In Dr. Rubi Li vs. Spouses Reynaldo and Lina Soliman, G.R. No. 165279 promulgated last June 7, 2011, the Supreme Court of the Philippines resolved
an issue on the application of the common-law doctrine of informed consent in a medical malpractice (medical negligence)
cases based on Article 2176 of the Civil Code. As Justice Brion noted in his Separate Opinion,
this case is of first impression in the Philippine
jurisdiction, especially so since informed
consent litigation is not an ordinary
medical negligence case.
The ponencia enumerated the
four essential elements that a plaintiff must prove in a medical malpractice
action based on the doctrine of informed consent,
paraphrased as follows: (1) the physician’s
duty to disclose material risks; (2) the physician’s failure to disclose, or inadequate disclosure, of those
risks; (3) the patient’s consent to the
treatment she otherwise would not have consented to, which is a direct and proximate result of the physician’s
failure to disclose; and (4) plaintiff’s
injury as a consequence 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.
Applying the foregoing to this case, it was held that petitioner Dr. Rubi Li, an oncologist who
performed chemotherapy on respondents’ daughter, who was sick with malignant
bone cancer, adequately disclosed material risks inherent in the chemotherapy
procedure performed with respondents’ consent. 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 parents of the child understood
very well that the severity of these side effects will not be the same for all
patients undergoing the procedure.
As a physician, Dr. Li can reasonably expect the
child’s parents 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 the parents’ claim that
petitioner Dr. Li 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 chemotherapy’s 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.
Quite
incongruously, however, the ponencia
went on to declare that in the absence of expert testimony on the standard of care in obtaining consent in
chemotherapy treatment [since the witness for the respondents-parents was
not an expert, not being an oncologist but a mere Medical Specialist of the
Department of Health charged with receiving complaints against hospitals], the
Court felt hesitant in defining the scope
of mandatory disclosure in cases of malpractice based on lack of informed
consent such as this case involving chemotherapy treatment.
Petitioner Dr.
Li was found NOT liable to pay damages to the suing parents.
The facts of the case
This case
involved the death of Angelica Soliman, respondents’ 11-year old daughter.
Previously, Angelica was diagnosed with osteosarcoma, osteoblastic
type, a highly malignant cancer of the [thigh] bone. To remove the tumor, her
right leg was amputated. And to eliminate any remaining cancer cells
and minimize the chances of recurrence and prevent the disease from spreading
to other parts of her body (metastasis), she subsequently underwent chemotherapy.
The chemotherapy was administered by petitioner Dr. Rubi Li, an oncologist at
St. Luke’s Medical Center (SLMC) upon consent by her parents, herein
respondents. Angelica died just eleven days after the administration of the
first cycle of the chemotherapy regimen.
The parents of the child thereafter sued the doctor
for damages before the RTC, charging the latter (along with other doctors and
the SLMC itself) with negligence in causing Angelica’s untimely demise. It was
specifically averred in the complaint that the doctor assured the parents that
Angelica would recover in view of 95% chance of healing with chemotherapy (“Magiging
normal na ang anak nyo basta ma-chemo. 95% ang healing”), and when asked
regarding the side effects, petitioner mentioned only slight vomiting, hair
loss and weakness (“Magsusuka ng kaunti. Malulugas ang buhok. Manghihina”). The
parents thus claimed that they would not have given their consent to
chemotherapy had the doctor not falsely assured them of its side effects.
The trial court however dismissed the case. It found that the doctor 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 [though] despite all
efforts said patient died.
The parents appealed to the Court of
Appeals (CA). While concurring with the trial court’s finding that there
was no negligence committed by the petitioner in the administration of
chemotherapy treatment to Angelica, the CA found that the doctor failed to
fully explain to the parents of the patient all the known side effects of
chemotherapy. The CA thus adjudged the doctor liable for damages.
