EN
BANC
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DR. RUBI LI, Petitioner, - versus - |
G.R. No. 165279 Present: CARPIO, CARPIO MORALES, VELASCO, JR., NACHURA, LEONARDO-DE CASTRO, BRION, PERALTA, BERSAMIN, ABAD, VILLARAMA, JR., PEREZ, SERENO, JJ. |
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SPOUSES REYNALDO and LINA SOLIMAN, as parents/heirs
of deceased Angelica Soliman, Respondents. |
Promulgated: June 7, 2011 |
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DECISION
VILLARAMA,
JR., J.:
Challenged in this petition for review
on certiorari is the Decision[1] dated
The
factual antecedents:
On
On
On the
other hand, the Certificate of Death[6] issued by SLMC
stated the cause of death as follows:
Immediate cause : a. Osteosarcoma,
Status Post AKA
Antecedent cause : b. (above knee amputation)
Underlying cause : c. Status Post Chemotherapy
On
In her
answer,[8] petitioner denied
having been negligent in administering the chemotherapy drugs to Angelica and
asserted that she had fully explained to respondents how the chemotherapy will
affect not only the cancer cells but also the patients normal body parts,
including the lowering of white and red blood cells and platelets. She claimed that what happened to Angelica
can be attributed to malignant tumor cells possibly left behind after surgery. Few as they may be, these have the capacity
to compete for nutrients such that the body becomes so weak structurally
(cachexia) and functionally in the form of lower resistance of the body to
combat infection. Such infection becomes
uncontrollable and triggers a chain of events (sepsis or septicemia) that
may lead to bleeding in the form of Disseminated Intravascular Coagulation
(DIC), as what the autopsy report showed in the case of Angelica.
Since
the medical records of Angelica were not produced in court, the trial and
appellate courts had to rely on testimonial evidence, principally the
declarations of petitioner and respondents themselves. The following chronology of events was
gathered:
On P70,000.00 to P150,000.00
a year from his jewelry and watch repairing business.[9] Petitioner,
however, assured them not to worry about her professional fee and told them to
just save up for the medicines to be used.
Petitioner claimed that she explained to respondents
that even when a tumor is removed, there are still small lesions undetectable
to the naked eye, and that adjuvant chemotherapy is needed to clean out the
small lesions in order to lessen the chance of the cancer to recur. She did not give the respondents any
assurance that chemotherapy will cure Angelicas cancer. During these consultations with respondents,
she explained the following side effects of chemotherapy treatment to
respondents: (1) falling hair; (2)
nausea and vomiting; (3) loss of appetite; (4) low count of white blood cells
[WBC], red blood cells [RBC] and platelets; (5) possible sterility due to the
effects on Angelicas ovary; (6) damage to the heart and kidneys; and (7)
darkening of the skin especially when exposed to sunlight. She actually talked with respondents four
times, once at the hospital after the surgery, twice at her clinic and the
fourth time when Angelicas mother called her through long distance.[10] This was disputed by respondents who
countered that petitioner gave them assurance that there is 95% chance of
healing for Angelica if she undergoes chemotherapy and that the only side
effects were nausea, vomiting and hair loss.[11] Those were the only side-effects of
chemotherapy treatment mentioned by petitioner.[12]
On
On
The following day, August 19, petitioner began
administering three chemotherapy drugs Cisplatin,[15] Doxorubicin[16] and Cosmegen[17]
intravenously. Petitioner was supposedly
assisted by her trainees Dr. Leo Marbella[18] and Dr. Grace
Arriete.[19] In his testimony, Dr. Marbella denied having
any participation in administering the said chemotherapy drugs.[20]
On the second day of chemotherapy, August 20,
respondents noticed reddish discoloration on Angelicas face.[21] They asked petitioner about it, but she
merely quipped, Wala yan. Epekto ng
gamot.[22] Petitioner recalled noticing the skin rashes
on the nose and cheek area of Angelica.
