(1970).Ð l d ÐÌà Œ àProponents€of€the€subjective€test€argue€that€a€patient€should€have€theÐ ü  Ðright€to€make€medical€determinations€regardless€of€whether€the€determination€isÐ ÐÈ  Ðrational€or€reasonable.€€òòGouse€v.€Casselóó,€615€A.2d€331,€335€(Pa.€1992).€Ð œ”  ÐOpponents,€however,€focus€on€the€unfairness€of€allowing€the€issue€of€causationÐ h` Ðto€turn€on€the€credibility€of€the€hindsight€of€a€person€seeking€recovery€afterÐ 4, Ðexperiencing€a€most€undesirable€result.€€òòSard€v.€Hardyóó,€379€A.2d€1014,€1025Ð ø Ð(Md.€1977).€€ð ðPatients€cannot€divorce€their€re„created€decision€process€fromÐ ÌÄ Ðhindsight.ðð€€F.€Rozovsky,€òòConsent€to€Treatmentóó,€ðð€1.13.4,€62„63€(1984).€Ð ˜ ÐAccordingly,€the€subjective€test€potentially€places€the€physician€in€jeopardy€of€theÐ d\ Ðpatientððs€hindsight€and€bitterness.€€òòSardóó,€379€A.2d€at€1025.€€Moreover,€theÐ 0 ( Ðadoption€of€a€subjective€standard€could€preclude€recovery€in€an€informedÐ ü!ô Ðconsent€case€in€which€the€patient€died€as€a€result€of€an€unforewarned€collateralÐ È#À  Ðconsequence.€€òòId.óóÐ ”%Œ" ÐÌÔ  ÔÓ  Óò òObjective€Standardó óÐ ,)$"& ÐÓÑAÓÌà Œ àThe€majority׃×Ý ƒ #ÃÝòòÚ  Ú1Ú  ÚóóÝ  Ý×  ×€approach€or€the€so„called€objective€standard€emanates€fromÐ Ð,È%* Ðthe€seminal€decision€in€òòCanterbury€v.€Spenceóó,€464€F.2d€772€(D.C.€Cir.€1972).€€InÐ œ.”', ÐòòCanterburyóó,€the€court€held€that€causation€in€informed€consent€cases€is€betterÐ h0`). Ðresolved€on€an€objective€basis€ð ðin€terms€of€what€a€prudent€person€in€the€patientððsÐ  Ðposition€would€have€decided€if€suitably€informed€of€all€perils€bearingÐ ÔÌ Ðsignificance.ðð€€òòId.óó€at€791.€€The€objective€view€recognizes€that€neither€the€plaintiffÐ   ˜ Ðnor€the€fact„finder€can€provide€a€definitive€answer€as€to€what€the€patient€wouldÐ l d Ðhave€done€had€the€patient€known€of€the€particular€risk€prior€to€consenting€to€theÐ 80 Ðprocedure€or€treatment.€€òòId.óó€at€790.€€Accordingly,€the€patientððs€testimony€isÐ ü  Ðrelevant€under€an€objective€approach,€but€the€testimony€is€not€controlling.€€òòId.óó€atÐ ÐÈ  Ð791.Ð œ”  ÐÌÔ  ÔÓ  Óò òModified€Objective€Standardó óÐ 4, ÐÓ­FÓÌà Œ àThe€modified€objective€standard€was€first€recognized€in€òòLeyson€v.Ð ØÐ ÐSteuermannóó,€705€P.2d€37€(Haw.€Ct.€App.€1985).€€In€òòLeysonóó,€the€Hawaii€Court€ofÐ ¤œ ÐAppeals€attempted€to€balance€patientððs€right€to€self„determination€with€theÐ ph Ðconcerns€espoused€in€òòCanterburyóó€of€subjecting€a€physician€to€a€patientððsÐ < 4 Ðbitterness€or€hindsight€following€an€undesirable€result.€€The€resulting€testÐ " Ðdetermined€causation€ð ðfrom€the€viewpoint€of€the€actual€patient€acting€rationallyÐ Ô#Ì  Ðand€reasonably.ðð€€òòId.óó€at€47,€n.€10.Ð  %˜" ÐÌà Œ àApproximately€ten€years€after€the€inception€of€the€modified€approach,€theÐ 8)0"& Ðapproach€was€declared€to€be€onerous€in€application.€€In€òòBernard€v.€Charóó,€903Ð +ü#( ÐP.2d€667€(Haw.