NOT FOR PUBLICATION WITHOUT THE
APPROVAL OF THE APPELLATE DIVISION
SUPERIOR COURT OF NEW JERSEY
APPELLATE DIVISION
A-2209-01T5
ROSA ACUNA, Administratrix
ad Prosequendum of the Estate
of MICHAEL DOE (fictitious
name of a real individual),
deceased infant of ROSA
ACUNA, General Administratrix
of the Estate of MICHAEL DOE
(fictitious name of a real
individual), deceased infant
of ROSA ACUNA, and ROSA ACUNA,
individually,
Plaintiffs-Appellants,
v.
SHELDON C. TURKISH, M.D.,
OBSTETRICAL AND GYNECOLOGICAL
GROUP OF PERTH AMBOY-EDISON, a
Partnership or P.C. organized
under the State of New Jersey,
JANET JONES, R.N. (a
fictitious name of a real
individual),
Defendants-Respondents.
Argued September 17, 2002 - Decided
October 29, 2002
Before Judges Havey, A.A. Rodríguez and
Payne.
On appeal from Superior Court of New Jersey,
Law Division, Middlesex County, Docket No.
L-3812-98.
Harold J. Cassidy argued the cause for
appellants (Cassidy, Messina & Laffey,
attorneys; Mr. Cassidy, on the brief).
John Zen Jackson argued the cause for
respondents Sheldon C. Turkish, M.D. and
Obstetrical-Gynecological Group of Perth
Amboy-Edison (Kalison, McBride, Jackson &
Murphy, attorneys; Mr. Jackson, on the
brief).
The opinion of the court was delivered by
HAVEY, P.J.A.D.
This is a medical malpractice, informed consent case. The
gravamen of the complaint, filed by plaintiff Rosa Acuna
individually, and in her capacity as Administratrix of the Estate
of "Michael Doe," is that defendant Dr. Sheldon C. Turkish
(defendant), a medical doctor specializing in the field of
obstetrics and gynecology, failed to obtain an informed consent
from plaintiff before terminating her pregnancy. Specifically,
plaintiff claimed that defendant "failed to inform her that [the
fetus, Michael Doe], although a person unborn, was a complete,
separate, unique and irreplaceable human being . . . ."
By leave granted, plaintiff appeals from an order for
summary judgment dismissing counts one and two of her complaint
setting forth a wrongful death cause of action against defendant
and his medical group, in which she seeks to recover pecuniary
loss "as the result of the death of the child . . . ." Plaintiff
also appeals from the dismissal of count five, setting forth a
cause of action for her emotional distress suffered as a result
of the "loss of her son."
We affirm dismissal of the wrongful death counts. The
Wrongful Death Act, N.J.S.A. 2A:31-1 to -6, "does not permit
recovery attributable to the wrongful death of an infant before
birth." Giardina v. Bennett,
111 N.J. 412, 413 (1988). We
reject plaintiff's argument that depriving her of a wrongful
death remedy violates the Equal Protection Clause under the
Fourteenth Amendment to the United States Constitution.
However, we reverse dismissal of plaintiff's emotional
distress claim. In the event plaintiff establishes a medical
malpractice claim based on a lack of informed consent,
defendant's tortious conduct constitutes a direct tort against
plaintiff, entailing emotional distress and mental suffering
arising from the loss of a fetus.See footnote 11
I
The evidentiary material considered in a light most
favorable to plaintiff,
Brill v. Guardian Life Ins. Co. of Am.,
142 N.J. 520 (1995), presents the following factual background.
On April 6, 1996, plaintiff consulted Dr. Turkish because of
abdominal pain. At the time, plaintiff was twenty-nine years of
age and had two children, two and one-half years and nine months
old, the latter having been delivered by defendant by caesarian
section. Defendant examined plaintiff and, and according to
plaintiff, advised her that she was pregnant and needed an
abortion because "[y]our kidneys are messing you up." Plaintiff
interpreted defendant's diagnosis and warnings to mean that,
without an abortion, she only had three months to live. In his
deposition, defendant testified that he performed a pelvic
examination and administered a sonogram, which revealed that the
gestational age of the fetus was approximately seven weeks old.
