482 Mich. 144

STONE v WILLIAMSON

Docket No. 133986.

Argued January 8, 2008

(Calendar No. 4).

Decided July 24, 2008.

*146Ferris & Salter, EC. (by Don Ferris), for the plaintiffs.

Kitch Drutchas Wagner Valitutti & Sherbrook (by Susan Healy Zitterman and Christina A. Ginter) for the defendants.

Amici Curiae:

Kerr, Russell and Weber, PLC (by Daniel J. Schulte and Joanne Geha Swanson), for the Michigan State Medical Society.

Warner Norcross & Judd LLP (by Matthew T. Nelson, Dean F. Pacific, John J. Bursch, Sarah A. Luke, Madelaine C. Lane, and Julie Lam) for Michigan Defense Trial Counsel.

Collins, Einhorn, Farrell & Ulanoff, PC. (by Noreen L. Slank and Geoffrey M. Brown), for ProNational Insurance Company.

Smith Haughey Rice & Roegge (by L. Roland Roegge and William L. Henn) for the Michigan Health and Hospital Association.

Charfoos & Christensen, P.C. (by David R. Parker), for Roy Waddell, M.D.

Olsman Mueller, PC. (by Jules B. Olsman and Donna M. MacKenzie), and Richard E. Shaw for Citizens for Better Care.

*147Mark Granzotto, EC. (by Mark Granzotto), for the Michigan Association for Justice.

TAYLOR, C.J.

In this case, the Court is called on to examine the doctrine of “lost opportunity” set forth in MCL 600.2912a(2), which prohibits recovery for the loss of an opportunity to survive or achieve a better result unless the opportunity was greater than 50 percent, and the construction of that statute in Fulton v William Beaumont Hosp, 253 Mich App 70; 655 NW2d 569 (2002). The Court of Appeals in this case considered the aggregate of complications plaintiff faced and concluded that plaintiff satisfied the statute, using Fulton’s requirement that the difference between his chance of a better result without malpractice and his chance of a better result despite the alleged malpractice was greater than 50 percentage points. I conclude that the second sentence of MCL 600.2912a(2) does not apply to this case. Moreover, I believe the second sentence is unenforceable because it provides no guidance regarding its meaning or how courts are to apply it. A medical-malpractice plaintiff must prove that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant. Because the evidence presented at trial would support the jury’s verdict under my analysis, I conclude that there is no need to conduct a new trial and would therefore affirm the result of the Court of Appeals judgment but not its analysis.

I. FACTS AND PROCEEDINGS

Plaintiff suffered the rupture of an abdominal aortic aneurysm that had gone undetected despite physical examinations and testing by a number of physicians.1 *148He underwent emergency surgery to repair the rupture, but, in part because of preexisting conditions, amputation of both legs at mid-thigh was ultimately necessary. After surgery, plaintiff continued to experience multiple organ failure and other complications, including acute renal failure, sepsis, rhabdomyolysis, osteomyelitis, recurrent pancreatitis, and depression. His home required structural changes to accommodate his wheelchair and specialized needs, and his wife quit her employment to assist with his daily care needs.

Plaintiff brought a medical-malpractice suit against the radiologist and two vicariously liable entities on the theory that a negligent diagnosis resulted in the rupture and all resulting harm. At the jury trial, plaintiff presented experts who testified that, had the aneurysm been properly diagnosed, elective surgery could have been performed. Such elective surgery would have greatly increased plaintiffs chance of a better medical outcome, including a reduction of the risk of amputation and other health complications. Plaintiffs medical experts testified that a patient having elective surgery to repair an aortic aneurysm has a 95 percent chance of attaining a good result, which includes surviving the rupture, as well as avoiding additional medical complications. In contrast, misdiagnosed patients whose aneurysms rupture have only a 10 percent chance to achieve a good result. Specifically, the experts opined that 80 percent of patients with a rupture of an aortic aneurysm die, either en route to obtain medical care or during the emergency surgery. Of the 20 percent of patients with ruptures who manage to survive, 40 to 50 percent have some form of complication. This contrasts markedly with those undergoing elective repair, who face less than a 5 percent risk of dying or suffering serious complications.

*149Defendants argued that the risk of death should be factored out because plaintiff avoided it and that the risk of complications other than death was 5 to 12 percent for elective surgery and up to 40 percent for emergency surgery. Taking the numbers most favorable to plaintiff, 5 and 40, defendants argued that the difference was at best 35 percent. The specific risk of amputation suffered by plaintiff was 1 percent for elective surgery and 5 percent for emergency surgery: a paltry difference of 4 percent. The trial court disagreed with defendants’ theory, however, and instructed the jury to consider the aggregate risk of complications.

The jury returned a verdict in favor of plaintiff for a total amount of $2,327,835. Following reduction for the damages cap2 and collateral sources, the court entered a judgment in the amount of $1,936,682, of which $1,640,800 was for the verdict and the remainder was for interest, costs, and attorney fees. The trial court denied defendants’ postjudgment motions for a new trial and judgment notwithstanding the verdict.

The Court of Appeals affirmed in an unpublished opinion per curiam, issued April 17, 2007 (Docket No. 265048). On the issue of “loss of opportunity,” it agreed with the trial court that plaintiff had met the requirements of the statute because he had gone from a 95 percent chance of attaining a good result to a 10 percent chance of attaining a good result. Id. at 5. The Court considered the aggregate of all the increased risks that plaintiff faced as a result of the alleged malpractice and applied the Fulton formula to that aggregate risk.

This Court granted leave to appeal, directing the parties to address

*150(1) whether the requirements set forth in the second sentence of MCL 600.2912a(2) apply in this case; (2) if so, whether the “loss of an opportunity to survive or an opportunity to achieve a better result” should be determined by considering the aggregate increased risk posed by the alleged malpractice, including risks associated with injuries that the patient did not suffer and any increased risk of death, or whether the only consideration should be the increased risk of the specific injury or injuries suffered by the patient; (3) whether Fulton v William Beaumont Hosp, 253 Mich App 70 (2002), was correctly decided, or whether a different approach is required to correctly implement the second sentence of § 2912a(2), such as that described in Roy W Waddell, M.D.’s A Doctor’s View of Opportunity to Survive: Fulton’s Assumptions and Math are Wrong, published in the March 2007 edition of the Michigan Bar Journal at 32; and (4) whether the Court of Appeals erred when it determined that the plaintiffs met the requirements of § 2912a(2). [480 Mich 895 (2007).]

II. STANDARD OP REVIEW

This Court reviews de novo a trial court’s decision on a motion for judgment notwithstanding the verdict, viewing the evidence and all legitimate inferences in the light most favorable to the nonmoving party. Sniecinski v Blue Cross & Blue Shield of Michigan, 469 Mich 124, 131; 666 NW2d 186 (2003). Similarly, we review de novo questions of statutory interpretation. Wickens v Oakwood Healthcare Sys, 465 Mich 53, 59; 631 NW2d 686 (2001). When interpreting a statute, the Court’s primary goal is to give effect to the intent of the Legislature. Brown v Detroit Mayor, 478 Mich 589, 593; 734 NW2d 514 (2007). The first step is to review the language of the statute. Id. If the statute is unambiguous on its face, we presume that the Legislature intended the meaning expressed, and judicial construction is neither required nor permissible. Id. However, when a statute is ambiguous on its face — that is, equally *151susceptible to more than a single meaning — judicial construction is appropriate to determine the meaning. Lansing Mayor v Pub Service Comm, 470 Mich 154, 164-166; 680 NW2d 840 (2004).

III. ANALYSIS

At issue in this case is subsection 2 of MCL 600.2912a, which reads:

In an action alleging medical malpractice, the plaintiff has the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant or defendants. In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%. [MCL 600.2912a(2).][3]

Although the lower courts did not question the applicability of the second sentence of MCL 600.2912a(2) to plaintiffs claim, treating it as one for loss of opportunity, this Court expressly requested the parties to address the issue. Plaintiff argues that he never pleaded his claim as one for loss of an opportunity; instead, his is a simple case of physical injury directly caused by negligence. In his brief, he asserts that a case involving a loss of opportunity occurs in very specific circumstances: “where a plaintiff cannot prove that the defendant’s acts or omissions proximately caused his injuries, but can prove that the defendant’s acts or omissions deprived him of some chance to avoid those injuries.”

*152This definition is in accord with Michigan caselaw. In the first Michigan case to refer to the legal theory of “the value of lost chance,” the Court of Appeals explained: “This theory is potentially available in situations where a plaintiff cannot prove that a defendant’s actions were the cause of his injuries, but can prove that the defendant’s actions deprived him of a chance to avoid those injuries.” Vitale v Reddy, 150 Mich App 492, 502; 389 NW2d 456 (1986). The Court in Vitale noted that allowing such claims would expand existing common law, and it declined to do so, stating that such a decision “is best left to either the Supreme Court or the Legislature.” Id. at 504. In a footnote, the Court observed that the wrongful-death statute, MCL 600.2922,

requires proof that the wrongful acts or omissions were the cause of death. The statutory provision would not allow a plaintiff to recover in a situation where he could prove only that defendant’s acts or omissions were the cause of a lost chance but could not prove that defendant’s acts or omissions were the cause of death. [Id. at 504 n 4.]

In accord with this analysis, this Court has stated: “The lost opportunity doctrine allows a plaintiff to recover when the defendant’s negligence possibly, i.e., [by] a probability of fifty percent or less, caused the plaintiffs injury.” Weymers v Khera, 454 Mich 639, 648; 563 NW2d 647 (1997) (emphasis added).4 The Weymers Court aptly described the lost-opportunity doctrine as “the antithesis of proximate cause.” Id.5 In cases in *153which the plaintiff alleges that the defendant’s negligence more probably than not caused the injury, the claim is one of simple medical malpractice. Id. at 647-648.