The doctor then appealed to the Supreme
Court (SC), raising the following issue: Under the facts, can she be held
liable [of failing] to fully disclose serious side effects of chemotherapy to
the parents of her patient despite the absence of finding that she was
negligent in administering the said treatment.
How
the High Tribunal voted
In this case, the Court voted 9-5 to
REVERSE the CA and AFFIRM the trial court. This 9-5 vote is however not as
simple and clear-cut as it seems. A closer scrutiny of the opinions would show
that the ponencia of Justice Villarama
was only concurred by Chief Justice
Corona and Justice Perez. Justice Brion, with whom Justices Nachura, Leonardo-De Castro, Bersamin and Mendoza fully concurred, wrote a Separate Opinion, concurring only in the result. Justice Abad wrote his own Concurring Opinion, essentially joining
the majority also in the result. Meanwhile, Justice
Carpio wrote a Dissenting Opinion.
Joining him were Justices Carpio-Morales, Velasco, Peralta, and Sereno.
The
ponencia
As indicated
above, Justice Villarama ruled that 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.
Examining
the evidence on record, the ponencia
held that there was
adequate disclosure of material risks inherent in the chemotherapy procedure
performed with the consent of Angelica’s parents. [The
parents] could not have been unaware in the course of initial treatment and
amputation of Angelica’s lower extremity, that her immune system was already
weak on account of the malignant tumor in her knee. When [the doctor] informed
the [parents] 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 [parents] understood very well that the severity of these side
effects will not be the same for all patients undergoing the procedure.
As a
physician, petitioner can reasonably expect the parents 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 chemotherapy’s
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.
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. Such expert testimony must show
the customary standard of care of physicians in the same practice as that of
the defendant doctor.
In this case, the testimony of Dr. Balmaceda [witness
for the girl’s parents] who is not an oncologist but a Medical Specialist of
the DOH’s 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 felt 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.
Thus, the Court REVERSED the CA and REINSTATED the
decision of the RTC dismissing the case.
The Separate
[Concurring] Opinion of Justice Brion
Justice
Brion concurred in the result of the ponencia and
its conclusion that the suing
parents failed to prove by preponderance of evidence the essential elements of
a cause of action based on the doctrine of informed consent. He
however disagreed with the ponencia’s
conclusion that “there was adequate
disclosure of material risks of the [chemotherapy administered] with the
consent of Angelica’s parents” in view of a complete absence of expert
testimony establishing [beforehand] a medical disclosure standard in the
present case.
Just like the ponencia and the dissent, Justice
Brion declared that in a lack of informed consent litigation, the plaintiff
must prove by preponderance of evidence the following requisites: (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.
In this case, Justice Brion concluded that the parents failed to prove by
competent expert testimony the first and fourth elements of
a prima facie case for lack of informed consent, specifically: (1) the scope of the duty to disclose and the violation of this
duty, i.e., the failure to define what should be disclosed and to
disclose the required material risks or side effects of the chemotherapy that
allow the patient (and/or her parents) to properly decide whether to undergo
chemotherapy; and (2) that the chemotherapy administered by the petitioner proximately caused
the death of Angelica Soliman.
Like Justice
Carpio, Justice Brion opted to use the reasonable patient standard, which
focuses “on the informational needs of an average reasonable patient, rather
than on professionally-established norms” since in the doctor-patient
relationship, it is the patient who is subjected to medical intervention and
who gets well or suffers as a result of this intervention. While the disclosure need not be an encyclopedic statement
bearing on the patient’s illness or condition, the doctor must disclose enough information to reasonably
allow the patient to decide. This notwithstanding, Justice Brion argued that in an informed consent litigation, at
least the testimony on the determination of the attendant risks and the
probabilities of the proposed treatment or procedure is a matter for a
medical expert, not for a layperson, to provide. The second step [after
the determination of the scope of the necessary disclosure] relates to
testimony on the determination of the adequacy of the disclosure based on the
materiality of the disclosed information to the patient’s decision-making. The [actual]
disclosure made is not total by reason of practicality, but must be adequate to
be a reasonable basis for an informed decision. For this aspect of
the process, non-expert testimony may be used on non-technical detail so that
the testimony may dwell on “a physician’s failure to disclose risk information,
the patient’s lack of knowledge of the risk, and adverse consequences following
the treatment.”
