Moore v.Regents of University of California
Supreme Court of California,1990
51 Cal.3d 120,793 P.2d 479,271 Cal.Rptr.146
Opinion by PANELLI,J.
[Plaintiff,John Moore,first visited UCLA Medical Center in October 1976,shortly after being diagnosed with hairy-cell leukemia.Defendant Golde,his treating physician at UCLA,withdraw blood,bone marrow,and other bodily substances to test them.Dr.Golde then recommended that Moore’s spleen be removed.Based upon Dr.Golde’s representation that the removal of the spleen was necessary to slow down the progress of the disease,Moore consented to the recommended surgery.Moore alleged that Dr.Golde “formed the intent and made the arrangements to obtain portions of his spleen following the removal” to use them in research which was unrelated to Moore’s medical care.Moore returned to UCLA Medical Center several times between November 1976 and September 1983 at Dr.Golde’s direction and based on Dr.Golde’s representations that the follow up was necessary for his treatment.After relocating to the Seattle area,Moore continued to return to UCLA because he had been told the procedures could only be performed there.In fact,Dr.Golde and some colleagues had discovered that Moore’s cells were unusually useful in the genetic research they were performing.Dr.Golde and others developed and patented a cell line from Mr.Moore’s cells and then licensed it for commercial development to Genetics Institute and Sandoz Pharmaceuticals,also named as defendants in the action.
Plaintiffs filed a complaint containing thirteen causes of action,including inter alia,conversion and lack of informed consent and breach of fiduciary duty for failing to disclose the financial interest of the defendants.The trial court sustained a demurrer to the conversion count and then dismissed the entire complaint without ruling on the other counts because of its view that the other counts simply repeated the inadequate allegations of the conversion count.The Court of Appeal reversed on the conversion count,holding that it did state a cause of action for conversion,agreed that the informed consent count against the commercial defendants was not adequate but directing the trial court to give Moore leave to amend,and directed the trial court to consider the remaining causes of action that had not been ruled upon.This appeal followed.]
A.Breach of Fiduciary Duty and Lack of Informed Consent
Moore repeatedly alleges that Golde failed to disclose the extent of his research and economic interests in Moore’s cells before obtaining consent to the medical procedures by which the cells were extracted.These allegations,in our view,state a cause of action against Golde for invading a legally protected interest of his patient.This cause of action can properly be characterized either as the breach of a fiduciary duty to disclose facts material to the patient’s consent or,alternatively,as the performance of medical procedures without first having obtained the patient’s informed consent.
Our analysis begins with three well-established principles.First,“a person of adult years and in sound mind has the right,in the exercise of control over his own body,to determine whether or not to submit to lawful medical treatment.”Second,“the patient’s consent to treatment,to be effective,must be an informed consent.” Third,in soliciting the patent’s consent,a physician has a fiduciary duty to disclose all information material to the patient’s decision.
These principles lead to the following conclusions: (1) a physician must disclose personal interests unrelated to the patient’s health,whether research or economic,that may affect the physician’s professional judgment;and (2) a physician’s failure to disclose such interests may give rise to a cause of action for performing medical procedures without informed consent or breach of fiduciary duty.
To be sure,questions about the validity of a patient’s consent to a procedure typically arise when the patient alleges that the physician failed to disclose medical risks,as in malpractice cases,and not when the patient alleges that the physician had a personal interest,as in this.The concept of informed consent,however,is broad enough to encompass the latter.“The scope of the physician’s communication to the patient … must be measured by the patient’s need,and that need is whatever information is material to the decision.”
Indeed,the law already recognizes that a reasonable patient would want to know whether a physician has an economic interest that might affect the physician’s professional judgment.As the Court of Appeal has said,“[c]ertainly a sick patient deserves to be free of any reasonable suspicion that his doctor’s judgment is influenced by a profit motive.” ….(https://www.daowen.com)
It is important to note that no law prohibits a physician from conducting research in the same area in which he practices.Progress in medicine often depends upon physicians,such as those practicing at the university hospital where Moore received treatment,who conduct research while caring for their patients.