In Falcon v Mem Hosp, 436 Mich 443; 462 NW2d 44 (1990), this Court first recognized a claim for lost opportunity to survive. Falcon was a wrongful-death case in which this Court allowed a claim to go forward even though the plaintiffs granddaughter would have had only a 37.5 percent chance of surviving a medical accident had she received proper care. Because proper medical procedures had not been followed, the granddaughter’s chance of surviving the accident went to essentially zero. The lead opinion in Falcon admitted that the plaintiff could not show that the malpractice had more likely than not caused her granddaughter’s death, but could show that it had caused her granddaughter to lose a “substantial opportunity of avoiding physical harm.” Id. at 470 (LEVIN, J.). The lead opinion disavowed the traditional rule that requires a plaintiff to show that, but for the defendant’s negligence, the patient would not have suffered the physical harm, saying that the “more probable than not standard, as well as other standards of causation, are analytic devices — tools to be used in making causation judgments.” Id. at 451. Instead, despite the fact that the plaintiff could not show that the doctor’s malpractice had more probably than not caused her granddaughter’s death, the plaintiff had a claim because the malpractice did cause her granddaughter harm. The 37.5 percent chance for a better outcome was “hardly the kind of opportunity that any of us would willingly allow *154our health care providers to ignore.” Id. at 460. This harm occurred before the granddaughter’s death, at the moment “[w]hen, by reason of the failure to implement [certain] procedures,” she was denied any opportunity of living. Id. at 469, 471 n 44. The lead opinion characterized its holding as requiring the plaintiff to show, more probably than not, that the malpractice reduced the opportunity of avoiding harm: “failure to protect [the granddaughter’s] opportunity of living.”6 Id. at 469. Loss of her 37.5 percent opportunity of living, the lead opinion stated, “constitutes a loss of a substantial opportunity of avoiding physical harm.” Id. at 470.

The lead opinion in Falcon thus concluded that the loss-of-opportunity claim accrued not when the patient died, but at the moment she went from having a 37.5 chance of survival to having no chance of survival. Under this theory, a plaintiff would have a cause of action independent of that for the physical injury and could recover for the malpractice that caused the plaintiff to go from a class of patients having a “good chance” to one having a “bad chance.” Without this analysis, the plaintiff in Falcon would not have had . a viable claim because it could not have been shown that the defendant more probably than not caused the physical injury. Until Falcon, medical-malpractice plaintiffs alleging that the defendant’s act or omission hastened or worsened the injury (such as by failing to diagnose a condition) had to prove that the defendant’s malprac*155tice more probably than not was the proximate cause of the injury. See, e.g., Morgan v Taylor, 434 Mich 180; 451 NW2d 852 (1990); Naccarato v Grob, 384 Mich 248, 252; 180 NW2d 788 (1970); Skeffington v Bradley, 366 Mich 552; 115 NW2d 303 (1962).

When the Court decided Falcon, MCL 600.2912a read:

In an action alleging malpractice the plaintiff shall have the burden of proving that in light of the state of the art existing at the time of the alleged malpractice:
(a) The defendant, if a general practitioner, failed to provide the plaintiff the recognized standard of acceptable professional practice in the community in which the defendant practices or in a similar community, and that as a proximate result of the defendant failing to provide that standard, the plaintiff suffered an injury.
(b) The defendant, if a specialist, failed to provide the recognized standard of care within that specialty as reasonably applied in light of the facilities available in the community or other facilities reasonably available under the circumstances, and as a proximate result of the defendant failing to provide that standard, the plaintiff suffered an injury.

Three years after Falcon, the Legislature enacted 1993 PA 78, amending MCL 600.2912a to add the second subsection. In its entirety, the statute as amended reads:

(1) Subject to subsection (2), in an action alleging malpractice, the plaintiff has the burden of proving that in light of the state of the art existing at the time of the alleged malpractice:
(a) The defendant, if a general practitioner, failed to provide the plaintiff the recognized standard of acceptable professional practice or care in the community in which the defendant practices or in a similar community, and that as *156a proximate result of the defendant failing to provide that standard, the plaintiff suffered an injury.
(b) The defendant, if a specialist, failed to provide the recognized standard of practice or care within that specialty as reasonably applied in light of the facilities available in the community or other facilities reasonably available under the circumstances, and as a proximate result of the defendant failing to provide that standard, the plaintiff suffered an injury.
(2) In an action alleging medical malpractice, the plaintiff has the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant or defendants. In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%. [New language emphasized.]

As can be seen, the Legislature retained the already-existing language, making it subsection 1 of the statute. Both subsection 1(a) and subsection 1(b) require the plaintiff to show that, “as a proximate result of the defendant failing to provide [the appropriate standard of practice or care], the plaintiff suffered an injury.” Further, the Legislature added subsection 2. Specifically, the first sentence of this new subsection codifies and reiterates the common-law requirement that a plaintiff show that the defendant’s malpractice more probably than not caused the plaintiffs injury. The second sentence of subsection 2 adds that, in medical-malpractice cases, a “plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%.” However, one must keep in mind that the relevant caselaw when subsection 2 was enacted held that the lost-opportunity doctrine applies “in situations where a plaintiff cannot prove that a defendant’s actions were the cause of his injuries . . . .” Vitale, supra at 502 *157(emphasis added). That is, the first sentence of subsection 2 requires plaintiffs in every medical-malpractice case to show the defendant’s malpractice proximately caused the injury while, at the same time, the second sentence refers to cases in which such proof not only is unnecessary, but is impossible. Accordingly, I conclude that the two sentences of subsection 2 create a paradox, allowing claims in the second sentence while precluding them by the first sentence.

While it is tempting to argue, as Justice CAVANAGH does, that the Legislature intended to allow as an “injury” a plaintiffs lost chance alone, without proof of physical injury, this Court addressed that issue in Wickens. In Wickens, supra at 60, the Court stated that the first sentence of subsection 2 “expressly limits recovery to injuries that have already been suffered and more probably than not were caused by the defendant’s malpractice.” A reduction of a person’s chances of avoiding injury is not itself a present injury, but is only an indication of the likelihood of suffering a future injury. Id. at 60-61. Therefore, because of the statutory present-injury requirement, the plaintiff in Wickens could not recover for her reduced expected life span— the exact kind of injury that Falcon allowed. Moreover, it has never been the law in this state that a negligence suit can be sustained when the alleged negligence did not cause a physical injury to a person or property. Henry v Dow Chem Co, 473 Mich 63, 75-76; 701 NW2d 684 (2005). The Legislature would have understood that this is what the term “injury” encompassed when it enacted the language reiterating this traditional requirement: the plaintiff must have an injury proximately caused by the defendant.7 Ford Motor Co v City *158of Woodhaven, 475 Mich 425, 439-440; 716 NW2d 247 (2006). Thus, what the Legislature intended by the statute was likely something more traditional: a situation in which an injury might have occurred anyway, but in which the defendant’s act or omission hastened or worsened it in such a way that the plaintiff suffered more severe physical injury than he or she would have had the negligence not occurred. As noted, before Falcon, such cases were litigated under the ambit of traditional medical-malpractice law.8

In my view, there is little question that the statute cannot be interpreted as written. Avoiding the underlying paradox of the statute allowing in one sentence suits that in another sentence it precludes, the Court of *159Appeals, interpreting the second sentence by itself in Fulton, found two possible, and fully contradictory, constructions, each of which could be achieved only by adding words to the statute. The Fulton Court expressed the issue before it as whether the second sentence of the statute requires a plaintiff to show “only that the initial opportunity to survive before the alleged malpractice was greater than fifty percent... or, instead, that the opportunity to survive was reduced by greater than fifty percent because of the alleged malpractice ....” Fulton, supra at 77-78 (emphasis added). The Court noted that the statute was ambiguous because reasonable minds could differ regarding which of these meanings could be read from the words of the statute. The Court concluded that the first interpretation required that the word “initial” be inferred to modify “opportunity” and that the second required that the words “loss of” be inferred to modify “opportunity.” Id. at 80. Apparently finding itself obligated to choose one of these two interpretations, the Court then decided that the second construction was the one intended by the Legislature because it reflected the Legislature’s rejection of Falcon.9 The Court asserted that the lead opinion in Falcon had focused on the “extent of the loss” and that the Legislature was insisting on a greater loss for the claim to be actionable. Id. at 82-83. However, Falcon’s focus was almost entirely on the plaintiffs initial opportunity being substantial, and so it is equally plausible that the Legislature merely intended for a plaintiff to have an initial opportunity of more *160than 50 percent. Both interpretations proposed in Fulton implicate a negative reaction to Falcon, and nothing in the statutory language, the statutory context, or the statute’s history gives any further clues to assist in choosing the “correct” interpretation.

It is confounding to attempt to ascertain just what the Legislature was trying to do with this amendment. Even if it was trying to create a remedy for the “injury” of a reduction in chances following medical malpractice, by imposing the threshold of greater than 50 percent it may well have eliminated most of the cases that might benefit from such a rule. For example, if the patient in Falcon had enjoyed a greater than 50 percent initial likelihood of survival (that is, she was not likely to die even with proper treatment), the plaintiff probably would have brought a standard medical-malpractice case, and the jury would have decided proximate cause in the usual way. It was only because the plaintiff could not show that the patient more probably than not would have survived but for the doctor’s negligence that prompted the plaintiff to seek her remedy under the doctrine of lost opportunity.