Applying the reasonable patient standard, which
focuses “on the informational needs of an average reasonable patient, rather
than on professionally-established norms,” Justice
Brion said expert testimony is required in determining the risks
and or side effects of chemotherapy that the attending physician should have
considered and disclosed as these are clearly beyond the knowledge of
a layperson to testify on. In other words, to prevail in their
claim of lack of informed consent, the patients’ parents must present expert
supporting testimony to establish the scope
of what should be disclosed and the significant
risks attendant to chemotherapy that the petitioner should have considered
and disclosed; the determination of the scope of disclosure, and the risks and
their probability are matters a medical expert must determine and testify on
since these are beyond the knowledge of laypersons.
Unfortunately for the child’s parents in this case, the
testimony of their physician-witness, Dr. Balmaceda of the DOH, failed to
establish the existence of the risks or side-effects the petitioner Dr. Li
should have disclosed to them in the use of chemotherapy in the treatment of
osteosarcoma. Dr. Balmaceda, although a medical doctor, could not have
testified as an expert on these points because she is neither an oncologist nor
a qualified expert on the diagnosis and treatment of cancers. Neither is she a
pharmacologist who can properly advance an opinion on the toxic side effects of
chemotherapy, particularly the effects of Cisplatin, Doxorubicin and
Cosmegen – the drugs
administered to Angelica [the child-patient]. As a doctor whose specialty
encompasses hospital management and administration, she is no different from a
layperson for purposes of testifying on the risks and probabilities that arise
from chemotherapy. At best, Dr. Balmaceda’s
testimony only established generally the petitioner’s duty to
disclose all the known risks of the proposed treatment and nothing more. Even if this testimony is deemed competent, its
probative value – on the risks attendant to chemotherapy and the probabilities
that the attending chemotherapy specialist should have considered and disclosed
to the patient and her parents – cannot but be negligible for lack of the
required capability to speak on the subject of the testimony.
Justice Brion did not agree with Justice Carpio’s view that the
petitioner herself, “as an expert in oncology[,] identified the material risks
and side effects of chemotherapy.” Arguably, the
medical disclosure standard can be established through the defendant doctor’s
own expert testimony, as has been done in some courts in the United
States in cases where the defendant physician testified that he did
disclose the risks, but the plaintiff denied it. Reliance on this line of American
cases for purposes of this case is, however, inapt. First, these cases
are appropriate only if we are to adopt the professional disclosure or the
“physician standard” [and not the reasonable patient standard] – a standard
that Justice Carpio himself admits
“is not the modern and prevailing standard among United
States courts.” Second, this line of cases also cannot
apply to the present case since the doctor’s testimony, on its own, did not
establish the medical standard in obtaining consent for chemotherapy
treatment. Her testimony did not specifically refer to the
prevailing medical practice insofar as what risks or side-effects of
chemotherapy should be disclosed to the patient [or her parents]. In
fact, during the trial,
the parents failed to elicit any expert testimony from the defendant doctor
regarding the recognized standard of care in the medical community about what
risks of chemotherapy should have been disclosed to them.
Justice
Brion did not also agree with the ponencia’s
conclusion that “there was adequate disclosure of material risks of the
[chemotherapy administered] with the consent of Angelica’s parents” [after the ponencia found that] the defendant doctor
informed the suing parents of the side effects of chemotherapy. Such conclusion
was made without the requisite premises. [Determining the] sufficiency of
disclosure can be made only after a [prior] determination and assessment of
risks have been made. No evidence exists showing that these premises
have been properly laid and proven. Hence, for lack of basis, no conclusion can be made on
whether sufficient disclosure followed. In other words, the
disclosure cannot be said to be sufficient in the absence of evidence of what,
in the first place, should be disclosed.