Plaintiff was not concerned how the termination of pregnancy
would be performed. Rather, she asked defendant whether "the
baby was already there." She testified in her deposition that
"[o]bviously I knew I was pregnant, I just needed to know and I
wanted to know if the baby was - - if there was a baby already in
me." By baby, she meant "human being" or "[l]ife in there."
According to plaintiff, defendant replied "don't be stupid, it's
only blood." Defendant testified he did not remember plaintiff
asking that question, but acknowledged that if a patient had
asked it, he would have answered that a "seven-week pregnancy is
not a living human being."
On April 9, 1996, plaintiff signed a consent form for a
termination of pregnancy (TOP), which stated in its entirety, "I
hereby give my consent for Dr. Turkish to perform a TOP. He has
explained all the risks and complications to me." On April 9,
1996, defendant performed a vacuum aspiration.See footnote 22 Defendant
admitted that the vacuum aspiration procedure "in fact, kills the
fetus." However, plaintiff continued to bleed for several weeks
and, on May 4, 1996, the bleeding became extremely heavy. She
was taken to Robert Wood Johnson Hospital where she was diagnosed
with an incomplete abortion. At the hospital, plaintiff
underwent a dilatation and curettage (D and C). According to
plaintiff, the nurse caring for her explained that the procedure
was necessary because "the [previous] doctor [defendant] had left
parts of the baby inside of you."
Plaintiff's expert, Theresa Karminski Burke, a psychologist,
concluded that, as a result of the termination of pregnancy,
plaintiff suffered severe emotional and psychological trauma,
which led to the development of acute post-traumatic stress
disorder, obsessive compulsive disorder, major clinical
depression and psychosexual dysfunction.
In granting summary judgment to defendants dismissing both
the wrongful death and emotional distress counts, the trial court
viewed the central issue as being whether "a six to eight week
fetus is a constitutional person; and the answer is no." Citing
Roe v. Wade,
410 U.S. 113,
93 S.Ct. 705,
35 L.Ed.2d 147 (1973),
the trial court reasoned that, although it sympathized with
plaintiff's argument, it "must adhere to the fact that the
highest Court of this country has held that a fetus is not a
human being under our constitution." Consequently, the wrongful
death claim "must be dismissed." Citing
Portee v. Jaffe,
84 N.J. 88 (1980), the court concluded that the fetus' lack of status as
a "constitutional person" also precluded a cause of action by
plaintiff for negligent infliction of emotional distress, since
that cause of action requires proof of an intimate, familial
relationship between plaintiff and an injured "person."
II
WRONGFUL DEATH CLAIMS
Plaintiff first argues that the trial court erred in
dismissing her wrongful death claims under counts one and two.
The Wrongful Death Act provides in
N.J.S.A. 2A:31-1:
When the death of a
person is caused by
a wrongful act, neglect or default, such as
would, if death had not ensued, have entitled
the person injured to maintain an action for
damages resulting from the injury, the person
who would have been liable in damages for the
injury if death had not ensued shall be
liable in an action for damages,
notwithstanding the death of the
person
injured and although the death was caused
under circumstances amounting in law to a
crime.
[Emphasis added.]
Plaintiff acknowledges that the Supreme Court in
Giardina,
supra,
111
N.J. at 413, held that the Act "does not permit recovery
attributable to the wrongful death of an infant before birth."
The Court so held after reviewing the legislative history of the
Act. It observed:
The distinctive statutory nature of this
derivative cause of action, the historical
origins of this statute and the subsequent
history and evolution of the Wrongful Death
Act in this state suggest that the
traditional definition of "person" under the
Act be retained. We are persuaded ultimately
because we find no compelling underlying
policy that would impel us to give the
statutory term "person" an expansive
interpretation here.
[
Id. at 427.]
Nevertheless, plaintiff challenges the constitutionality of
the Act as applied in
Giardina. She argues that denying her
recovery under the Act, "in light of the fact that she can prove
every element of the claim and [that] she sustained exactly the
same loss as mothers who are allowed recovery," violates her
Equal Protection Rights under the Fourteenth Amendment of the
United States Constitution. She observes that, under
Giardina,
"[i]f a child is injured in utero, at any age of gestation, but
lives but for a moment outside the mother, Wrongful Death damages
may be recovered. If the same child, at the same age, is injured
in utero by the same tortious act, but his death ensues in the
mother's body, the mother may not recover these damages." She
reasons that this distinction is irrational because a mother's
entitlement to wrongful death damages should "not depend on where
her child happened to be at the time the death ensued . . . ."