As written, the second sentence of MCL 600.2912a(2) can be made understandable only by adding words or by redefining “injury” in a way significantly contrary to the mass of caselaw at the time the sentence was added. Another possible alternative reading is that the second sentence of subsection 2 was intended not to create a new type of claim, but to limit courts from expanding the common law so far as to allow cases like Falcon. None of these multiple, contradictory interpretations can be shown to be the “correct” construction of legislative intent. Choosing between them can only be a guess. Moreover, it remains that the second sentence impossibly conflicts with the requirement of a proxi*161mate cause of the injury in both the first sentence of subsection 2 and in subsection 1. Accordingly, I conclude that the second sentence of subsection 2 cannot be judicially enforced because doing so requires the Court to impose its own prerogative on an act of the Legislature.10

I find the second sentence of MCL 600.2912a(2), as written, substantially incomprehensible because (1) it either cannot be harmonized with the proximate-cause requirement of the rest of the statute or creates by implication a new cause of action contrary to common law and (2) it provides no guidance regarding its correct application. The remaining portions of MCL 600.2912a should continue in effect. MCL 8.5.

This would leave, for medical-malpractice claims, the requirement imposed by the statute that “the plaintiff has the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant or defendants.” MCL 600.2912a(2).11 In addition, the word “injury” would continue to retain its meaning in tort of a present physical injury to person or property. I believe that, by codifying and restating the requirements of causation and injury in existence at the time Falcon was decided, the Legislature effectively overruled Falcon and reinstated the traditional elements of medical-malpractice claims.

*162In accord with my conclusion that the second sentence of MCL 600.2912a(2) is incomprehensible as written, I would hold that Fulton’s construction of that part of the statute is no longer good law.121 believe that the Legislature intended to retain the traditional proximate-cause requirement in effect before Falcon and that that is what a plaintiff must prove.13

IV APPLICATION

Although I believe that the lower courts erred by applying Fulton and that the trial court incorrectly instructed the jury on the issue of whether plaintiff had shown that defendant’s negligence caused him to lose a greater than 50 percent chance of a better result, I would conclude that it is not necessary to order a new trial. For each defendant, the trial court instructed the jury that it had to find by a preponderance of the evidence (1) that the defendant was professionally negligent, (2) *163that plaintiff sustained injury and damages, and (3) that the professional negligence or malpractice of that defendant was a proximate cause of the injury and damages. After giving these instructions, the court farther instructed the jury: “I’m going to talk about damages. In an action alleging claims of professional negligence against a physician, even if you find professional negligence, the Plaintiff cannot recover unless the Plaintiffs chance of having a better result was changed by greater than 50 percent.” Thus, after being instructed that it had to find the traditional elements of medical malpractice and, in addition, had to find that plaintiff had lost an opportunity of greater than 50 percent, the jury returned a verdict indicating it had found that all these elements were satisfied. Indeed, a review of the record shows that plaintiff suffered amputations and other injuries, and from the testimony presented the jury could have concluded that it was more likely than not that the amputations and other injuries were caused by the defendants’ negligence and would not have occurred absent that negligence. Most importantly, regardless of the jury’s finding of lost opportunity, it is clear from the way the instructions were given that the jury found that the traditional elements were met: defendants’ negligence more probably than not caused plaintiffs injuries. Thus, I believe that the jury properly found that plaintiff had satisfied the causation and injury elements. Accordingly, I would hold that reversal is not required and would affirm the result of the judgment of the Court of Appeals.

V SUMMARY

In an attempt to clarify for the reader the majority and minority positions on each issue, I provide the following summary:

*164All seven justices would affirm the result of the Court of Appeals decision and the judgment for plaintiff. Six of the justices believe that this is not a lost-opportunity case; Justice MARKMAN would hold that it is such a case. All seven justices believe that Fulton’s analysis is incorrect or should be found to no longer be good law, though their reasons for doing so vary.14 Justices CORRIGAN and YOUNG and I would find that Fulton is no longer good law because we would hold that the statute is unenforceable as written. Justice MARKMAN would hold that Fulton is inconsistent with the statutory language. Justices Weaver, Cavanagh, and Kelly would hold that Fulton is incorrect because it erroneously added words to the statute when analyzing the phrase “the opportunity.” Of the four justices holding that the statute is not unenforceable as written (Justices WEAVER, CAVANAGH, Kelly, and Markman), only Justice Markman would define the term “opportunity” in accordance with the Waddell article, while the other three (Justices WEAVER, CAVANAGH, and Kelly) would define it in accordance with Falcon, but with a higher threshold than Falcon required. The same four justices (Justices WEAVER, Cavanagh, Kelly, and Markman) would hold that loss of the opportunity is, by itself, a compensable injury, although the opportunity must be “lost” — that is, the bad result must occur — in order for a claim to accrue.

Given this montage of issues and positions created by the language of this statute, it would be helpful for the *165Legislature to reexamine its goal and the policies it wishes to promote and strive to better articulate its intent in that regard.

Corrigan and Young, JJ., concurred with Taylor, C.J.

CAVANAGH, J. I agree with Chief Justice TAYLOR that the evidence presented in this case supports a traditional medical-malpractice claim; thus, I concur that the jury’s verdict should be upheld. However, I do not agree with the conclusion that the second sentence of MCL 600.2912a(2) is incomprehensible and unenforceable. Therefore, I respectfully disagree with Chief Justice TAYLOR’s analysis of that provision.

Chief Justice TAYLOR identifies two problems with MCL 600.2912a(2) that he believes render it partially unenforceable: (1) the first and second sentences conflict and (2) the second sentence is incomprehensible. I disagree, because the circumstances of the 1993 amendment of this statute clarify the meaning of the statutory language and resolve both concerns.

THE ORIGINS OF THE LOSS-OF-OPPORTUNITY DOCTRINE

The history of the loss-of-opportunity doctrine is highly relevant to the interpretation of MCL 600.2912a(2) because this Court’s adoption of the doctrine evidently prompted the Legislature to add that provision. In Falcon v Mem Hosp, 436 Mich 443; 462 NW2d 44 (1990), this Court first recognized the loss-of-opportunity doctrine.1 Falcon involved a wrongful-*166death claim brought on behalf of a woman who had suffered an amniotic embolism during childbirth. As in all negligence cases, the plaintiff was required to show causation to establish a valid medical-malpractice claim. Falcon discussed various causation theories. Some courts have required a plaintiff to establish “that it is more probable, measured as more than fifty percent, that, but for such negligence, the patient would not have suffered the physical harm.” Id. at 449 (LEVIN, J.). Falcon termed this the “more probable than not standard.” Id. at 451. Under this standard, “a plaintiff who establishes that the patient would have had more than a fifty percent opportunity of not suffering physical harm had the defendant not acted negligently, recovers one hundred percent of the damages.” Id. at 450. The plaintiff in Falcon could not have maintained a wrongful-death action under the more-probable-than-not standard — the decedent only had a 37.5 percent chance of surviving even without the alleged malpractice, so it was not more probable than not that the physician’s malpractice caused the decedent’s death. Id. at 460.

While the plaintiff in Falcon could not recover for the injury of her granddaughter’s wrongful death, we ruled that the plaintiff nevertheless had a different cause of action available to her. Falcon adopted the approach taken by other courts that recognized “loss of an opportunity for a more favorable result, as distinguished from the unfavorable result, as compensable in medical malpractice actions.” Id. at 461 (emphasis added). “Under this approach, damages are recoverable for the loss of opportunity although the opportunity lost *167was less than even, and thus it was not more probable than not that the unfavorable result would or could have been avoided.” Id. at 461-462. Thus, the Falcon decision explicitly recognized loss of an opportunity to avoid physical harm as a distinct injury. A plaintiff could bring a claim for loss of an opportunity to avoid death, even if she could not maintain a claim for the death itself because she could not establish causation for the death.

Falcon’s approach to calculating damages for a loss-of-opportunity claim also indicates that it treated the lost opportunity as a distinct injury, not simply a direct physical-harm injury that enjoyed a lower causation standard. Because the plaintiffs granddaughter in Falcon allegedly lost a 37.5 percent chance of survival, we concluded that the appropriate measure of damages would be “37.5 percent times the damages recoverable for wrongful death. . . .” Id. at 471. Thus, generally speaking, “ ‘[t]he proper computation of damages would limit the damages recoverable to only that amount of reduced chance of recovery actually caused by the physician’s negligent conduct.’ ” Id. at 472 n 47 (citation omitted). We consulted Mays v United States, 608 F Supp 1476, 1482-1483 (D Colo, 1985), for its method of computing damages attributable to the defendant. Falcon, 436 Mich at 471-472 (LEVIN, J.). In Mays, malpractice had reduced the patient’s opportunity to survive from 40 to 15 percent, so the court computed the damages by multiplying the opportunity lost (40 minus 15) by the net pecuniary loss to determine the damages for the harm caused by the defendant. Id. Calculating the damages this way permitted the plaintiff “to recover damages only for the reduction in the patient’s opportunity of survival.” Id. at 472. This calculation isolates the value of the injury that can be causally linked to a defendant’s negligence — the loss *168of an opportunity. The value of a loss-of-opportunity claim is measured by the extent of the loss; so, clearly, the injury being compensated is the loss of a particular amount of opportunity. By contrast, the measure of damages in a traditional claim for wrongful death or physical harm is, generally speaking, the value of damages attributable to the death or physical harm; as such, the injury being compensated is the death or physical harm.