Also, the mother’s testimony on the point of
insufficiency of disclosure bears close examination in light of the totality of
the evidence adduced. A first consideration is the
nature of the illness of the deceased – osteosarcoma – that
according to the undisputed expert testimony of [another doctor-witness for the
petitioner] is a very aggressive type of cancer that requires adjuvant
chemotherapy. The amputation of Angelica’s right leg was not
sufficient, chemotherapy must follow; despite modern chemotherapy, the
mortality rate of osteosarcoma is 80 to 90%. In light of this
expert testimony, the mother’s testimony that she was assured of a 95%
chance of healing (should Angelica undergo chemotherapy) by the petitioner
cannot be accepted at face value. A second consideration is
that the claim of a 95% chance of healing cannot also be given any credence
considering the respondent Lina Soliman’s inconsistent testimony on this
point. A third consideration is that specific
disclosures such as life expectancy probabilities are not legally
necessary or “required to be disclosed in informed consent situations, thus the
mother’s testimony on this point cannot be given any probative value.
In addition to the failure to prove the first
element [the scope of the duty
to disclose and the violation of this duty] to properly decide whether
to undergo chemotherapy, Justice
Brion submitted that the parents failed to prove that the chemotherapy
administered by the petitioner proximately caused the death
of Angelica Soliman. Traditionally, he said plaintiffs alleging lack of
informed consent must show two types of causation: 1) adequate disclosure would
have caused the plaintiff to decline the treatment, and 2) the
treatment proximately caused injury to the plaintiff. The
second causation requirement is critical since a medical procedure performed
without informed consent does not, in itself, proximately cause an
actionable injury to a plaintiff; a plaintiff must show that he or she has
suffered some injury as a result of the undisclosed risk to present a complete
cause of action. Citing an American case, Justice
Brion averred that expert testimony is essential to demonstrate that the
treatment proximately caused the injury to the plaintiff.
In
this case, the mother’s lay testimony at best only satisfied the first type of
causation – that adequate disclosure by the petitioner of all the side effects
of chemotherapy would have caused them to decline treatment. The parents must
still show by competent expert testimony that the chemotherapy administered by
the petitioner proximately caused Angelica’s death. On the other hand, the other
physician-witness for the suing parents, Dr. Vergara [Medico-Legal Officer of
the PNP-Crime Laboratory], admitted that the opinions she advanced to the court
were not based on her opinion as an expert witness but on the interview she had
previously conducted with an oncologist. Under these terms, Dr. Vergara’s
expert testimony was clearly incompetent to prove that the chemotherapy
proximately caused Angelica’s demise for two reasons. First, Dr.
Vergara, who is an autopsy expert, is not qualified to be an expert witness in
an osteosarcoma case involving chemotherapy. Her
admission that she consulted an oncologist prior to her testimony in court
confirms this. Dr. Vergara is also not a pharmacologist who can
competently give expert opinion on the factual issue of whether the toxic
nature of the chemotherapy proximately caused Angelica’s death. As
previously stated, the suing parents failed to present competent experts in the
field of oncology despite their representation to do so during trial. Second,
Dr. Vergara’s testimony is doubly incompetent as it is hearsay; her opinions
were not based on her own knowledge but based on the opinion of another
oncologist she previously interviewed. Dr. Vergara could not have adequately
testified regarding the medical condition and the cause of death of Angelica
without referring to her medical records. As the records of the case
show, these medical records were never introduced into evidence by either party
to the case. The absence of these medical records significantly
lessened the probative value of Dr. Vergara’s testimony regarding the causation
of Angelica’s death.