€1995),€the€Hawaii€Supreme€Court€elaborated€that:Ð Ð,È%* ÐÌÓÓà8 Œ àIn€its€effort€to€achieve€the€desired€result€of€combining€the€objectiveÐ h0`). Ðand€subjective€standards,€the€modified€objective€standard€injects€atÐ N1F*/ Ðleast€one€extra€level€of€complexity€into€the€causation€analysis.€Ð 42,+0 ÐUnder€the€objective€standard,€the€factfinder€must€suspend€his€orÐ 3,1 Ðher€own€viewpoint€and€step€into€the€viewpoint€of€a€reasonableÐ 4ø,2 Ðperson€to€objectively€assess€the€plaintiff„patientððs€decision€toÐ æ4Þ-3 Ðundergo€treatment.€€Under€the€subjective€standard,€the€factfinderÐ Ì5Ä.4 Ðmust€simply€assess€the€credibility€of€the€plaintiff„patient€when€he€orÐ ²6ª/5 Ðshe€invariably€asserts€that€he€or€she€would€have€declined€treatmentÐ ˜706 Ðwith€proper€disclosure.€€Under€the€ð ðmodified€objective€standard,ððÐ ~8v17 Ðhowever,€the€factfinder€must€first€suspend€his€or€her€viewpoint,Ð  Ðthen€place€himself€or€herself€in€the€mind€of€the€actual€patient,€and,Ð îæ Ðthen,€while€maintaining€the€viewpoint€of€the€actual€patient,€try€toÐ ÔÌ Ðdetermine€what€the€actual€patient€would€have€decided€about€theÐ º ² Ðproposed€medical€treatment€or€procedure,€if€the€actual€patient€wereÐ   ˜ Ðacting€rationally€and€reasonably.ÓÊJÓІ ~Œ ü!Œ ü! ÐÌòòId.óó€at€673.€€Accordingly,€the€modified€approach€was€abandoned€in€favor€of€theÐ   Ðobjective€standard.Ð êâ  ÐÌÓÓà8 Œ à[D]espite€being€well„intentioned,€[it]€exacts€too€much€of€a€cost€in€theÐ ‚z  Ðform€of€added€complexity€in€seeking€to€solve€problems€associatedÐ h` Ðwith€the€preexisting€objective€and€subjective€standards€while€at€theÐ NF Ðsame€time€remaining€faithful€to€the€laudable€purposes€behind€suchÐ 4, Ðstandards.ÓðPÓÐŒ ü!Œ ü! ÐÌòòId.óó€€The€Court€held:€(1)€€that€the€objective€standard€provided€ð ða€better,€simpler,Ð ²ª Ðand€more€equitable€analytical€process;ðð€and€(2)€that€the€objective€standardÐ ~v Ðultimately€addressed€the€concerns€which€prompted€the€creation€of€the€modifiedÐ JB Ðtest.Ð ! ÐÌÔ  Ôò òÓ  ÓCONCLUSIONó óÐ ®$¦! ÐÓ TÓÌà Œ àWe€agree€with€the€majority€of€jurisdictions€having€addressed€this€issueÐ R(J!% Ðand€hold€that€the€objective€approach€is€the€better€approach.€€The€objectiveÐ *#' Ðapproach€circumvents€the€need€to€place€the€fact„finder€in€a€position€of€decidingÐ ê+â$) Ðwhether€a€speculative€and€perhaps€emotional€answer€to€a€purely€hypotheticalÐ ¶-®&+ Ðquestion€shall€dictate€the€outcome€of€the€litigation.€€The€objective€standard€isÐ ‚/z(- Ðconsistent€with€the€prevailing€standard€in€negligence€cases€which€measures€theÐ N1F*/ Ðconduct€of€the€person€in€question€with€that€of€a€reasonable€person€in€likeÐ 3,1 Ðcircumstances.€€Restatement€(Second)€of€Torts€ðð€283,€p.€12€(1965);€òòseeóó€òòalsoóó€1Ð æ4Þ-3 ÐS.€Pegalis€&€H.€Wachsman,€òòAmerican€Law€of€Medical€Malpracticeóó,€ðð€2.15,€103„Ð ²6ª/5 Ð104€(1980)€(criticizing€subjective€test€as€being€out€of€step€with€generalÐ ~8v17 Ðnegligence€concepts).€€The€objective€test€provides€a€realistic€framework€forÐ  Ðrational€resolution€of€the€issue€of€causation.