Plaintiff adds that this "irrational" distinction frustrates the
Wrongful Death Act's purpose of protecting
all mothers, as well
as the sanctity of life.
A similar argument was presented to and rejected by the
Third Circuit in
Alexander v. Whitman,
114 F.3d 1392, 1400 (3rd
Cir.),
cert. denied,
522 U.S. 949,
118 S.Ct. 367,
139 L.Ed.2d 286 (1997). There, the court determined that a mother "can only
establish a [wrongful death] claim on behalf of her child . . .
if her child . . . fall(s) within the protections afforded
'person[s]' as that term is used in the Fourteenth Amendment, and
it is clear that it does not."
Id. at 1400 (citing
Roe v. Wade,
supra, 410
U.S. at 158, 93
S.Ct. at 729, 35
L.Ed.
2d at 180,
holding that the word "person" as used in the Fourteenth
Amendment does not include the unborn). The court added that the
fact that plaintiff's pleadings and expected proofs support the
conclusion that a fetus was a "human being" did not alter the
legally established definition of "persons" under the Fourteenth
Amendment.
Alexander,
supra, 114
F.
3d at 1401.
Plaintiff dismisses the holdings in
Roe and
Alexander on the
basis that she does not challenge the statutory classification of
pre-birth fetus and born children. Rather, she seeks equal
protection for herself as a mother, a member of a
constitutionally protected class, who has the same relationship
with her fetus as mothers who give birth to live babies. She
adds that because the Wrongful Death Act
implicates a mother's
fundamental interest in her relationship with her child, the
"strict scrutiny" standard applies, and thus only a compelling
state interest can justify the distinction made by the
Giardina
Court.
The Equal Protection Clause of the Fourteenth Amendment
provides, "No State shall . . . deny to any person within its
jurisdiction the equal protection of the laws."
U.S. Const.
amend XIV, § 1. This protection has been explained as follows:
The equal protection of the laws means that
no person or class of persons shall be denied
the protection of the laws enjoyed by other
persons or classes of persons under similar
conditions and circumstances, in their lives,
liberty, and property, and in the pursuit of
happiness, both as respects privileges
conferred and burdens imposed.
[
Washington Nat'l Ins. Co. v. Board of
Review,
1 N.J. 545, 553 (1949).]
The equal protection guarantee applies to the decisions of the
courts as well as to the acts of the Legislature.
Jersey Shore
Med. Center-Fitkin Hosp. v. Baum's Estate,
84 N.J. 137, 145
(1980). Also, "'[f]ederal equal-protection analysis employs
different tiers of review: strict scrutiny when an act involves
a fundamental right or a suspect class; intermediate scrutiny
when an act involves a semi-suspect class; and minimal rational-
basis scrutiny in all other cases.'"
McGann v. Clerk, City of
Jersey City,
167 N.J. 311, 325 (2001) (quoting
Drew Assocs. v.
Travisano,
122 N.J. 249, 258 (1991)).
In support of application of the strict scrutiny test,
plaintiff relies on the United States Supreme Court's decisions
in
Levy v. Louisiana,
391 U.S. 68,
88 S.Ct. 1509,
20 L.Ed.2d 436
(1968);
Glona v. American Guar. & Liab. Ins. Co.,
391 U.S. 73,
88 S.Ct. 1515,
20 L.Ed.2d 441 (1968); and
Weber v. Aetna Cas. &
Sur. Co.,
406 U.S. 164,
92 S.Ct. 1400,
31 L.Ed.2d 768 (1972).
In
Levy, the Court declared unconstitutional on equal protection
grounds a Louisiana statute denying illegitimate children the
right to maintain an action for their mother's wrongful death.
391
U.S. at 71, 88
S.Ct. at 1511, 20
L.Ed.
2d at 439. In
Glona,
the Court held that Louisiana violated the Equal Protection
Clause by denying statutory recovery by surviving mothers for the
wrongful death of illegitimate children. 391
U.S. at 75, 88
S.Ct. at 1516, 20
L.Ed.
