1. Core Principle: Reibl v Hughes (1980, Supreme Court of Canada)

Facts

• The plaintiff, Reibl, underwent carotid artery surgery performed by Dr. Hughes.
• The doctor did not fully warn him about the risk of stroke and paralysis, especially given his recent retirement situation (which affected his insurance benefits).
• Reibl suffered a stroke after surgery and became partially paralyzed.

Legal Issue

What is the standard for disclosure of risk by doctors when obtaining patient consent?

Decision

The Supreme Court of Canada held:

• Doctors must disclose material risks of treatment.
• The test is objective patient-based, not what the doctor personally thinks is important.

The “Modified Objective Test”

The Court created a hybrid standard:

A doctor must disclose:

1. Risks that a reasonable person in the patient’s position would want to know
2. Risks that the doctor actually knows or should know are important to this particular patient

Key Importance

• Shifted law away from “professional standard” (what doctors customarily disclose)
• Moved toward patient autonomy

2. Hopp v Lepp (1980, Supreme Court of Canada)

Facts

• Patient underwent surgery without being told about alternative treatments and risks.
• Developed complications.

Legal Principle

The Court held:

• Doctors must disclose material risks and reasonable alternatives
• Consent is invalid if patient is not informed enough to make a meaningful choice

Importance in relation to Reibl

• Reinforced that consent requires real understanding, not just signature
• Helped build the foundation for the Reibl objective standard

3. Malette v Shulman (1990, Ontario Court of Appeal)

Facts

• A Jehovah’s Witness patient carried a card refusing blood transfusion.
• Doctor gave blood during emergency to save her life.

Issue

Can a doctor override expressed refusal of treatment?

Decision

• Court held: NO.
• Even in emergencies, valid refusal of treatment must be respected.

Legal Principle

• Autonomy outweighs medical necessity
• Consent includes the right to refuse treatment, even if it leads to death

Connection to Reibl

• Strengthens the idea that consent is about patient choice, not medical paternalism

4. Arndt v Smith (1997, British Columbia Court of Appeal)

Facts

• Pregnant woman contracted chickenpox.
• Doctor did not fully warn her of risks to fetus.
• Child was born with severe disabilities.

Legal Issue

Would full disclosure have changed her decision?

Decision

• Court applied a modified objective test (Reibl standard).
• Found that even if fully informed, she likely would have proceeded.

Legal Principle

• Must assess causation using:
  • “Would a reasonable person in the patient’s situation have refused treatment if properly informed?”

Importance

• Clarified how courts apply Reibl in causation analysis

5. Chatterton v Gerson (1981, England & Wales High Court)

Facts

• Patient consented to surgery but was not told all risks.
• Later claimed lack of informed consent.

Decision

• Court held:
  • If patient understands nature of procedure, consent is valid
  • Lack of disclosure usually becomes negligence, not battery

Legal Principle

• Distinction between:
  • Battery (no consent at all)
  • Negligence (inadequate disclosure)

Connection to Reibl

• Canadian law (Reibl) leans toward negligence-based analysis, similar to Chatterton

6. Sidaway v Board of Governors of Bethlem Royal Hospital (1985, UK House of Lords)

Facts

• Patient not warned about small but serious risk of spinal surgery complications.
• She became partially paralyzed.

Decision

• Majority applied Bolam test:
  • Disclosure depends on what a responsible body of doctors would do

Legal Principle

• Doctor-centric standard (later criticized)

Importance compared to Reibl

• Reibl rejected this approach
• Canada moved toward patient-centered disclosure, unlike Sidaway at the time

7. Stewart v Romberg (1992, Alberta Court of Appeal)

Facts

• Patient underwent surgery without being warned of specific risks.
• Complications occurred.

Legal Principle

• Reaffirmed Reibl standard:
  • Material risks must be disclosed if a reasonable patient would consider them important

Importance

• Applied Reibl directly in Canadian provincial courts
• Confirmed that non-disclosure = breach of duty

FINAL SUMMARY: REIBL CONSENT STANDARD

The Reibl v Hughes doctrine establishes that:

1. Standard of Disclosure

Doctors must disclose:

• Material risks
• Alternatives
• Risks specific to the patient’s circumstances

2. Test Used

• Modified objective test
  • Reasonable patient in the same situation
  • Plus patient-specific known factors

3. Legal Shift

• From doctor-centered (Bolam/Sidaway style)
• To patient-centered autonomy model

4. Causation Requirement

• Patient must prove:
  • They would have refused treatment if properly informed (objective assessment)