At that moment, she entertained the possibility that Angelica also had
systemic lupus and consulted Dr. Victoria Abesamis on the matter.[23]
On the third day of chemotherapy, August 21, Angelica
had difficulty breathing and was thus provided with oxygen inhalation
apparatus. This time, the reddish discoloration on Angelicas face had extended
to her neck, but petitioner dismissed it again as merely the effect of
medicines.[24] Petitioner testified that she did not see any
discoloration on Angelicas face, nor did she notice any difficulty in the
childs breathing. She claimed that
Angelica merely complained of nausea and was given ice chips.[25]
On
The following day, August 23, petitioner yielded to
respondents request to take Angelica home. But prior to discharging Angelica,
petitioner requested for a repeat serum calcium determination and explained to
respondents that the chemotherapy will be temporarily stopped while she
observes Angelicas muscle twitching and serum calcium level. Take-home medicines were also prescribed for
Angelica, with instructions to respondents that the serum calcium test will
have to be repeated after seven days. Petitioner told respondents that she will
see Angelica again after two weeks, but respondents can see her anytime if any
immediate problem arises.[28]
However, Angelica remained in confinement because
while still in the premises of SLMC, her convulsions returned and she also
had LBM. Angelica was given oxygen and
administration of calcium continued.[29]
The next day, August 24, respondents claimed that
Angelica still suffered from convulsions. They also noticed that she had a
fever and had difficulty breathing.[30] Petitioner insisted it was carpo-pedal spasm, not convulsions. She verified that
at around
By August 26, Angelica was bleeding through the mouth.
Respondents also saw blood on her anus and urine. When Lina asked petitioner
what was happening to her daughter, petitioner replied, Bagsak ang platelets ng anak mo.
Four units of platelet concentrates were then transfused to
Angelica. Petitioner prescribed
Solucortef. Considering that Angelicas fever was high and her white blood cell
count was low, petitioner prescribed Leucomax.
About four to eight bags of blood, consisting of packed red blood cells,
fresh whole blood, or platelet concentrate, were transfused to Angelica. For two days (August 27 to 28), Angelica
continued bleeding, but petitioner claimed it was lesser in amount and in
frequency. Petitioner also denied that
there were gadgets attached to Angelica at that time.[34]
On August 29, Angelica developed ulcers in her mouth,
which petitioner said were blood clots that should not be removed. Respondents claimed that Angelica passed
about half a liter of blood through her anus at around
On August 30, Angelica continued bleeding. She was restless as endotracheal and
nasogastric tubes were inserted into her weakened body. An aspiration of the
nasogastric tube inserted to Angelica also revealed a bloody content. Angelica
was given more platelet concentrate and fresh whole blood, which petitioner
claimed improved her condition.
Petitioner told Angelica not to remove the endotracheal tube because
this may induce further bleeding.[35] She was also transferred to the intensive
care unit to avoid infection.
The next day, respondents claimed that Angelica became
hysterical, vomited blood and her body turned black. Part of Angelicas skin
was also noted to be shredding by just rubbing cotton on it. Angelica was so restless she removed those
gadgets attached to her, saying Ayaw ko na; there were tears in her
eyes and she kept turning her head.
Observing her daughter to be at the point of death, Lina asked for a
doctor but the latter could not answer her anymore.[36] At this time, the
attending physician was Dr. Marbella who was shaking his head saying that
Angelicas platelets were down and respondents should pray for their
daughter. Reynaldo claimed that he was
introduced to a pediatrician who took over his daughters case, Dr. Abesamis
who also told him to pray for his daughter. Angelica continued to have
difficulty in her breathing and blood was being suctioned from her
stomach. A nurse was posted inside
Angelicas room to assist her breathing and at one point they had to revive
Angelica by pumping her chest. Thereafter, Reynaldo claimed that Angelica
already experienced difficulty in urinating and her bowel consisted of
blood-like fluid. Angelica requested for
an electric fan as she was in pain.