Thus, in the
absence of competent evidence that the chemotherapy proximately caused Angelica’s
death, what stands in the record in this case is the petitioner’s
uncontroverted and competent expert testimony that Angelica died of sepsis
brought about by the progression of her osteosarcoma – an
aggressive and deadly type of bone cancer. That the petitioner
is a competent expert witness cannot be questioned since she was properly
qualified to be an expert in medical oncology. Justice Brion disagreed with Justice
Carpio’s view that the facts as stated by the RTC and the CA clearly show
that the chemotherapy caused Angelica’s death. He reiterated that in the absence of competent
expert testimony, the Court has no factual basis to declare that the chemotherapy
administered by the petitioner proximately caused Angelica’s death.
In sum, the suing parents failed to prove by appropriate evidence – i.e., by
expert testimony – that Angelica’s death was caused by the
chemotherapy the petitioner administered. This failure in
establishing the fourth requisite of the suing parents’ cause of action fatally seals
the fate of the respondent’s claim of medical negligence due to lack of
informed consent.
The
concurrence of Justice Abad
Justice Abad, for his
part, concurred with the majority out of the belief
that, ultimately, the issue in this case rests on a question of fact, i.e., whether
Dr. Li failed to disclose (or inadequately disclosed) to the respondents
Soliman spouses the risks of chemotherapy for their daughter. This question of
fact arises because Dr. Li and the Solimans gave opposing versions of what were
disclosed. Thus, the question then was who to believe between them.
To Justice
Abad’s mind, at the heart of the
Solimans’ claim for damages is the proposition that they would not have agreed
to submit their daughter to chemotherapy had they known that the side effects
she faced were more than just hair loss, vomiting, and weakness. They
would not have agreed if they had known that she would suffer greater distress
and soon die. But the Solimans
are arguing from hindsight. The fact is that they were willing to
assume huge risks on the chance that their daughter could cheat death. They did not mind that their
young daughter’s left leg would be amputated from above the knee for a 50%
chance of preventing the spread of the cancer. There is probably no
person on this planet whose family members, relatives, or close friends have
not been touched by cancer. Everyone knows of the travails and
agonies of chemotherapy, yet it is rare indeed for a cancer patient or his
relatives not to take a chance with this treatment, which had proved successful
in extending the lives of some. Unfortunately for the Solimans,
their daughter did not number among the successful cases.
Indeed, it was not Dr. Li, according to
Reynaldo, who convinced him to agree to submit his daughter to chemotherapy but
Dr. Tamayo [the doctor who performed the amputation of their daughter’s leg]. The
latter explained to him the need for her daughter to undergo chemotherapy
[after the amputation of her leg] to increase the chance of containing her
cancer. This consultation took place even before the Solimans met
Dr. Li. It is a mark of their insensitivity that the Solimans included as
proof of the damages they suffered, the expenses they incurred for the surgical
procedure performed by Dr. Tamayo, including the latter’s professional
fees. The amputation that Dr. Tamayo performed took place before the
chemotherapy and before the Solimans met Dr. Li. The Solimans cannot
be trusted to make an appropriate claim.
The dissenting opinion of Justice Carpio
Justice Carpio began his disquisition on
the merits by saying that the doctrine of
informed consent requires doctors, before administering treatment to their
patients, to disclose adequately the material risks and side effects of the
proposed treatment. The duty to obtain
the patient’s informed consent is distinct from the doctor’s duty to skillfully
[sic] diagnose and treat the patient.
He echoed the major premise of the ponencia
that four requisites must be proven by the plaintiff in cases involving the
doctrine of informed consent: (1) the doctor had a duty to disclose the
associated risks and side effects of a proposed treatment; (2) the doctor
failed to disclose or inadequately disclosed the associated risks and side
effects of the proposed treatment; (3) the plaintiff consented to the proposed
treatment because of the doctor’s failure to disclose or because of the
inadequate disclosure of the associated risks and side effects of the proposed
treatment; and (4) the plaintiff was injured as a result of the treatment.