2d at 443. Finally, in
Weber, the Court
held that a Louisiana workmen's compensation statute that denied
wrongful death benefits to a dependent, unacknowledged
illegitimate child that were provided to legitimate and to
acknowledged illegitimate children violated the Equal Protection
Clause of the Fourteenth Amendment. 406
U.S. at 173-76, 92
S.Ct.
at 1405-07, 31
L.Ed.
2d at 779.
Contrary to plaintiff's argument, the cited cases applied
the "rational basis," rather than the "strict scrutiny" test.
See e.g.,
Levy,
supra, 391
U.S. at 71, 88
S.Ct. at 1511, 20
L.Ed.
2d at 439 ("[t]hough the test has been variously stated, the
end result is whether the line drawn is a rational one").
Although
Levy observed that "[t]he rights asserted here involve
the intimate, familial relationship between a child and his own
mother," the Court's holding is based on irrational
classification, not interference with that relationship.
Ibid.
"When the child's claim of damage for loss of his mother is in
issue, why, in terms of 'equal protection,' should the
tortfeasors go free merely because the child is illegitimate?"
Ibid. In each case, no rational basis for the statutory
distinction was present, and no state interest in legitimate
family relations was being served.
Weber,
supra, 406
U.S. at
175, 92
S.Ct. at 1406, 31
L.Ed.
2d at 778-79;
Glona,
supra, 391
U.S. at 75,
88 S.Ct. 1516,
20 L.Ed.2d 443.
Here, as well, we find no fundamental rights implicated by
Giardina's holding that the Wrongful Death Act does not permit
recovery attributable to the wrongful death of a fetus.
Plaintiff is correct that a woman may have a fundamental right to
a relationship with her child.
See In re Baby M,
109 N.J. 396,
447 (1988) ("the rights of personal intimacy, of marriage, of
sex, of family, of procreation . . .are fundamental rights
protected by both the federal and state Constitutions").
However, plaintiff's premise is contradicted by the terms of the
Wrongful Death Act itself. Nothing in the Act attempts to
classify mothers, or give them special status based on whether or
not they are pregnant, nor does the statute, on its face, focus
on any special familial relationship or even the sanctity of
life.
Moreover, as applied by
Giardina, nothing in the Act
interferes with a mother's relationship with her fetus. Whether
or not a mother's relationship with her unborn child is a
fundamental right is not dispositive because the Act does not
affect plaintiff's "relationship" with her unborn child. As the
Alexander court observed, "[a] mother's relationship with her
fetus is exactly the same whether or not she can bring a wrongful
death or survivor action. It is not the relationship that is
affected here, it is the ability to recover for the loss of that
relationship."
Alexander,
supra, 114
F.
3d at 1404. It is
difficult to imagine, for example, that a mother would consider
the availability or nonavailability of a wrongful death remedy in
making her choice whether or not to terminate her pregnancy in
the informed consent context.
See ibid. ("[i]t is impossible for
us to imagine that any such decision [the mother made or might
have made about her stillborn child] would be the least bit
influenced by whether or not a mother could bring a wrongful
death or survival action to recover damages for the loss of a
fetus").
Absent a fundamental right, suspect class or semi-suspect
class, we do not hesitate to apply the rational basis test in
this case. The question is whether the challenged statute is
supported by any "conceivable rational basis."
Greenberg v.
Kimmelman,
99 N.J. 552, 563 (1985). "The equal protection
guarantee is offended only if the classification is wholly
unrelated to the legislative objective."
In re Regulation of
Operator Serv. Providers,
343 N.J. Super. 282, 324 (App. Div.
2001). In applying that standard, we find no indiscriminate
classification. "'The fundamental purpose of the wrongful death
action is to compensate survivors for the pecuniary losses they
suffer because of the tortious conduct of others.'"
Smith v.
Whitaker,
160 N.J. 221, 231 (1999) (quoting
Alexander,
supra, 114
F.
3d at 1398);
see also LaFage v. Jani,
166 N.J. 412, 430 (2001)
("our Wrongful Death Act is remedial in nature and is designed
'to compensate surviving dependants for the pecuniary losses
resulting from the death' of, in many cases, the 'breadwinner'";
quoting
Kibble v. Weeks Dredging & Constr. Co.,
161 N.J. 178, 189
(1999)). Simply stated, the Act focuses on dependency and
pecuniary loss. As such, its classifications are rationally
related to its purpose.