Hospital staff attempted to take blood samples from Angelica but were
unsuccessful because they could not even locate her vein. Angelica asked for a fruit but when it was
given to her, she only smelled it. At
this time, Reynaldo claimed he could not find either petitioner or Dr.
Marbella. That night, Angelica became
hysterical and started removing those gadgets attached to her. At
By petitioners own account, Angelica was merely
irritable that day (August 31).
Petitioner noted though that Angelicas skin was indeed sloughing off.[38] She stressed that at
While he was seeking the release of Angelicas cadaver
from SLMC, Reynaldo claimed that petitioner acted arrogantly and called him
names. He was asked to sign a promissory
note as he did not have cash to pay the hospital bill.[43]
Respondents also presented as witnesses Dr. Jesusa
Nieves-Vergara, Medico-Legal Officer of the PNP-Crime Laboratory who conducted
the autopsy on Angelicas cadaver, and Dr. Melinda Vergara Balmaceda who is a
Medical Specialist employed at the Department of Health (DOH) Operations and
Management Services.
Testifying on the findings stated in her medico-legal
report, Dr. Vergara noted the following: (1) there were fluids recovered from
the abdominal cavity, which is not normal, and was due to hemorrhagic shock
secondary to bleeding; (2) there was hemorrhage at the left side of the heart;
(3) bleeding at the upper portion of and areas adjacent to, the esophagus; (4)
lungs were heavy with bleeding at the back and lower portion, due to
accumulation of fluids; (4) yellowish discoloration of the liver; (5) kidneys
showed appearance of facial shock on account of hemorrhages; and (6)
reddishness on external surface of the spleen. All these were the end result of
hypovolemic shock secondary to multiple organ hemorrhages and disseminated
intravascular coagulation. Dr. Vergara
opined that this can be attributed to the chemical agents in the drugs given to
the victim, which caused platelet reduction resulting to bleeding sufficient to
cause the victims death. The time lapse
for the production of DIC in the case of Angelica (from the time of diagnosis
of sarcoma) was too short, considering the survival rate of about 3 years. The witness conceded that the victim will
also die of osteosarcoma even with amputation or chemotherapy, but in this case
Angelicas death was not caused by osteosarcoma. Dr. Vergara admitted that she is not a
pathologist but her statements were based on the opinion of an oncologist whom
she had interviewed. This oncologist
supposedly said that if the victim already had DIC prior to the chemotherapy,
the hospital staff could have detected it.[44]
On her part, Dr. Balmaceda declared that it is the
physicians duty to inform and explain to the patient or his relatives every
known side effect of the procedure or therapeutic agents to be administered,
before securing the consent of the patient or his relatives to such procedure
or therapy. The physician thus bases his
assurance to the patient on his personal assessment of the patients condition
and his knowledge of the general effects of the agents or procedure that will
be allowed on the patient. Dr. Balmaceda
stressed that the patient or relatives must be informed of all known side
effects based on studies and observations, even if such will aggravate the
patients condition.[45]
Dr. Jaime Tamayo, the orthopaedic surgeon who operated
on Angelicas lower extremity, testified for the defendants. He explained that in case of malignant
tumors, there is no guarantee that the ablation or removal of the amputated
part will completely cure the cancer. Thus, surgery is not enough. The mortality rate of osteosarcoma at the
time of modern chemotherapy and early diagnosis still remains at 80% to
90%. Usually, deaths occur from
metastasis, or spread of the cancer to other vital organs like the liver,
causing systemic complications. The
modes of therapy available are the removal of the primary source of the
cancerous growth and then the residual cancer cells or metastasis should be
treated with chemotherapy. Dr. Tamayo further explained that patients with
osteosarcoma have poor defense mechanism due to the cancer cells in the blood
stream. In the case of Angelica, he had
previously explained to her parents that after the surgical procedure,
chemotherapy is imperative so that metastasis of these cancer cells will
hopefully be addressed. He referred the
patient to petitioner because he felt that petitioner is a competent
oncologist. Considering that this type
of cancer is very aggressive and will metastasize early, it will cause the
demise of the patient should there be no early intervention (in this case, the patient developed sepsis
which caused her death). Cancer
cells in the blood cannot be seen by the naked eye nor detected through bone
scan. On cross-examination, Dr. Tamayo stated that of the more than 50 child
patients who had osteogenic sarcoma he had handled, he thought that probably
all of them died within six months from amputation because he did not see them
anymore after follow-up; it is either they died or had seen another doctor.[46]
In
dismissing the complaint, the trial court held that petitioner was not liable
for damages as she observed the best known procedures and employed her highest
skill and knowledge in the administration of chemotherapy drugs on Angelica but
despite all efforts said patient died.