Justice
Carpio further explained that there are two standards by which courts determine
what constitutes adequate disclosure
of associated risks and side effects of a proposed treatment: the physician standard, and the patient standard of materiality. Under
the physician standard, a doctor is obligated to disclose that information
which a reasonable doctor in the same field of expertise would have disclosed
to his or her patient. Under
the patient standard of materiality, a doctor is obligated to disclose that
information which a reasonable patient would deem material in deciding whether to
proceed with a proposed treatment. While historically courts used the
physician standard, the modern and prevailing trend is to use the patient
standard of materiality. Under the patient standard of materiality, what should be disclosed
depends on what a reasonable person, in the same or similar situation as the
patient, would deem material in deciding whether to proceed with the proposed
treatment.
Moreover, testimony by an expert witness is not necessary in order
to determine what risks and side effects of a proposed treatment are material and,
thus, should be disclosed to the patient. The testimony of an expert witness is
necessary [only] to determine the associated risks and side effects of the
treatment [and not to determine their materiality to the patient]. In this
case, an expert witness identified the associated risks and side effects of
chemotherapy – Dr. Li [herself, who is] an expert in oncology. Dr. Li admitted [in
her affirmative and special defenses] that she assured [the parents of the child]
that there was an 80% chance that Angelica’s cancer would be controlled and
that she disclosed to them only some of the associated risks and side effects
of chemotherapy. She likewise admitted that she informed the parents that
chemotherapy will be given through dextrose and will, therefore, affect not
only the cancer cells, but also the patient’s normal parts of the body, more
particularly the fast growing parts, and as a result, the patient was expected
to experience, as she has in fact experienced, side effects consisting of: 1)
Falling hair; 2) Nausea and vomiting; 3) Loss of appetite considering that
there will be changes in the taste buds of the tongue and lead to body
weakening; 4) Low count of white blood cells (WBC count), red blood cells (RBC
count), and platelets as these would be lowered by the chemotherapy; 5) The
deceased patient’s ovaries may be affected resulting to sterility; 6) The
kidneys and the heart might be affected; and 7) There will be darkening of the
skin especially when the skin is exposed to sunlight.
Based on the foregoing, Justice Carpio concluded that Dr. Li impliedly admitted that she failed to disclose to [the
child’s parents] many of the other associated risks and side effects of
chemotherapy, including the most material – infection, sepsis and death. She impliedly admitted that
she failed to disclose as risks and side effects (1) rashes; (2) difficulty in
breathing; (3) fever; (4) excretion of blood in the mouth; (5) excretion of
blood in the anus; (6) development of ulcers in the mouth; (7) sloughing off of
skin; (8) systemic lupus erythematosus; (9) carpo-pedal spasm; (10) loose bowel
movement; (11) infection; (12) gum bleeding; (13) hypovolemic shock; (14)
sepsis; and (15) death in 13 days. Clearly, infection, sepsis and death are
material risks and side effects of chemotherapy. To any reasonable person, the
risk of death is one of the most important, if not the most important,
consideration in deciding whether to undergo a proposed treatment. Thus, Dr. Li
should have disclosed to [the parents of the child] that there was a chance
that their 11-year old daughter could die as a result of chemotherapy as, in
fact, she did after only 13 days of treatment.
As admitted
by Dr. Li, infection, sepsis and death are associated risks and side effects of
chemotherapy. These risks and side effects are material to [the parents], and
to any other reasonable person, in deciding whether to undergo chemotherapy.
Had Dr. Li adequately disclosed to [the parents] that there was a chance that
their 11-year old daughter could die of infection as a result of chemotherapy,
they may have decided against it and sought for an alternative treatment.
Thus, Justice
Carpio voted to DENY the petition [and to AFFIRM the CA in ruling that the doctor failed to fully explain to the parents of the
child all the known side effects of chemotherapy and is thus liable for damages].
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