See N.J.S.A. 2A:31-4 ("[t]he amount
recovered . . . shall be for the exclusive benefit of the persons
entitled to take any intestate personal property of the decedent,
and in the proportions in which they are entitled to take the
same. If any of the persons so entitled were dependent on the
decedent at his death, they shall take the same as though they
were sole persons so entitled, in such proportions, as shall be
determined by the court without a jury").
Moreover,
Giardina's application of the Act does not leave
an aggrieved mother without a remedy. The Court accommodates the
rights of parents by recognizing a common law cause of action to
recover for emotional distress and mental anguish arising from
the death of an infant before birth.
See infra at III. The
Court's determination that no cause of action under the Wrongful
Death Act existed was based not only on its perception that a
fetus was not intended to be included as a "person" under the
statute, but also that, to modify the statute to include a fetus
in the term "person," was "unnecessary in light of the
concomitant common-law right we determine to exist" in a parent
to recover for emotional distress arising out of the death of an
unborn fetus.
Giardina,
supra, 111
N.J. at 428. Plaintiff's
constitutional challenge to the Wrongful Death Act is therefore
rejected.
III
EMOTIONAL DISTRESS CLAIM
Plaintiff's emotional distress claim is founded on the
proposition that defendant "terminated the life" of plaintiff's
"child" under circumstances where he denied plaintiff the ability
to make an informed decision whether or not to consent to the
procedure. She argues that defendant failed to tell her a
material fact; "that a reasonable and prudent patient in
[plaintiff's] circumstance would want to know whether the
proposed procedure would terminate the life of an existing human
being." The trial court concluded that there were fact issues
concerning the informed consent issue, but, as noted, dismissed
the claim on the ground that the fetus was not a "constitutional
person."
A physician's duty of disclosure in the typical malpractice
case is measured by the "prudent patient" or "materiality of
risk" standard.
Largey v. Rothman,
110 N.J. 204, 212-13 (1988);
Blazoski v. Cook,
346 N.J. Super. 256, 267 (App. Div.),
certif.
denied,
172 N.J. 181 (2002). The standard relates to the
patient's needs, not the physician's judgment.
Niemiera v.
Schneider,
114 N.J. 550, 565 n.4 (1989). "[A] physician must
disclose to a patient all material information that a 'prudent
patient' might find significant for a determination whether to
undergo the proposed [medical procedure]."
Id. at 562. This
standard is objective.
Largey,
supra, 110
N.J. at 211. "The
test for determining whether a particular risk must be disclosed
is its materiality to the patient's decision,
i.e., all risks
potentially affecting the decision must be divulged."
Blazoski,
supra, 346
N.J. Super. at 268 (citing
Largey,
supra, 110
N.J. at
211-12). Aside from establishing that the physician failed to
comply with this applicable standard of disclosure, a plaintiff
must also establish proximate cause.
Largey,
supra, 110
N.J. at
215;
see also Howard v. University of Med. & Dentistry of N.J.,
172 N.J. 537, 559 (2002) (a plaintiff must "show a causal
connection between the inadequately disclosed risk of the
procedure and the injury sustained"). Plaintiff must demonstrate
that a prudent person under her circumstances would not have
consented and submitted to the medical procedure had she been
properly informed.
Teilhaber v. Greene,
320 N.J. Super. 453, 465
(App. Div. 1999). Thus, the issue of causation is also governed
by an objective standard.
Largey, 110
N.J. at 215-16.
Applying these principles in the context of a termination of
pregnancy context raises difficult questions because moral,
philosophical or religious beliefs may be implicated in a woman's
choice. Therefore, during oral argument before us, both parties
have agreed that it is premature to define what duty of care is
owed by a physician in this context. The parties also rightly
agree that we should not, at this posture of the case, address
the fact-sensitive issues concerning what dangers incident to, or
consequences resulting from, such a procedure would be "material"
to the "prudent patient." Both parties concur that resolution of
these issues should await a complete factual record. Therefore,
we do not address these perplexing issues. Consequently, solely
for the purpose of addressing the narrow issue before us, we will
assume that defendant owed a duty to plaintiff to disclose all
material information that a prudent patient might find
significant in deciding whether or not to terminate her
pregnancy. We also assume that defendant breached that duty, and
the breach was a proximate cause of plaintiff's choice to undergo
the procedure.