It cited the testimony of Dr. Tamayo who testified that he considered
petitioner one of the most proficient in the treatment of cancer and that the
patient in this case was afflicted with a very aggressive type of cancer
necessitating chemotherapy as adjuvant treatment. Using the standard of negligence laid down in
Picart v. Smith,[47] the trial
court declared that petitioner has taken the necessary precaution against the
adverse effect of chemotherapy on the patient, adding that a wrong decision is
not by itself negligence. Respondents
were ordered to pay their unpaid hospital bill in the amount of P139,064.43.[48]
Respondents
appealed to the CA which, while concurring
with the trial courts finding that there was no negligence committed by the
petitioner in the administration of chemotherapy treatment to Angelica, found
that petitioner as her attending physician failed to fully explain to the
respondents all the known side effects of chemotherapy. The appellate court stressed that since the
respondents have been told of only three side effects of chemotherapy, they
readily consented thereto. Had
petitioner made known to respondents those other side effects which gravely
affected their child -- such as carpo-pedal spasm, sepsis, decrease in the
blood platelet count, bleeding, infections and eventual death -- respondents
could have decided differently or adopted a different course of action which
could have delayed or prevented the early death of their child.
The CA thus declared:
Plaintiffs-appellants child was suffering from a malignant
disease. The attending physician
recommended that she undergo chemotherapy treatment after surgery in order to
increase her chances of survival.
Appellants consented to the chemotherapy treatment because they believed
in Dr. Rubi Lis representation that the deceased would have a strong chance of
survival after chemotherapy and also because of the representation of appellee Dr.
Rubi Li that there were only three possible side-effects of the treatment.
However, all sorts of painful side-effects resulted from the treatment
including the premature death of Angelica. The appellants were clearly and totally
unaware of these other side-effects which manifested only during the
chemotherapy treatment. This was shown
by the fact that every time a problem would take place regarding Angelicas
condition (like an unexpected side-effect manifesting itself), they would
immediately seek explanation from Dr. Rubi Li. Surely, those unexpected side-effects
culminating in the loss of a love[d] one caused the appellants so much trouble,
pain and suffering.
On this point therefore, [w]e find defendant-appellee Dr. Rubi Li
negligent which would entitle plaintiffs-appellants to their claim for damages.
x x x x
WHEREFORE, the instant appeal is hereby GRANTED. Accordingly, the assailed decision is hereby
modified to the extent that defendant-appellee Dr. Rubi Li is ordered to pay
the plaintiffs-appellants the following amounts:
1. Actual damages of P139,064.43, plus P9,828.00 for funeral expenses;
2. Moral damages of P200,000.00;
3. Exemplary damages of P50,000.00;
4. Attorneys fee of P30,000.00.
SO ORDERED.[49] (Emphasis supplied.)
Petitioner
filed a motion for partial reconsideration which the appellate court denied.
Hence, this petition.
Petitioner assails the CA in finding her guilty of
negligence in not explaining to the respondents all the possible side effects of
the chemotherapy on their child, and in holding her liable for actual, moral
and exemplary damages and attorneys fees.
Petitioner emphasized that she was not negligent in the pre-chemotherapy
procedures and in the administration of chemotherapy treatment to Angelica.