€€We,€therefore,€believe€thatÐ ÔÌ Ðcausation€may€best€be€assessed€in€informed€consent€cases€by€the€finder€of€factÐ   ˜ Ðdetermining€how€nondisclosure€would€affect€a€reasonable€person€in€the€plaintiffððsÐ l d Ðposition.Ð 80 ÐÌà Œ àWe€also€are€of€the€opinion€that€the€objective€test€appropriately€respects€aÐ ÐÈ  Ðpatientððs€right€to€self„determination.€€The€finder€of€fact€may€consider€and€giveÐ œ”  Ðweight€to€the€patientððs€testimony€as€to€whether€the€patient€would€have€consentedÐ h` Ðto€the€procedure€upon€full€disclosure€of€the€risks.€€When€applying€the€objectiveÐ 4, Ðstandard,€the€finder€of€fact€may€also€take€into€account€the€characteristics€of€theÐ ø Ðplaintiff€including€the€plaintiffððs€idiosyncrasies,€fears,€age,€medical€condition,€andÐ ÌÄ Ðreligious€beliefs.€€òòBernard€v.€Charóó,€903€P.2d€667,€674€(Haw.€1995);€òòFain€v.Ð ˜ ÐSmithóó,€479€S.2d€1150,€1155€(Ala.€1985);€òòBacklund€v.€University€of€Washingtonóó,Ð d\ Ð975€P.2d€950€(Wash.€1999).€€Accordingly,€the€objective€standard€affords€theÐ 0 ( Ðease€of€applying€a€uniform€standard€and€yet€maintains€the€flexibility€of€allowingÐ ü!ô Ðthe€finder€of€fact€to€make€appropriate€adjustments€to€accommodate€theÐ È#À  Ðindividual€characteristics€and€idiosyncracies€of€an€individual€patient.€€€We,Ð ”%Œ" Ðtherefore,€hold€that€the€standard€to€be€applied€in€informed€consent€cases€isÐ `'X $ Ðwhether€a€reasonable€person€in€the€patientððs€position€would€have€consented€toÐ ,)$"& Ðthe€procedure€or€treatment€in€question€if€adequately€informed€of€all€significantÐ ø*ð#( Ðperils.Ð Ä,¼%* ÐÌà Œ àIn€applying€the€objective€standard€to€the€facts€of€this€case,€we€agree€withÐ \0T). Ðthe€Court€of€Appeals€that€the€jury€should€not€have€been€precluded€from€decidingÐ (2 +0 Ðthe€issue€of€informed€consent.€€Under€the€objective€analysis,€the€plaintiffððsÐ ô3ì,2 Ðtestimony€is€only€a€factor€when€determining€the€issue€of€informed€consent.€€TheÐ À5¸.4 Ðdispositive€issue€is€not€whether€Ms.€Ashe€would€herself€have€chosen€a€differentÐ Œ7„06 Ðcourse€of€treatment.€€The€issue€is€whether€a€reasonable€patient€in€Ms.€AsheððsÐ  Ðposition€would€have€chosen€a€different€course€of€treatment.€€The€jury,€therefore,Ð ÔÌ Ðshould€have€been€allowed€to€decide€whether€a€reasonable€person€in€Ms.€AsheððsÐ   ˜ Ðposition€would€have€consented€to€the€radiation€therapy€had€the€risk€of€paralysisÐ l d Ðbeen€disclosed.Ð 80 ÐÌà Œ àThe€judgment€of€the€Court€of€Appeals€reversing€the€trial€court€is€affirmed.€Ð ÐÈ  ÐThe€case€is€remanded€for€a€new€trial€consistent€with€this€opinion.€€Costs€of€theÐ œ”  Ðappeal€to€the€Court€of€Appeals€shall€be€as€previously€taxed;€costs€of€the€appealÐ h` Ðto€this€Court€shall€be€taxed€against€the€plaintiff€for€which€execution€may€issue€ifÐ 4, Ðnecessary.Ð ø ÐÌÌÓÓà Œ àà ä àà < àà ” àà ì àà D àòòà€T$T$MT$àóóˆÌà Œ àà ä àà < àà ” àà ì àà D àJANICE€M.€HOLDER,€JUSTICEÐ JB ÐÌÌÌÔ& ž Ôò òConcurring:ó óÐ â"Ú ÐÌAnderson,€C.J.Ð ´$¬! ÐDrowota,€Birch,€and€Barker,€J.J.Ô'žâ"ZfÔ