We conclude that the trial court erred in dismissing her
emotional distress claim on the basis that a fetus is not a
"constitutional person."
Roe indeed held that the word "person"
as used in the Fourteenth Amendment does not include the
"unborn."
Roe,
supra, 410
U.S. at 158, 93
S.Ct. at 729, 35
L.Ed.
2d at 180. However,
Roe involved a woman's privacy right,
derived from the Due Process Clause of the Fourteenth Amendment's
"concept of personal liberty and restrictions upon state action
. . . ."
410
U.S. at 153, 93
S.Ct. at 7272, 35
L.Ed.
2d at 177.
The issue in
Roe was whether that privacy right is "broad enough
to encompass a woman's decision whether or not to terminate her
pregnancy."
Ibid. The Court held that "the right of personal
privacy includes the abortion decision, but that this right is
not unqualified and must be considered against important state
interests in regulation." 410
U.S. at 154, 93
S.Ct. at 727, 35
L.Ed.
2d at 177-78.
Roe is not dispositive here because this is not a case
implicating a government's attempt to limit a woman's privacy
right to terminate a pregnancy. Crediting plaintiff's proofs, it
is about a woman who claims severe emotional distress caused by
medical advice resulting in her grudging
consent to terminate a
pregnancy, purportedly given because of defendant's failure to
advise her of the material consequences of the procedure. The
fact that a fetus may not be a "person" under the Fourteenth
Amendment is irrelevant because plaintiff's claim is not
dependent upon whether or not the fetus enjoys a constitutional
status as a "person." The claimed malpractice committed by
defendant was directed against plaintiff as an expectant mother
and thus was a direct, not a derivative claim.
See Giardina,
supra, 111
N.J. at 413 ("the medical malpractice causing an
infant stillbirth constitutes a tort against the parents,
entailing the direct infliction of injury . . .").
In our view, plaintiff's emotional distress claim is well-
founded under New Jersey law. The claim of emotional distress in
this context has evolved by recognition of the intimate familial
relationship between the claimant and the immediate victim,
Giardina,
supra, 111
N.J. at 417, and "the foreseeability of
parental suffering . . . ."
Ibid.
For example, in
Portee,
supra, the Court recognized a
common-law cause of action for negligent infliction of emotional
distress in a "bystander" case, where plaintiff established the
following elements: "(1) the death or serious physical injury of
another caused by defendant's negligence; (2) a marital or
intimate, familial relationship between plaintiff and the injured
person; (3) observation of the death or injury at the scene of
the accident; and (4) resulting severe emotional distress." 84
N.J. at 101. In the so-called wrongful birth cases, the Court
held in
Berman v. Allan,
80 N.J. 421, 439 (1979), that a
defendant's failure to advise a pregnant woman of the
availability of amniocentesis permits recovery by the parents for
their mental and emotional injury on account of their child being
born with congenital defects. Similarly, in
Schroeder v. Perkel,
87 N.J. 53, 63-64 (1981), the Court held that an emotional
distress claim of parents was cognizable for defendant's
negligent genetic counseling, which deprived the parents of the
opportunity of considering the wisdom of having another child.
In
Giardina,
supra, 111
N.J. at 420, the Court extended the
emotional distress cause of action to parents of a stillborn
infant. It concluded that "the medical malpractice causing an
infant stillbirth constitutes a tort against the parents,
entailing the direct infliction of injury, their emotional
distress and mental suffering, for which they are entitled to
recover compensatory damages."
Id. at 413. It explained, "[b]y
recognizing such a cause of action we protect the interests
affected by the tortious conduct resulting in the death of an
infant before birth."
Ibid. The Court added:
Medical malpractice causing a stillbirth
results in infliction of a direct injury to
the mother as well as to her unborn child.
Even without any permanent physical harm, the
mother suffers severe and genuine injuries in
the form of emotional distress and mental
anguish occasioned by her baby's stillbirth.