On her
supposed non-disclosure of all possible side effects of chemotherapy, including
death, petitioner argues that it was foolhardy to imagine her to be
all-knowing/omnipotent. While the
theoretical side effects of chemotherapy were explained by her to the
respondents, as these should be known to a competent doctor, petitioner cannot possibly predict how a
particular patients genetic make-up, state of mind, general health and body
constitution would respond to the treatment.
These are obviously dependent on too many known, unknown and
immeasurable variables, thus requiring that Angelica be, as she was, constantly
and closely monitored during the treatment.
Petitioner asserts that she did everything within her professional
competence to attend to the medical needs of Angelica.
Citing numerous trainings, distinctions and
achievements in her field and her current position as co-director for clinical
affairs of the Medical Oncology, Department of Medicine of SLMC, petitioner
contends that in the absence of any clear showing or proof, she cannot be
charged with negligence in not informing the respondents all the side effects
of chemotherapy or in the pre-treatment procedures done on Angelica.
As to
the cause of death, petitioner insists that Angelica did not die of platelet
depletion but of sepsis which is a complication of the cancer itself. Sepsis itself leads to bleeding and
death. She explains that the response
rate to chemotherapy of patients with osteosarcoma is high, so much so that
survival rate is favorable to the patient.
Petitioner then points to some probable consequences if Angelica had not
undergone chemotherapy. Thus, without chemotherapy, other medicines and
supportive treatment, the patient might have died the next day because of
massive infection, or the cancer cells might have spread to the brain and
brought the patient into a coma, or into the lungs that the patient could have
been hooked to a respirator, or into her kidneys that she would have to undergo
dialysis. Indeed, respondents could have
spent as much because of these complications.
The patient would have been deprived of the chance to survive the
ailment, of any hope for life and her quality of life surely compromised. Since she had not been shown to be at fault,
petitioner maintains that the CA erred in holding her liable for the damages
suffered by the respondents.[50]
The
issue to be resolved is whether the petitioner can be held liable for failure
to fully disclose serious side effects to the parents of the child patient who
died while undergoing chemotherapy, despite the absence of finding that
petitioner was negligent in administering the said treatment.
The petition is meritorious.
The type of lawsuit which has been called medical
malpractice or, more appropriately, medical negligence, is that type of claim
which a victim has available to him or her to redress a wrong committed by a
medical professional which has caused bodily harm. In order to successfully pursue such a claim,
a patient must prove that a health care provider, in most cases a physician,
either failed to do something which a reasonably prudent health care provider
would have done, or that he or she did something that a reasonably prudent
provider would not have done; and that that failure or action caused injury to
the patient.[51]
This
Court has recognized that medical negligence cases are best proved by opinions
of expert witnesses belonging in the same general neighborhood and in the same
general line of practice as defendant physician or surgeon. The deference of
courts to the expert opinion of qualified physicians stems from the formers
realization that the latter possess unusual technical skills which laymen in
most instances are incapable of intelligently evaluating, hence the indispensability
of expert testimonies.[52]
In this
case, both the trial and appellate courts concurred in finding that the alleged
negligence of petitioner in the administration of chemotherapy drugs to
respondents child was not proven considering that Drs. Vergara and Balmaceda,
not being oncologists or cancer specialists, were not qualified to give expert
opinion as to whether petitioners lack of skill, knowledge and professional
competence in failing to observe the standard of care in her line of practice
was the proximate cause of the patients death. Furthermore, respondents case was not at
all helped by the non-production of medical records by the hospital (only the
biopsy result and medical bills were submitted to the court). Nevertheless, the
CA found petitioner liable for her failure to inform the respondents on all
possible side effects of chemotherapy before securing their consent to the said
treatment.