In sum, when Falcon adopted the loss-of-opportunity doctrine, it recognized that the injury of loss of an opportunity was distinct from the injury of suffering the associated physical harm — which, in that case, was death. However, Falcon indicated that not all losses of opportunity were actionable; rather, a plaintiff must suffer the loss of a substantial opportunity for a better result. “The cause of action accrues when harm and damages result from the loss of a substantial opportunity for a better result.” Id. at 470 n 43. We concluded “that loss of a 37.5 percent opportunity of living constitutes a loss of a substantial opportunity of avoiding physical harm,” but declined to “decide what lesser percentage would constitute a substantial loss of opportunity” in other circumstances. Id. at 470.

Finally, Falcon emphasized that a loss-of-opportunity cause of action was not exempt from the more-probable-than-not standard of causation. “Under this approach, the plaintiff must establish more-probable-than-not causation. He must prove, more probably than not, that the defendant reduced the opportunity of avoiding harm.” Id. at 462. Unlike a claim for wrongful death or physical injury, the “patient. .. need not show that it was probable, measured as more than fifty percent, that the course of the disease and treatment would have been different.” Id. at 470 n 43. Instead, “[i]t is suffi*169cient to show, more probably than not, that had there been a correct diagnosis, the patient would have had a substantial opportunity of avoiding the course of the disease and treatment that occurred.” Id. Therefore, while a claim for loss of opportunity addresses a different injury than a cause of action for the physical injury itself, it is still subject to the same standard of proof of causation.

Falcon’s enunciation of the loss-of-opportunity doctrine is significant, because it apparently provoked the Legislature to amend MCL 600.2912a. In 1993, the Legislature amended that provision by adding a second subsection, which states:

In an action alleging medical malpractice, the plaintiff has the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant or defendants. In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%. [MCL 600.2912a(2).]

The amendment was widely understood to be a direct reaction to the Falcon decision. As a majority of this Court noted, after Falcon adopted the lost-opportunity doctrine, “[o]ur Legislature immediately rejected Falcon and the lost opportunity doctrine. MCL 600.2912a(2) . . . .” Weymers v Khera, 454 Mich 639, 649; 563 NW2d 647 (1997). I agree that the amendment of MCL 600.2912a(2) was a reaction to Falcon, but I would not characterize it as a rejection of the lost-opportunity doctrine entirely. It merely established the threshold for loss-of-opportunity claims.

THE PROPER INTERPRETATION OF MCL 600.2912a(2)

The Legislature’s addition of MCL 600.2912a(2) should be read in light of the Falcon decision. This *170Court follows the principle that when a statute uses a common-law term and there is no clear legislative intent to alter the common law, the term will be interpreted as having the same meaning as at common law. Ford Motor Co v City of Woodhaven, 475 Mich 425, 439; 716 NW2d 247 (2006). Additionally, the Legislature is presumed to be aware of judicial interpretations of existing law when passing legislation. Id. at 439-440. In this instance, the Legislature appears to have reacted to a particular opinion of this Court, so that opinion’s holdings offer considerable insight into the Legislature’s intent. When interpreting MCL 600.2912a(2), then, it is important to keep in mind several principles established by the Falcon decision: (1) loss-of-opportunity claims are subject to the more-probable-than-not standard for proving causation, (2) the “injury” in a loss-of-opportunity claim is the loss of a substantial opportunity to avoid physical harm, not the actual physical harm itself, and (3) loss of a 37.5 percent opportunity of living constitutes a compensable loss of a substantial opportunity to avoid physical harm. Chief Justice TAYLOR interprets MCL 600.2912a(2) without considering these principles from Falcon, and thus comes to the mistaken conclusion that the statute is unenforceable and inconsistent with the lost-opportunity doctrine.

The first sentence of MCL 600.2912a(2) assigns a medical-malpractice plaintiff “the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant or defendants.” Chief Justice TAYLOR concludes that this sentence precludes lost-opportunity claims because those claims only arise when a plaintiff cannot prove that a defendant’s negligence more probably than not caused the plaintiffs injury. Ante at 157. But this overlooks two principles gleaned from Falcon that the Legislature would have been aware of while drafting this sentence: loss-of-opportunity claims are *171subject to the more-probable-than-not standard of causation and, in such claims, the “injury” is the loss of an opportunity to avoid the physical harm, not the associated physical harm itself. When the first sentence of MCL 600.2912a(2) is interpreted according to Falcon’s articulation, its causation requirement does not preclude claims for loss of opportunity. It simply codifies the causation requirement that applies to claims for the injury of suffering physical harm as well as claims for the injury of the loss of an opportunity to avoid physical harm. Just like Falcon, MCL 600.2912a(2) requires that a plaintiff asserting a cause of action for loss of opportunity prove that the defendant more probably than not caused the loss of an opportunity to survive or the loss of an opportunity to achieve a better result.

The first sentence of MCL 600.2912a(2) should also be interpreted in accordance with Falcon’s understanding of the word “injury.” In medical-malpractice cases, the underlying injury is quite often death or some physical harm. But Falcon identified a distinct injury in medical-malpractice cases — the loss of a substantial opportunity to avoid physical harm. This is significant, because a lost-opportunity plaintiff, by definition, cannot prove that a defendant’s malpractice more probably than not caused the patient to suffer physical harm or death. Take the example of a patient who before treatment had a 40 percent chance of survival as the result of a preexisting condition. If that patient died after being negligently treated by a physician, the plaintiff would not be able to prove that the physician’s malpractice more probably than not (50 percent or greater) caused the patient’s death. There was a 60 percent chance that the patient would have died regardless of the malpractice, as a result of the preexisting condition. But the plaintiff might be able to show that the physician’s malpractice more probably than not caused the *172patient to lose up to a 40 percent chance of avoiding death.2 The first sentence of MCL 600.2912a(2) simply places this burden to prove causation on a plaintiff, whether the alleged injury is the physical harm itself or the loss of an opportunity to avoid harm.

Moreover, the explicit recognition of the loss-of-opportunity doctrine in the second sentence of MCL 600.2912a(2) supports the conclusion that the Legislature did not intend to preclude lost-opportunity claims by adopting the more-probable-than-not standard of causation. The second sentence states: “In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%.” MCL 600.2912a(2). If the Legislature had intended to reject the lost-opportunity doctrine, it would have entirely prohibited plaintiffs from recovering for a loss of an opportunity. Instead, it permitted recovery for loss of an opportunity under certain circumstances — if the opportunity was greater than 50 percent. This sentence merely sets the threshold for invoking the loss-of-opportunity doctrine. It requires that a plaintiffs premalpractice opportunity to survive or achieve a better result was greater than 50 percent.3

*173The conclusion that the first and second sentences of MCL 600.2912a(2) do not conflict is also related to the proper interpretation of the second sentence. Chief Justice TAYLOR identifies an ambiguity in the second sentence that, he contends, can only be resolved by adding words or by redefining the term “injury.” Ante at 160.4 The Court of Appeals also identified this ambiguity in Fulton v William Beaumont Hosp, 253 Mich App 70; 655 NW2d 569 (2002). Fulton described the ambiguity: the second sentence of the statute requires a plaintiff to show either that the premalpractice opportunity was greater than 50 percent or that the opportunity was reduced by more than 50 percent. Id. at 77. In short, the ambiguous term is the statute’s second use of the word “opportunity.” I disagree with the conclusion that none of the multiple, contradictory interpretations can be shown to be the correct construction of legislative intent. While reasonable minds could differ with respect to the meaning of this statute, the correct interpretation can be discerned by conventional means of construction.

The proper interpretation of the second use of the word “opportunity” in MCL 600.2912a(2) can be resolved by simply considering the entire text of the sentence. The first time “opportunity” is used, the statute speaks of recovery for “loss of an opportunity to survive.” MCL 600.2912a(2). By using this term from *174Falcon without modification, the Legislature adopted Falcon’s articulation of the lost-opportunity cause of action. And we know from Falcon that by the very nature of a lost-opportunity claim, the opportunity alleged to have been lost must be the premalpractice opportunity. The word “opportunity” in the phrase “loss of an opportunity” must refer to the premalpractice opportunity because that is the opportunity that is lost in some measure and, thus, creates a claim.

The second time “opportunity” is used in the sentence, it is not preceded by the phrase “loss of an.” But the statute’s replication of the term “opportunity” within the same sentence clearly indicates that they relate to each other and are to be construed identically. Thus, the term “opportunity” in isolation has the same meaning that it does within the phrase “loss of an opportunity to survive.” Accordingly, a plaintiff cannot recover for the loss of an opportunity unless the opportunity — the premalpractice opportunity that was allegedly lost in some measure — was greater than 50 percent. Thus, this interpretation does not require that any words be added to the sentence; it merely requires the word “opportunity” to be construed consistently within the same sentence.

The other proposed meaning of the statute’s second use of the word “opportunity” would conflict with the sentence’s first use of the word. Instead of reading the phrase “unless the opportunity was greater than 50%” as written, this interpretation would infer the words “loss of” in front of “opportunity.” Justice MARKMAN advocates this interpretation. He concludes that “the opportunity” clearly refers back to the “loss of an opportunity,” and thus the sentence means that the loss of the opportunity must be greater than 50 percent. Post at 195. But this interpretation conflates the phrase *175“loss of an opportunity” with the phrase “the opportunity.” It assumes that the Legislature used the phrase “the opportunity” as a shorthand reference for “loss of an opportunity” and requires the reader to infer the phrase “loss of” before the second use of the word “opportunity.” This interpretation is less plausible than my interpretation, which gives the term “opportunity” the same meaning regardless of whether it appears alone or within the phrase “loss of an opportunity,” and does not require reading language into the statute.5 In sum, I cannot conclude that this competing interpretation is correct when it poses linguistic problems that are not found in the other interpretation.