This suffering is experienced, also, by the
father of the infant. Thus, in a case such
as this, the injury suffered by the mother
and father on the stillbirth of their eagerly
expected first child is palpable and
predictable.
[
Id. at 415.]
We are satisfied that the
Giardina cause of action should be
available to plaintiff. It is, of course, true that in this
case, unlike
Giardina, there was no "birth" at all. Thus,
defendant argues,
Giardina's cause of action in the present
context is not available because there was no expectation of
birth of a healthy child and no birth process at all. Defendant
reasons that without these facts, the claim for negligent
infliction of emotional distress is constitutionally precluded
because it is not a direct claim by plaintiff, but like a
wrongful death claim, wholly derivative. We reject the argument.
First, as stated, the cause of action for emotional distress set
forth in
Giardina is not derivative, but direct.
See 111
N.J. at
413.
Second, the thrust of plaintiff's claim is that there was no
expectation of birth of a healthy child and no birth process
because of defendant's tortious conduct. In other words, she was
deprived of these intimate experiences because she was not
informed of the material consequences of the procedure. In
Giardina, it was negligent treatment. Here, it is the failure on
the part of a physician to impart information about the status of
the fetus and other information that may have been material to
plaintiff in making her choice. There is no logical basis to
distinguish the cases simply because the tortious conduct of the
defendants differed, or that the fetus in this case did not
survive full term.
Defendant further argues that the "death" of a fetus as a
result of a termination of pregnancy should not be treated as
akin to a stillbirth because, unlike a stillbirth, it is the
desired outcome. This argument, of course, begs the question.
Whether the termination was the "desired outcome" is a fact-based
issue. Defendant's argument wrongly presumes the failure of
plaintiff's proffered proof that her consent to the termination
of pregnancy was not informed.
We deem plaintiff's emotional distress cause of action as a
logical complement to the "wrongful birth" cases, which involve a
"violation of the interest in self-determination," and which
focus on "the parents' lost opportunity to make the personal
decision of whether or not to give birth to a child who might
have birth defects."
Canesi v. Wilson,
158 N.J. 490, 501-02
(1999) (citing
Schroeder,
supra, 87
N.J. at 66;
Berman,
supra,
80 N.J. 421, and
Procanik v. Cillo,
97 N.J. 339 (1984)). "[A]
woman's right to determine for herself whether or not to continue
or terminate her pregnancy . . . protects a distinctively
personal interest."
Canesi,
supra, 158
N.J. at 501. The
"distinctively personal interest" to choose not to give birth to
a baby has a logical corollary; a distinctively personal
interest, based on a woman's circumstances and discrete moral and
religious beliefs, to choose
not to terminate the pregnancy after
being informed by her physician regarding the status of the fetus
and all other facts that may be deemed material in making that
choice. The wrongful birth of a baby with a congenital defect
may obviously give rise to profound mental anguish. Based on the
circumstances, background and beliefs of a mother, inducing her
to terminate the pregnancy, even at eight weeks, because of the
physician's failure to obtain an informed consent may also result
in severe distress and mental anguish.
See Willis v. Ashby,
353 N.J. Super. 104, 112 (App. Div. 2002) (quoting James R. Woods,
Jr., M.D. and Jenifer L. Esposito Woods, M.B.A.,
Loss During
Pregnancy or in the New Born Period: Principles of Care with
Clinical Cases and Analyses 5 (Jannetti 1997) ("'[t]he vast
majority of people respond to pregnancy loss,
regardless of
gestational age, as the death of a baby and the subsequent death
of their hopes and dreams'"; emphasis added). Plaintiff, of
course, is left to her proofs on this point. We reverse
dismissal of plaintiff's emotional distress claim and remand for
further proceedings.
Affirmed in part; reversed in part and remanded for further
proceedings.
Footnote: 1 1Plaintiff has not appealed from the trial court's dismissal
of counts three and four, asserting a survivorship claim. Count
six, plaintiff's claim against defendant that he negligently
performed the abortion, count eleven, for personal injury to
plaintiff against all defendants, and counts seven through ten,
against an unidentified nurse, are not the subject of this
appeal.
Footnote: 2 2According to plaintiff, she is prepared to prove at trial
that her "child" was eight weeks old on April 9, 1996.