The
doctrine of informed consent within
the context of physician-patient relationships goes far back into English
common law. As early as 1767, doctors
were charged with the tort of battery (i.e., an unauthorized physical contact
with a patient) if they had not gained the consent of their patients prior to
performing a surgery or procedure. In
the
Subsequently,
in Canterbury v. Spence[56] the court observed that the duty to disclose should
not be limited to medical usage as to arrogate the decision on revelation to
the physician alone. Thus, respect for the patients right of
self-determination on particular therapy demands a standard set by law for
physicians rather than one which physicians may or may not impose upon
themselves.[57] The scope of disclosure is premised on the
fact that patients ordinarily are persons unlearned in the medical
sciences. Proficiency in diagnosis and
therapy is not the full measure of a physicians responsibility. It is also his duty to warn of the dangers
lurking in the proposed treatment and to impart information which the patient
has every right to expect. Indeed, the
patients reliance upon the physician is a trust of the kind which
traditionally has exacted obligations beyond those associated with armslength
transactions.[58] The physician is not expected to give the
patient a short medical education, the disclosure rule only requires of him a
reasonable explanation, which means generally informing the patient in
nontechnical terms as to what is at stake; the therapy alternatives open to
him, the goals expectably to be achieved, and the risks that may ensue from
particular treatment or no treatment.[59] As to the issue of demonstrating what risks
are considered material necessitating disclosure, it was held that experts are
unnecessary to a showing of the materiality of a risk to a patients decision
on treatment, or to the reasonably, expectable effect of risk disclosure on the
decision. Such unrevealed risk that
should have been made known must further materialize, for otherwise the
omission, however unpardonable, is without legal consequence. And, as in malpractice actions generally,
there must be a causal relationship between the physicians failure to divulge
and damage to the patient.[60]
Reiterating
the foregoing considerations, Cobbs v.
Grant[61]
deemed it as integral part of physicians overall obligation to patient, the
duty of reasonable disclosure of available choices with respect to proposed
therapy and of dangers inherently and potentially involved in each. However, the physician is not obliged to
discuss relatively minor risks inherent in common procedures when it is common
knowledge that such risks inherent in procedure of very low incidence. Cited as
exceptions to the rule that the patient should not be denied the opportunity to
weigh the risks of surgery or treatment are emergency cases where it is evident
he cannot evaluate data, and where the patient is a child or incompetent.[62] The court thus concluded that the patients
right of self-decision can only be effectively exercised if the patient
possesses adequate information to enable him in making an intelligent
choice. The scope of the physicians
communications to the patient, then must be measured by the patients need, and
that need is whatever information is material to the decision. The test therefore for determining whether a
potential peril must be divulged is its materiality to the patients decision.[63]
Cobbs v. Grant further reiterated the
pronouncement in Canterbury v. Spence
that for liability of the physician for failure to inform patient, there must
be causal relationship between physicians failure to inform and the injury to
patient and such connection arises only if it is established that, had
revelation been made, consent to treatment would not have been given.
There are four essential elements a plaintiff must
prove in a malpractice action based upon the doctrine of informed consent: (1)
the physician had a duty to disclose material risks; (2) he failed to disclose
or inadequately disclosed those risks; (3) as a direct and proximate result of
the failure to disclose, the patient consented to treatment she otherwise would
not have consented to; and (4) plaintiff was injured by the proposed
treatment. The gravamen in an informed consent case requires the plaintiff to
point to significant undisclosed information relating to the treatment which
would have altered her decision to undergo it.[64]
Examining the evidence on record, we hold that
there was adequate disclosure of material risks inherent in the chemotherapy
procedure performed with the consent of Angelicas parents. Respondents could not have been unaware in
the course of initial treatment and amputation of Angelicas lower extremity,
that her immune system was already weak on account of the malignant tumor in
her knee. When petitioner informed the respondents beforehand of the side
effects of chemotherapy which includes lowered counts of white and red blood
cells, decrease in blood platelets, possible kidney or heart damage and skin
darkening, there is reasonable expectation on the part of the doctor that the
respondents understood very well that the severity of these side effects will
not be the same for all patients undergoing the procedure. In other words, by the nature of the disease
itself, each patients reaction to the chemical agents even with pre-treatment
laboratory tests cannot be precisely determined by the physician. That death can possibly result from complications of the treatment or the
underlying cancer itself, immediately or sometime after the administration of
chemotherapy drugs, is a risk that cannot be ruled out, as with most other
major medical procedures, but such
conclusion can be reasonably drawn from the general side effects of
chemotherapy already disclosed.