Moreover, interpreting the word “opportunity” to mean premalpractice opportunity comports with the purpose of the statute and the context in which it was adopted, while the other interpretation does not. Falcon adopted the loss-of-opportunity doctrine to provide a cause of action to plaintiffs who could not establish causation for physical harm, but could establish causation for the loss of a substantial opportunity to avoid that physical harm. MCL 600.2912a(2) cannot limit *176recovery for the loss of an opportunity to cases in which the loss was greater than 50 percent, because any plaintiff who satisfied that condition would have a traditional medical-malpractice claim for the death or physical harm itself.6 A plaintiff who can show that malpractice caused the loss of a more than 50 percent opportunity to avoid death or physical harm can meet the more-probable-than-not standard of causation for the associated death or physical harm. This interpretation would permit a loss-of-opportunity claim when a *177plaintiffs chance for survival was reduced from 80 percent to 20 percent, but not when the plaintiffs chance for survival was reduced from 80 percent to 40 percent. It would not make sense to permit a plaintiff whose chance of survival was reduced from 80 percent to 20 percent to bring a lost-opportunity claim, because that plaintiff could show that the negligence more probably than not caused the death, thus establishing a traditional wrongful-death claim. Meanwhile, the statute would deny recovery for the loss of an opportunity to a plaintiff who suffered death, but could only show that the malpractice reduced his opportunity to survive from 80 percent to 40 percent. The plaintiff in that case would be left with no cause of action at all; he could not meet the more-probable-than-not standard of causation for the injury of death, and he would be precluded from bringing a lost-opportunity claim because he lost only 40 percent of his opportunity. This cannot be the result intended by the Legislature. This interpretation of the statute would prevent Falcon's intended class of plaintiffs from bringing a loss-of-opportunity claim, while still recognizing a cause of action for loss of opportunity. It would provide a class of plaintiffs who already have a traditional medical-malpractice cause of action with an additional cause of action for loss of opportunity. Such a result is illogical in light of one significant purpose of the statute — to codify the loss-of-opportunity doctrine recognized in Falcon.

Finally, interpreting the statute as referring to the premalpractice opportunity is consistent with the history of the amendment. That is, MCL 600.2912a(2) is understood to be a legislative reaction to Falcon. MCL 600.2912a(2) retained the loss-of-opportunity doctrine, so it could not have been intended to entirely preclude the class of plaintiffs recognized by Falcon from bringing such claims; such a drastic step would be entirely at *178odds with the rationale of the loss-of-opportunity doctrine. Rather, MCL 600.2912a(2) retained the doctrine, but set the threshold at 50 percent, so that only plaintiffs who had a greater than 50 percent premalpractice opportunity to survive or achieve a better result could bring a claim. This interpretation is the only reasonable explanation for the Legislature’s action — it aligns with the Legislature’s apparent intent to both endorse the doctrine and place a limit on it. In sum, I concur with Chief Justice TAYLOR that plaintiff in this case proved a traditional medical-malpractice claim based on his physical injuries and that the jury’s verdict should be upheld.7 Plaintiff did not assert, or need to resort to, a claim for loss of opportunity. However, I disagree that the second sentence of MCL 600.2912a(2) is substantially incomprehensible. The correct interpre*179tation of the second sentence can be discerned by an examination of the text of the statute. The result of this analysis is confirmed by the history of both the loss-of-opportunity doctrine and the statute. There is no internal conflict within the statute. The loss-of-opportunity doctrine is entirely consistent with the more-probable-than-not causation standard, so there is no conflict between the first and second sentences of MCL 600.2912a(2).

RESPONSE to justice markman

Justice Markman’s approach to interpreting MCL 600.2912a(2) is grounded in several faulty premises. The first is that traditional medical-malpractice cases require that there be “no question that the proper treatment would have resulted in a good outcome,” because otherwise “it cannot be proved that the improper treatment caused the bad outcome.” Post at 217. This proposition would preclude plaintiffs with preexisting conditions that might have contributed slightly to their injuries from bringing medical-malpractice claims. It would also preclude medical-malpractice claims from arising in situations in which proper medical treatment does not always succeed.8 This proposition cannot be *180correct. Plaintiffs alleging medical malpractice, regardless of whether they have preexisting conditions, are not required to prove that a defendant was a 100 percent cause of their injuries; they must simply prove more-probable-than-not causation. After all, traditional medical-malpractice claims are subject to the same principles of causation as other negligence claims. As Prosser & Keeton, Torts (5th ed), § 41, p 270, notes, “[w]hen a child is drowned in a swimming pool, no one can say with certainty that a lifeguard would have saved the child; but the experience of the community permits the conclusion that the absence of the guard played a significant part in the drowning.” There is no reason to treat medical-malpractice claims any differently in this regard. For example, even if an expert testified that a properly performed medical procedure will avoid a bad result 99 percent of the time, a jury could still conclude that the physician’s negligence was more probably than not the cause of the bad result. See post at 217.

Second, Justice MarkmAN’s approach suggests that the factor distinguishing a medical-malpractice claim from a lost-opportunity claim is whether there is another possible cause of an injury, such as a preexisting condition. He states:

... I conclude that a “lost opportunity” case is one in which it is at least possible that the bad outcome would have occurred even if the patient had received proper treatment. By contrast, if there is no question that the *181proper treatment would have resulted in a good outcome, then the patient who suffered a bad outcome has a traditional medical-malpractice action. [Post at 186.]

But this definition of a lost-opportunity case is contrary to both the doctrine as described by Falcon and the doctrine as adopted by the Legislature in MCL 600.2912a(2). The distinction between a lost-opportunity case and a medical-malpractice case does not pivot on a plaintiffs preexisting condition or the absolute certainty that proper medical treatment would have prevented the harm the plaintiff suffered. Rather, the determining factor is whether the plaintiff can prove, more probably than not, that the defendant’s negligence caused physical harm. If a plaintiff can prove more-probable-than-not causation for physical harm, then he has a medical-malpractice claim for that injury. If not, he may have a claim for loss of opportunity to avoid harm, if he can prove that the defendant’s negligence caused that injury: the loss of an opportunity to avoid harm. Of course, many lost-opportunity cases arise when a plaintiff has a preexisting condition that could have caused physical harm without negligence, but this is a correlation, not a cause. The fact that a plaintiff has a preexisting condition does not, by itself, cause a claim to be a lost-opportunity claim rather than a medical-malpractice claim. Similarly, the existence of other possible causes for a bad result does not determine the cause of action available to that plaintiff. Specifically, the possibility that a patient’s disease or injury itself may have caused the bad result does not mean that the patient cannot bring a traditional medical-malpractice claim.9 Rather, as Falcon ex*182plained, traditional medical-malpractice claims require a plaintiff to show that the negligence more probably than not caused physical harm. Falcon, 436 Mich at 449. The Legislature adopted Falcon’s term “loss of opportunity” as well as the traditional more-probable-than-not standard of causation. Accordingly, there is no reason to conclude that the distinguishing feature between medical-malpractice claims and lost-opportunity claims is the existence of other possible causes of the harm, as Justice MARKMAN appears to posit.

These faulty suppositions are significant, because they lead Justice MARKMAN to endorse Dr. Roy Waddell’s formula for calculating loss of opportunity. Waddell’s formula purports to calculate a plaintiffs lost opportunity to survive by determining “what percent of patients who would die without treatment” could otherwise “be saved with treatment.”10 If proper treatment creates a greater than 50 percent chance of survival within the set of patients who would have died without treatment, then a cause of action exists. But Waddell’s formula is flawed for several reasons. It operates from a mistaken understanding of a lost-opportunity case. The formula identifies plaintiffs who can show that negligence was more than a 50 percent cause of their death or physical harm. But that set of plaintiffs can, by definition, maintain a traditional cause of action for medical malpractice for the injury of death or physical harm itself. Accordingly, his formula would preclude true lost-opportunity plaintiffs from bringing claims *183and provide medical-malpractice claimants with lost-opportunity causes of action for which they have no need. Moreover, aside from its theoretical problems, the Waddell formula is blatantly inconsistent with the language of MCL 600.2912a(2).11 It is inconceivable that Justice MARKMAN can read the sentence “In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%” and conclude that it should be translated into this formula:

(Premalpractice chance) - (Postmalpractice chance) x 100 (Postmalpractice chance)

This formula has no basis in the language of MCL 600.2912a(2) or Falcon. MCL 600.2912a(2) simply requires that the opportunity was greater than 50 percent. Again, it is noteworthy that my interpretation does not require adding any inferred language to the statute. A plaintiffs premalpractice opportunity to survive or to achieve a better result must simply have been “greater than 50%.” The approach taken by Justice MARKMAN and Dr. Waddell requires this sentence to be rewritten to state *184that the plaintiffs opportunity to survive or to achieve a better result must have been decreased by 50 percent. See post at 195-197.

Finally, the Waddell approach leads to such anomalous results that it cannot possibly reflect the intention of the Legislature. The Legislature crafted MCL 600.2912a(2) as a reaction to Falcon, which permitted a lost-opportunity cause of action when the plaintiffs premalpractice opportunity to survive was 37.5 percent. As Justice MARKMAN acknowledges, if a plaintiff dropped from a 99.99 percent premalpractice chance of survival to a 99.97 percent postmalpractice chance of survival, the Waddell formula would conclude that the plaintiff had experienced an actionable 66.67 percent loss of opportunity. On the other hand, recovery would be barred if a plaintiff dropped from a 60 percent premalpractice chance of survival to a 40 percent chance of survival, because the plaintiff would have experienced only a 33 percent loss of opportunity. It is unlikely that the Legislature intended to compensate a loss of just 0.02 percentage points, while simultaneously precluding a loss of 20 percentage points. It is more likely that the Legislature disagreed with the threshold limit for lost-opportunity cases established by Falcon, 37.5 percent, and amended MCL 600.2912a(2) to raise the threshold to 50 percent.

