Supreme Court reaffirms landmark informed-consent ruling in chickenpox case.

In June the Supreme Court of Canada ruled that a British Columbia family physician had adequately discharged her duty to disclose even though she failed to tell her patient of a serious but very small increased risk to her fetus posed by a case of chickenpox. The patient, Carole Arndt, gave birth in 1986 to a daughter who was diagnosed with congenital varicella syndrome. She requires feeding through a tube because she is unable to swallow. When asked about the possible effects of chickenpox on the patient’s developing fetus, Dr. Margaret Smith had explained that there were frequently occurring risks of limb and skin abnormalities. However, she did not discuss more serious although less frequent risk of possible brain damage and other defects. This case reaffirmed the landmark 1980 judgement in Reibl v. Hughes concerning the legal requirement for informed consent. The Supreme Court ruling also supported the ruling of the trial judge, who had dismissed Arndt’s claim. During that trial, Arndt contended that had Smith advised her appropriately of the serious risk of injury to her fetus, she would have terminated her pregnancy and thus have avoided the considerable expense of providing the long-term care for her daughter. Smith responded that her patient would not have had an abortion even if she had been fully advised. The trial judge concluded that Arndt would not have aborted the fetus. That conclusion supported Smith’s request for dismissal of the claim, despite the patient’s testimony to the contrary. The judge made the decision because of evidence that: • Arndt desired a child; • she was sceptical of mainstream medicine; • an abortion in the second trimester of pregnancy held increased risks; and • an abortion at this stage would have required the approval of a committee on health-related grounds. Other supportive testimony included evidence that the risk of serious injury to the fetus was very small and medical advisers would have recommended against abortion for a patient in Arndt’s situation. In ruling on Arndt v. Smith, the Supreme Court explained the significance of the Reibl precedent, stating that the case marked “the rejection of the paternalistic Education