Yet a physician who treats a patient in whom he also has a research interest has potentially conflicting loyalties.This is because medical treatment decisions are made on the basis of proportionality – weighing the benefits to the patient against the risks to the patient.As another court has said,“the determination as to whether the burdens of treatment are worth enduring for any individual patient depends upon the facts unique in each case,” and “the patient’s interests and desires are the key ingredients of the decision-making process.” A physician who adds his own research interests to this balance may be tempted to order a scientif-i cally useful procedure or test that offers marginal,or no,benefits to the patient.The possibility that an interest extraneous to the patient’s health has affected the physician’s judgment is something that a reasonable patient would want to know in deciding whether to consent to a proposed course of treatment.It is material to the patient’s decision and,thus,a prerequisite to informed consent.
Golde argues that the scientific use of cells that have already been removed cannot possibly affect the patient’s medical interests.The argument is correct in one instance but not in another.If a physician has no plans to conduct research on a patient’s cells at the time he recommends the medical procedure by which they are taken,then the patient’s medical interests have not be impaired.In that instance the argument is correct.On the other hand,a physician who does have a preexisting research interest might,consciously or unconsciously,take that into consideration in recommending the procedure.In that instance the argument is incorrect: the physician’s extraneous motivation may affect his judgment and is,thus,material to the patient’s consent.
We acknowledge that there is a competing consideration.To require disclosure of research and economic interests may corrupt the patient’s own judgment by distracting him from the requirements of his health.But California law does not grant physicians unlimited secretion to decide what to disclose.Instead,“it is the prerogative of the patient,not the physician,to determine for himself the direction in which he believes his interests lie.” “Unlimited discretion in the physician is irreconcilable with the basic right of the patient to make the ultimate informed decision.”
However,we made that statement in the context of a physician-patient relationship unaffected by possible conflicts of interest.Cobbs v.Grant permits a physician acting solely in the patient’s best interests to consider whether excessive disclosure will harm the patient.Disclosure of possible conflicts of interest raises different considerations.To illustrate,a physician who orders a procedure partly to further a research interest unrelated to the patient’s health should not be able to avoid disclosure with the argument that the patient might object to participation in research.In some cases,however,a physician’s research interest might play such an insignificant role in the decision to recommend a medically indicated procedure that disclosure should not be required because the interest is not material.By analogy,we have not required disclosure of “remote” risks that “are not central to the decision to administer or reject [a] procedure.”
Accordingly,we hold that a physician who is seeking a patient’s consent for a medical procedure must,in order to satisfy his fiduciary duty and to obtain the patient’s informed consent,disclose personal interests unrelated to the patient’s health,whether research or economic,that may affect his medical judgment.
[The court then discussed the specific allegations of the complaint relating to each of the medical procedures.First,Moore did not state a cause of action with respect to the original drawing of blood and tissue samples because Dr.Golde did not y et know of the rare nature of Moore’s cells.Second,Moore stated a cause of action with respect to the surgical removal of the spleen even though the surgery had therapeutic value for Moore because Moore alleged that Dr.Golde planned to keep the removed spleen for scientific research but did not disclose that to Moore.Third,the postoperative takings of bodily tissues were done at a time when Dr.Golde had an undisclosed financial interest in them and even though they had no therapeutic purpose.Thus the complaint stated a cause of action against Dr.Golde for those procedures.
The court found that the remaining defendants could be liable to Moore for a failure of informed consent if they were vicariously liable for Dr.Golde’s actions and ruled that Moore could amend his complaint to attempt to state a lack of informed consent cause of action against them.
On the conversion issue,the Court decided that the traditional common law doctrine of conversion did not cover Moore’s cells and that the court should not expand the common law doctrine to cover this kind of case.]
The decision of the Court of Appeal is affirmed in part and reversed in part.The case is remanded to the Court of Appeal,which shall direct the superior court to: (1) overrule Golde’s demurrers to the causes of action for breach of fiduciary duty and lack of informed consent;(2) sustain,with leave to amend,the demurrers of the [commercial defendants] to the purported causes of action for breach of fiduciary duty and lack of informed consent;(3) sustain,without leave to amend,all defendants’ demurrers to the purported cause of action for conversion;and (4)hear and determine all defendants’ remaining demurrers.