RESPONSE TO CHIEF JUSTICE TAYLOR

While we reach different interpretations of MCL 600.2912a(2), I nevertheless agree with Justice MARKMAN that Chief Justice TAYLOR errs by concluding that the second sentence of the statute is incomprehensible and unenforceable. I share Justice MARKMAN’s objection to the unprecedented approach Chief Justice TAYLOR has taken in concluding that this statute is unenforceable simply *185because it presents a complex matter of interpretation. While the fracture of this Court on this matter certainly illustrates the difficulty of interpreting this statute, I disagree that it compels the conclusion that the statute is unenforceable. And, in fact, Chief Justice Taylor’s opinion paradoxically indicates that the statute will continue to be enforced unless the Legislature amends it, because the Fulton panel’s interpretation will remain controlling law. Ante at 164 n 14.

CONCLUSION

I disagree with Chief Justice Taylor’s conclusion that the second sentence of MCL 600.2912a(2) is incomprehensible and cannot be judicially enforced. Therefore, I respectfully disagree with his analysis of that provision. However, I agree that the jury’s verdict should be upheld, because plaintiff has presented evidence that supports a traditional medical-malpractice claim.

Weaver and Kelly, JJ., concurred with Cavanagh, J.

Markman, J.

(concurring in the result only). We granted leave to appeal to address the proper interpretation of the second sentence of MCL 600.2912a(2), which states: “In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%. ” Chief Justice TAYLOR’S opinion concludes that this sentence is “substantially incomprehensible,” and, therefore, “unenforceable.” Ante at 147, 161, 164. Although this statutory language is by no means a model of clarity, I am in accord with Justice CAVANAGH’s opinion that the “lost opportunity” provision is enforceable. *186However, Justice CAVANAGH concludes that the “lost opportunity” provision requires only that the patient’s premalpractice chance to survive or obtain a better result be greater than 50 percent. Finally, he concludes that this is not even a “lost opportunity” case. In these respects, I also disagree with his opinion.

Instead, I conclude that a “lost opportunity” case is one in which it is at least possible that the bad outcome would have occurred even if the patient had received proper treatment. By contrast, if there is no question that the proper treatment would have resulted in a good outcome, then the patient who has suffered a bad outcome has a traditional medical-malpractice action. In order for a traditional medical-malpractice plaintiff to prevail, he or she must prove that the bad outcome was more probably than not caused by the defendant’s malpractice. In order for a “lost opportunity” plaintiff to prevail, he or she must prove that the “lost opportunity” to achieve a better result was more probably than not caused by the defendant’s malpractice and that the “lost opportunity” was greater than 50 percent. In order to determine whether the “lost opportunity” was greater than 50 percent, the postmalpractice chance of obtaining a better result must be subtracted from the premalpractice chance, the postmalpractice chance must then be subtracted from 100, the former number must be divided by the latter number, and then this quotient must be multiplied by 100 to obtain a percentage. If this percentage is greater than 50, the plaintiff may be able to prevail; if this percentage is 50 or less, then the plaintiff cannot prevail.

Because it is possible that the bad outcome in the instant case, i.e., amputation, would have occurred even if plaintiff had received proper treatment, given that there was some chance of amputation in the latter circum*187stance, this is a “lost opportunity” action. Because plaintiffs “lost opportunity” was greater than 50 percent,1 I would affirm the result reached by the. Court of Appeals.

I. “LOST OPPORTUNITY”

A. COMMON LAW

This Court first recognized a “lost opportunity” claim in Falcon v Mem Hosp, 436 Mich 443; 462 NW2d 44 (1990). In Falcon, the plaintiffs expert witness testified that had the defendant physician not been negligent, the plaintiffs decedent would have had a 37.5 percent chance of surviving. Before Falcon, plaintiffs claiming medical malpractice were required to prove that the malpractice in fact caused the patient’s physical harm. Falcon, 436 Mich at 448-449 (LEVIN, J.). Thus, in a wrongful-death case grounded in medical malpractice, the plaintiff was required to prove that the malpractice in fact caused the patient’s death. In Falcon, the defendants argued that because the patient’s premalpractice chance of survival was only 37.5 percent, the plaintiff could not prove that the malpractice caused the patient’s death; the patient might very well have died even with proper treatment.

Although this Court agreed with the defendants that the plaintiff could not prove that the malpractice caused the patient’s death, it nonetheless held that the plaintiff could prove that the malpractice caused the patient to suffer the loss of a 37.5 percent opportunity to survive. Id. at 460. “In reducing [the patient’s] opportunity of living. . ., her physician caused her harm, although it cannot be said . . . that he caused her death.” Id. “We *188thus see the injury resulting from medical malpractice as not only, or necessarily, physical harm, but also as including the loss of opportunity of avoiding physical harm” because a “patient goes to a physician precisely to improve his opportunities of avoiding, ameliorating, or reducing physical harm . ...” Id. at 461. Thus, we recognized a “loss of an opportunity for a more favorable result, as distinguished from the unfavorable result [itself], as compensable in medical malpractice actions.” Id.2 “Under this approach, damages are recoverable for the loss of opportunity although the opportunity lost was less than even, and thus it is not more probable than not that the unfavorable result would or could have been avoided.” Id. at 461-462.3

*189However, even “[u]nder this approach, the plaintiff must establish more-probable-than-not causation.” Id. at 462. That is, the plaintiff “must prove, more probably than not, that the defendant reduced the opportunity of avoiding harm.” Id. Therefore, in both a traditional medical-malpractice action, in which the alleged injuiy is the physical injury itself, and a “lost opportunity” action, in which the alleged injury is the “lost opportunity” to achieve a better result, the plaintiff must prove that it is more probable than not that the defendant’s malpractice caused the injuiy. In other words, the difference between these two causes of action is not the standard of proof for causation, but the nature of the alleged injury.

This Court also held that the “lost opportunity” must be a “substantial” lost opportunity. Id. at 470. However, this Court did not define the parameters of a “substantial” lost opportunity other than to say that the “loss of a 37.5 percent opportunity of living constitutes a loss of a substantial opportunity of avoiding physical harm.” Id4 This Court explained that a “37.5 percent opportunity of living is hardly the kind of opportunity that any of us would willingly allow our health care providers to ignore.” Id. at 460.5

*190Finally, this Court held that “recovery should be allowed ‘only for the lost chance of survival.’ ” Id. at 471 (citation omitted) (emphasis in original). That is, the “ ‘proper computation of damages would limit the damages recoverable to only that amount of reduced chance of recovery actually caused by the physician’s negligent conduct.’ ” Id. at 472 n 47 (citation omitted). Therefore, we concluded that if the jury were to find that the physician’s malpractice more probably than not had caused the patient to lose a 37.5 percent opportunity to survive, “37.5 percent times the damages recoverable for wrongful death would be an appropriate measure of damages.” Id. at 471.6

In Weymers v Khera, 454 Mich 639, 642; 563 NW2d 647 (1997), this Court refused to “recognize a cause of action for the loss of an opportunity to avoid physical *191harm less than death.”7 Although Weymers did not overrule Falcon, it clearly disagreed with Falcon8 and “refuse[d] to extend Falcon.” Id. at 649. In Weymers, the plaintiffs expert testified that “if defendants had given plaintiff proper care she would have had a thirty to forty percent chance of retaining the functioning of her kidneys.” Id. at 644. However, the plaintiff did not receive proper care and her kidneys totally failed, requiring her to undergo a kidney transplant. Because the plaintiffs premalpractice chance to avoid kidney failure was not greater than 50 percent, Weymers held that she could not prove that the malpractice more probably than not caused her kidney failure. The Court refused to recognize a cause of action for the plaintiffs “lost opportunity” to avoid kidney failure.

In doing so, Weymers, in my judgment, mischaracterized the “lost opportunity” doctrine that had been developed in Falcon. Weymers stated: “The antithesis of proximate cause is the doctrine of lost opportunity,” because the “lost opportunity doctrine allows a plaintiff to recover when the defendant’s negligence possibly, i.e., a probability of fifty percent or less, caused the plaintiffs injury.” Id. at 648. Weymers also accused the *192Falcon Court of “lower[ing] the standard of causation” and “allow[ing] [a plaintiff] to recover without establishing cause in fact.” Id. at 650. Finally, Weymers stated that under the Falcon approach, “the plaintiff must show that there is a substantial possibility that the defendant’s negligence caused his injury,” and, thus, a plaintiff is allowed “to recover for his injury even though it was more likely than not that he would have suffered the injury if the defendant had not been negligent.” Id. at 651.

Although Weymers noted that Falcon had “defined the injury as the loss of opportunity to avoid the harm, i.e., the death, rather than the harm itself,” Weymers failed to recognize the significance of this distinction, as shown by its very next sentence, which stated that Falcon’s approach allows “ ‘a plaintiff [to] receive[] compensation despite the greater probability that he or she would have suffered the injury even if the physician had used due care.’ ” Id. at 651 n 19 (citation omitted). This is further shown by the fact that the Weymers majority believed that it would have to “scrap[]” or “discard” causation in order to “recognize a cause of action for the loss of an opportunity to avoid physical harm less than death.” Id. at 653.

However, as discussed earlier, Falcon did not lower the standard of causation when it adopted the “lost opportunity” doctrine. Falcon, 436 Mich at 462 (LEVIN, J.). Instead, it applied the same standard of causation, i.e., more probable than not, to a new type of injury, i.e., a “lost opportunity” to survive. Id. Falcon specifically held that a plaintiff bringing a “lost opportunity” claim “must prove, more probably than not, that the defendant reduced the opportunity of avoiding harm.” Id. *193Therefore, Weymers erred when it described the “lost opportunity” doctrine developed in Falcon as lowering the standard of causation.