As a physician, petitioner can reasonably expect
the respondents to have considered the variables in the recommended treatment
for their daughter afflicted with a life-threatening illness. On the other hand, it is difficult to give
credence to respondents claim that petitioner told them of 95% chance of
recovery for their daughter, as it was unlikely for doctors like petitioner who
were dealing with grave conditions such as cancer to have falsely assured
patients of chemotherapys success rate.
Besides, informed consent laws in other countries generally require only
a reasonable explanation of potential harms, so specific disclosures such as
statistical data, may not be legally necessary.[65]
The
element of ethical duty to disclose material risks in the proposed medical
treatment cannot thus be reduced to one simplistic formula applicable in all
instances. Further, in a medical malpractice
action based on lack of informed consent,
the plaintiff must prove both the duty and the breach of that duty through
expert testimony.[66] Such expert testimony must show the customary
standard of care of physicians in the same practice as that of the defendant
doctor.[67]
In this case, the testimony of Dr. Balmaceda who is not an
oncologist but a Medical Specialist of the DOHs Operational and Management
Services charged with receiving complaints against hospitals, does not qualify
as expert testimony to establish the standard of care in obtaining consent for
chemotherapy treatment. In the absence
of expert testimony in this regard, the Court feels hesitant in defining the
scope of mandatory disclosure in cases of malpractice based on lack of informed
consent, much less set a standard of disclosure that, even in foreign
jurisdictions, has been noted to be an evolving one.
As society has grappled with the juxtaposition between personal autonomy and the medical profession's intrinsic impetus to cure, the law defining adequate disclosure has undergone a dynamic evolution. A standard once guided solely by the ruminations of physicians is now dependent on what a reasonable person in the patients position regards as significant. This change in perspective is especially important as medical breakthroughs move practitioners to the cutting edge of technology, ever encountering new and heretofore unimagined treatments for currently incurable diseases or ailments. An adaptable standard is needed to account for this constant progression. Reasonableness analyses permeate our legal system for the very reason that they are determined by social norms, expanding and contracting with the ebb and flow of societal evolution.
As we progress
toward the twenty-first century, we now realize that the legal standard of disclosure is not subject to construction as a
categorical imperative. Whatever formulae or processes we adopt are only
useful as a foundational starting point; the
particular quality or quantity of disclosure will remain inextricably bound by
the facts of each case. Nevertheless, juries that ultimately determine
whether a physician properly informed a patient are inevitably guided by what
they perceive as the common expectation of the medical consumera reasonable
person in the patients position when deciding to accept or reject a
recommended medical procedure.[68]
(Emphasis supplied.)
WHEREFORE, the petition for review on
certiorari is GRANTED. The Decision dated
The Decision dated
No costs.
SO ORDERED.
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MARTIN
S. VILLARAMA, JR. Associate
Justice |
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WE
CONCUR: RENATO C. CORONA Chief Justice |
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|
See Dissenting Opinion Associate Justice |
I join the dissent of J.
Carpio Associate Justice |
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|
I join dissent of J.
Carpio Associate Justice |
I join J. Brions Separate Opinion Associate Justice |
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|
I join the separate opinion of Justice Brion Associate Justice |
In the result: See Separate
Opinion Associate Justice |
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|
I join the dissent opinion
of Jus. Carpio Associate Justice |
Concur in the result, and
I join the Separate Opinion of J. Brion Associate Justice |
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|
(No Part) MARIANO C. Associate Justice |
Please see my concurring
opinion Associate Justice |
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|
JOSE Associate Justice |
I join J. Brion in his
concurrence Associate Justice |
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|
I dissent. Evidence was
provided by the doctor-petitioner herself. Associate Justice |
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C
E R T I F I C A T I O N
Pursuant to Section 13, Article VIII
of the 1987 Constitution, I certify that the conclusions in the above
Decision had been reached in consultation before the case was assigned to the
writer of the opinion of the Court.