B. STATUTORY PROVISION

In 1993, three years after Falcon was decided, the Legislature enacted MCL 600.2912a(2), which provides:

In an action alleging medical malpractice, the plaintiff has the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant or defendants. In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%.

Everybody agrees that this provision was enacted in response to this Court’s decision in Falcon.

In Wickens v Oakwood Healthcare Sys, 465 Mich 53, 62; 631 NW2d 686 (2001), this Court held that “a living plaintiff may not recover for loss of an opportunity to survive on the basis of a decrease in her chances of long-term survival.” The plaintiffs expert testified that the defendants’ negligent one-year delay in diagnosing her breast cancer had caused plaintiff to suffer a reduction in her chances of surviving another 10 years. This Court relied on the first sentence of MCL 600.2912a(2), which states that a medical-malpractice plaintiff “has the burden of proving that he or she suffered an injury that more probably than not was proximately caused by the negligence of the defendant.” (Emphasis added.) We held that this provision “expressly limits recovery to injuries that have already been suffered and more probably than not were caused by the defendant’s malpractice.” Wickens, 465 Mich at 60. “Thus, plaintiff can only recover for a present *194injury not for a potential future injury.” Id.9 Because the plaintiff in Wickens survived, she had not suffered a loss of an opportunity to survive. Id. That is, a person who survives cannot be said to have suffered a loss of an opportunity to survive. A person does not suffer a loss of an opportunity to survive until that person ceases to survive. Although we held that the surviving plaintiff in Wickens could not bring a claim for a loss of an opportunity to survive, this Court did hold that the plaintiffs claims that the delayed diagnosis resulted in the “need for more invasive medical treatments, emotional trauma, and pain and suffering” could proceed because she had already suffered those injuries. Id. at 61.

In Fulton v William Beaumont Hosp, 253 Mich App 70, 77-78; 655 NW2d 569 (2002), the Court of Appeals described the issue as

whether the second sentence of [MCL 600.2912a(2)] requires a plaintiff in order to recover for loss of an opportunity to survive to show only that the initial opportunity to survive before the alleged malpractice was greater than fifty percent, as argued by plaintiff, or, instead, that the opportunity to survive was reduced by greater than fifty percent because of the alleged malpractice, as argued by defendants.

The Court held that the language “the opportunity” was ambiguous, because it could be referring to the “initial opportunity” or it could be referring to the “loss of opportunity.” Id. at 80. However, because the Court believed that “MCL 600.2912a(2) was enacted to codify and increase the requirements [set forth in Falcon] for *195what constitutes a ‘substantial loss of opportunity,’ ” id. at 82, quoting Falcon, 436 Mich at 470, and because Falcon “did not focus on the initial opportunity to survive, but focused on whether the decrease in the decedent’s opportunity to survive was substantial,” Fulton, 253 Mich App at 81, the Court chose the latter interpretation, id. at 83. That is, the Court held that the “lost opportunity,” not just the initial opportunity, must “exceed 50 percent.” Id.

I agree with this. The second sentence of MCL 600.2912a(2) reads: “In an action alleging medical malpractice, the plaintiff cannot recover for loss of an opportunity to survive or an opportunity to achieve a better result unless the opportunity was greater than 50%. ” (Emphasis added.) This sentence first refers to the “loss of an opportunity” and then to “the opportunity.” In my judgment, the language “the opportunity” clearly refers back to the “loss of an opportunity.” Therefore, the second sentence can reasonably be read to mean that the loss of the opportunity must be greater than 50 percent. In contrast, there is no reasonable means of reading the language “initial opportunity” into the sentence. Therefore, I agree with Fulton’s conclusion that the lost opportunity, not just the initial opportunity, must be greater than 50 percent.10

*196The Court of Appeals in Fulton next concluded that because the plaintiffs premalpractice chance of survival was 85 percent and her postmalpractice chance of survival was 60 percent to 65 percent, her “lost opportunity” was 20 percent to 25 percent and, thus, because the plaintiffs “lost opportunity” was not greater than 50 percent, she could not recover under MCL 600.2912a(2). However, Fulton did not offer any explanation as to why it merely subtracted the postmalpractice chance from the premalpractice chance to determine the “lost opportunity.” This might have been the correct method of determining the “lost opportunity” if MCL 600.2912a(2) required that such a loss be “greater than 50 percentage points.” However, MCL 600.2912a(2) requires that the “lost opportunity” be “greater than 50%. ” There is a significant distinction between 50 percentage points and 50 percent. As Dr. Roy Waddell, a board-certified orthopedic surgeon in Grand Rapids, has explained: “A decrease in survival rate from 50 percent to 10 percent is a 40-percentage-point decrease, but it is an 80 percent decrease.” Wad-dell, A doctor’s view of “opportunity to survive”: Fulton’s assumptions and math are wrong, 86 Mich B J 32, 33 (March 2007) (emphasis in original). Similarly, a reduction in wages from $5 an hour to $1 an hour is not a 4 percent reduction in wages; rather, it is an 80 percent reduction in wages. See amicus curiae brief on behalf of Dr. Roy W Waddell, pp 12-13.11

*197The other problem with Fulton’s method of calculating the “lost opportunity” is that it does not differentiate between those patients who would have survived regardless of whether they received proper or improper treatment and those patients who needed the proper treatment in order to survive.12 Such a differentiation is necessary because only those in the latter group have truly suffered a “lost opportunity” as a result of the improper treatment. That is, if a patient would have survived regardless of whether he received proper or improper treatment, the improper treatment cannot be said to have caused him to lose an opportunity to survive. On the other hand, if the patient would have survived only if he had received the proper treatment, the improper treatment can be said to have caused him to lose an opportunity to survive. MCL 600.2912a(2) requires us to determine whether the patient more likely than not fell into the latter category rather than the former category, because the statute only allows a plaintiff to recover for a “loss of an opportunity” that was “greater than 50%” and that was “caused by the negligence of the defendant.. . .” Dr. Waddell’s calculation does just that:

(Premalpractice chance)13 - (Postmalpractice chance)14 100 - (Postmalpractice chance)

*198The quotient resulting from this numerator and denominator is then multiplied by 100 to obtain a percentage.15 This number must be “greater than 50%” in order to satisfy the requirement of the second sentence of MCL 600.2912a(2). For instance, if the patient’s pre*199malpractice chance to achieve a better result was 80 percent and, as a result of the defendant’s malpractice, the patient’s postmalpractice chance is reduced to 20 percent, the patient has suffered a 75 percent loss of an opportunity to survive.16

What the Waddell formula essentially does is test the sufficiency of the expert testimony, which is typically presented in the form of two statistics: the likelihood that a patient would have had a good outcome with proper treatment (the “treated survival rate”) and the likelihood that a patient would have had a good outcome with negligent treatment (the “untreated survival rate”). The Waddell formula allows a court analyzing this data to determine whether the plaintiff, when the patient has experienced a bad outcome, has created a question of material fact concerning whether proper treatment more likely than not would have made a difference. The formula does this by identifying the universe of patients who would have had a bad outcome (the denominator) and the subset of those patients who could have been favorably treated (the numerator).

It is easiest to start with the formula’s denominator. This denominator consists of the universe of all patients who would have had a bad outcome, for whatever reason. This group includes two subsets of patients: those who would have had a bad outcome because they received negligent treatment, and those who would have had a bad outcome despite receiving proper treatment. The formula identifies this group by subtracting from 100 the percentage of patients who would have had a good outcome even without proper treatment; in other words, it subtracts the “untreated survival rate” *200from 100. In this way, a court can take the expert’s statistics and identify those patients who were not treated properly and who experienced a bad outcome. A patient who is the subject of a medical-malpractice action is a member of this group. But we cannot determine whether the patient is a member of this group because he or she was denied the proper treatment or because he or she would have suffered a bad outcome even with proper treatment.

One more calculation must then be made in order to answer the dispositive question posed by the statute: whether it is more likely than not that the patient would have benefited from proper treatment or, put another way, whether the “opportunity to survive or . . . to achieve a better result” was “greater than 50%.” MCL 600.2912a(2). A court has to determine what percentage of those patients with a bad outcome (those patients in the denominator) would have benefited from treatment. This brings us to the Waddell formula’s numerator. The numerator consists of those patients who would have had a bad outcome only if they had been negligently treated. It is calculated by subtracting the “untreated survival rate” from the “treated survival rate,” thus identifying those patients who required treatment to avoid a bad outcome.

Once the numerator and denominator have been calculated, comparison of these two numbers by their quotient allows a court to reasonably determine whether improper treatment more likely than not made a difference in the patient’s outcome. If the number of patients who would have had a bad outcome only if they had been negligently treated (the numerator) comprises more than half of the number of patients who would have had a bad outcome overall (the denominator), then the plaintiff has established that proper treatment *201more likely than not would have made a difference. In other words, when this has been shown, the plaintiff has created a question of material fact concerning whether the “opportunity”— the benefit that would have been realized by a group of patients from the treatment that was not given to this specific patient — was greater than 50 percent. Such a plaintiff has presented adequate expert testimony to establish a “lost opportunity” cause of action within the meaning of the statute.

As Dr. Waddell has explained:

[T]he intent of the law is to disallow damages unless it can be shown that proper treatment creates a better than even (“greater than 50%”) chance of survival of the patients who would have died without treatment. In other words, if appropriate treatment cannot save at least half of the patients who otherwise would have died, then you do not have sufficient evidence to show that the negligence made the difference in the adverse outcome (death). Conversely, if good treatment can save more than half of the patients who otherwise would have died, then you have adequate evidence that the poor treatment or negligence was likely to blame for the bad outcome. This is exactly what this definition of opportunity measures. [Waddell, 86 Mich B J at 33 (emphasis in original).]