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|
RENATO C. CORONA Chief
Justice |
* No part.
[1] Rollo, pp. 33-63. Penned by
Associate Justice Mariano C. Del Castillo (now a Member of this Court) and
concurred in by Associate Justices Roberto A. Barrios and Magdangal M. De Leon.
[2]
[3]
[4] Records, p. 174.
[5]
[6]
[7] Rollo,
pp. 80-89.
[8]
[9] TSN,
[10] TSN,
[11] Rollo,
p. 35.
[12]
[13] TSN,
[14]
[15] Cisplatin
is in a class of drugs known as platinum-containing compounds. It slows or
stops the growth of cancer cells inside the body. Source: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684036.html. (Site visited on
[16] Doxorubicin
is an anti-cancer (antineoplastic or cytotoxic) chemotherapy drug. It is
classified as an anthracycline antibiotic. Source: http://www.chemocare.com/bio/doxorubicin.asp (Site visited on
[17] Cosmegen is the trade name for
Dactinomycin, an anti-cancer (antineoplastic or cytotoxic) chemotherapy drug
classified as an alkylating agent. Source: http://www.chemocare.com/bio/cosmegen.asp (Site visited on
[18] TSN,
[19] Rollo,
p. 124.
[20] TSN,
[21] Rollo,
p. 35.
[22]
[23] TSN,
[24] TSN,
[25] Par. 11 of Answer, rollo, p. 100.
[26] TSN,
[27] TSN,
[28] Rollo,
p. 101.
[29] TSN,
[30] Rollo, p. 36.
[31]
[32] http://www.rxlist.com/bactrim-drug.htm (Site visited
[33] Paragraph 14 of Answer, rollo, pp. 101-102.
[34] Paragraphs 19-20 of Complaint, rollo, pp. 83; paragraphs 15-17 of
Answer, pp. 102-103.
[35] Paragraph 17 of Answer, rollo, p. 103.
[36] Paragraph 23 of Complaint, rollo, p. 83; TSN,
[37] TSN,
[38] Paragraph 17 of Answer, rollo, p. 103.
[39]
[40] Rollo, p. 37.
[41] TSN,
[42]
[43] TSN,
[44] TSN,
[45] TSN,
[46] TSN,
[47] 37 Phil. 809 (1918).
[48] Rollo,
pp. 160-162.
[49]
[50]
[51] Garcia-Rueda
v. Pascasio, G.R. No. 118141,
[52] Lucas
v. Tuao, G.R. No. 178763, April 21, 2009, 586 SCRA 173, 201-202,
citing Dr. Cruz v. Court of Appeals, 346 Phil. 872, 884-885 (1997).
[53] 105 N.E. 92, 93 (N.Y. 1914).
[54]
[55] Blacks
Law Dictionary, Fifth Edition, p. 701, citing Ze Barth v. Swedish Hospital Medical
Center, 81 Wash.2d 12, 499 P.2d 1, 8.
[56] 464 F.2d 772 C.A.D.C., 1972.
[57]
[58]
[59]
[60]
[61] 8 Cal.3d 229, 502 P.2d 1
[62]
[63]
[64]
[65] Arato
v. Avedon, 858 P.2d 598 (
[66] Mason
v. Walsh, 26 Conn.App. 225, 229-30, 00 A.2d 326 (1991).
[67]
[68] Informed
Consent: From the Ambivalence of Arato to the Thunder of Thor Issues in Law
& Medicine, Winter, 1994 by Armand Arabian.
Sourced at Internet - http://findarticles.com/p/articles/mi_m6875/is_n3_10/ai_n25022732/pg_37/?tag=content;col1