MCL 600.2912a(2) only allows a plaintiff to recover for a “loss of an opportunity” that was “greater than 50%” and that was “caused by the negligence of the defendant ... .” Use of Dr. Waddell’s formula, which generates the actual percentage lost rather than the number of percentage points lost, and excludes those who would have achieved a good result regardless of the malpractice, best ensures, in my judgment, that these statutory requirements are satisfied. That is, this calculation would impose liability, in accordance with MCL 600.2912a(2), in those instances in which the medical *202care received more likely than not affected whether the patient survived.17

II. APPLICATION

Plaintiffs premalpractice chance to obtain a better result was 99 percent, and his postmalpractice chance of obtaining a better result was 95 percent. Pursuant to the Waddell calculation, plaintiff lost an 80 percent opportunity to achieve a better result:

99-95 100 - 95 x 100=80%

Therefore, plaintiffs “lost opportunity” was “greater than 50%. ” Accordingly, plaintiff satisfied the requirements of MCL 600.2912(a)(2). Therefore, I would affirm the result of the Court of Appeals judgment.18

*203III. RESPONSE TO CHIEF JUSTICE TAYLOR

Chief Justice Taylor’s opinion concludes that the second sentence of MCL 600.2912a(2) is “substantially incomprehensible,” and, therefore, “unenforceable.” Ante at 147, 161, 164.19 Although he does not expressly rely on the “void for vagueness” doctrine, he is apparently doing just that, because I am unaware of any other doctrine that would allow a court to conclude that a statutory provision is “unenforceable” on the basis that it is “substantially incomprehensible.” The enactments of the Legislature are, as a rule, enforceable in the courts of this state absent a violation of the Michigan or the United States constitutions.

The “void for vagueness” doctrine derives from the Due Process Clause. “ ‘It is a basic principle of due process that an enactment is void for vagueness if its *204prohibitions are not clearly defined.’ ” People v Howell, 396 Mich 16, 20 n 4; 238 NW2d 148 (1976), quoting Groyned, v City of Rockford, 408 US 104, 108; 92 S Ct 2294; 33 L Ed 2d 222 (1972). “The void-for-vagueness doctrine reflects the principle that ‘a statute which either forbids or requires the doing of an act in terms so vague that [persons] of common intelligence must necessarily guess at its meaning.. . violates the first essential of due process of law.’ ” Roberts v United States Jaycees, 468 US 609, 629; 104 S Ct 3244; 82 L Ed 2d 462 (1984), quoting Connally v Gen Constr Co, 269 US 385, 391; 46 S Ct 126; 70 L Ed 2d 322 (1926). However,

“this prohibition against excessive vagueness does not invalidate every statute which a reviewing court believes could have been drafted with greater precision. Many statutes will have some inherent vagueness, for ‘[in] most English words and phrases there lurk uncertainties.’ Even trained lawyers may find it necessary to consult legal dictionaries, treatises, and judicial opinions before they may say with any certainty what some statutes may compel or forbid. All the Due Process Clause requires is that the law give sufficient warning that men may conduct themselves so as to avoid that which is forbidden.” [People v Petrella, 424 Mich 221, 255; 380 NW2d 11 (1985) (citations omitted).]

The “void for vagueness” doctrine serves three related interests:

“First, because we assume that man is free to steer between lawful and unlawful conduct, we insist that laws give the person of ordinary intelligence a reasonable opportunity to know what is prohibited, so that he may act accordingly. Vague laws may trap the innocent by not providing fair warning. Second, if arbitrary and discriminatory enforcement is to he prevented, laws must provide explicit standards for those who apply them. A vague law impermissibly delegates basic policy matters to policemen, judges, and juries for resolution on an ad hoc and subjective *205basis, with the attendant dangers of arbitrary and discriminatory application. Third, but related, where a vague statute ‘abut[s] upon sensitive areas of basic First Amendment freedoms,’ it ‘operates to inhibit the exercise of [those] freedoms.’ ” [Howell, 396 Mich at 20 n 4, quoting Groyned, 408 US at 108-109.]

I would add that the “void for vagueness” doctrine also ensures that the “judicial power” of this state, see Const 1963, art 6, § 1, is not inappropriately exercised by “interpreting” a statute whose language is simply not susceptible to reasonable interpretation; an attempt to give meaning to such a statute will inevitably devolve into a legislative or policy-making determination on the part of a branch of government whose responsibilities do not entail such determinations.

The “void for vagueness” doctrine has generally been held applicable only to criminal statutes or to laws infringing First Amendment freedoms. Indeed, to the best of my knowledge, this Court has never struck down a civil statute that does not implicate First Amendment freedoms under the “void for vagueness” doctrine. Chief Justice TAYLOR’S opinion cites no Michigan or federal caselaw to the contrary. Nor can any support for his conclusion be found in any of the parties’ briefs or the numerous amicus curiae briefs filed in this Court. Indeed, not one of those briefs even suggests that the “lost opportunity” provision in MCL 600.2912a(2) is unconstitutionally vague.

This Court has held that a

statute may he challenged for vagueness on the grounds that it
—is overbroad, impinging on First Amendment freedoms, or
—does not provide fair notice of the conduct proscribed, or
*206—is so indefinite that it confers unstructured and unlimited discretion on the trier of fact to determine whether an offense has been committed. [Woll v Attorney General, 409 Mich 500, 533; 297 NW2d 578 (1980).]

Chief Justice Taylor’s opinion does not indicate on which of these grounds it finds the “lost opportunity” provision to be unconstitutionally vague. The first ground certainly is not pertinent, because the “lost opportunity” provision does not impinge on any First Amendment freedoms. Neither of the other two grounds seems to be pertinent either, as both seem to pertain to criminal offenses, given that the second ground refers to “the conduct proscribed” and the third ground refers to “whether an offense has been committed.” The “lost opportunity” provision neither “proscribe[s]” conduct nor confers “unlimited discretion on the trier of fact to determine whether an offense has been committed.” Therefore, there does not seem to be any basis under our current case-law to strike down the “lost opportunity” provision as being unconstitutionally vague. Chief Justice TAYLOR should, at the least, explain and justify his extension of this doctrine, which enables this Court to strike down an enactment of the Legislature.

In A B Small Co v American Sugar Refining Co, 267 US 233; 45 S Ct 295; 69 L Ed 589 (1925), the United States Supreme Court held that a buyer could not elude a contract to purchase refined sugar on the basis that the seller was charging an “unjust” or “unreasonable” price in violation of a federal statute, because the federal statute was unconstitutionally vague. It is noteworthy that although American Sugar involved a civil breach-of-contract action, the statutory language invalidated was a criminal statute. However, even putting that aside, the Court held that the provision was unconstitutionally vague because it required people to *207“conform to a rule or standard which was so vague and indefinite that no one could know what it was.” Id. at 238-239. That is, it was so “indefinite as to be unintelligible ....” Id. at 240. In order for something to be “unintelligible,” it must be “not capable of being understood.” Random House Webster’s College Dictionary (1991). As discussed throughout this opinion, I simply do not believe that the provision at issue is incapable of being understood. MCL 600.2912a(2) may conceivably be unwise or imprudent, it could conceivably have been drafted with greater clarity and precision, and its interpretation may require an unusual investment of judicial effort, but it is not incapable of being understood.

In Exxon Corp v Busbee, 644 F2d 1030, 1031 (CA 5, 1981), the United States Court of Appeals for the Fifth Circuit held that a state commercial regulatory statute was not unconstitutionally vague, because it was not “ ‘impossible to divine.’ ” (Citation omitted.) That court explained that “[b]ecause the statute is not concerned with either the first amendment or the definition of criminal conduct,... we must be lenient in evaluating its constitutionality.” Id. at 1033. It further explained that “uncertainty in this statute is not enough for it to be unconstitutionally vague; rather, it must be substantially incomprehensible.” Id. (emphasis added).20 Finally, the court indicated that “the parties themselves have offered possible interpretations” of the provision, and then concluded that “[t]hese attempts at statutory construction illustrate that [the provision] is, while most assuredly not a ‘model of clarity,’ at least amenable to some sensible construction.” Id. at 1034 (cita*208tion omitted). Because I conclude that the “lost opportunity” provision at issue in the instant case is likewise “amenable to some sensible construction,” I strongly disagree with Chief Justice TAYLOR’S conclusion that this|provision should be struck down on the grounds of vagueness.

Furthermore, I must emphasize the well-established rule that “this Court will presume that all legislation is constitutional and will attempt to construe legislation so as to preserve its constitutionality[.]” People v Neumayer, 405 Mich 341, 362; 275 NW2d 230 (1979).

No rule of construction is better settled in this country, both upon principle and authority, than that the acts of a state legislature are to be presumed constitutional until the contrary is shown; and it is only when they manifestly infringe some provision of the constitution that they can be declared void for that reason. In cases of doubt, every possible presumption, not clearly inconsistent with the language and the subject matter, is to be made in favor of the constitutionality of the act. [Sears v Cottrell, 5 Mich 251, 259 (1858) (emphasis in original).]

“We are duty bound under the Michigan Constitution to preserve the laws of this state. . . .” People v Bricker, 389 Mich 524, 528; 208 NW2d 172 (1973). Therefore, “courts [must] construe the language of a statute so as to give it effect rather than to nullify it.” Petrella, 424 Mich at 241. “Every reasonable presumption or intendment must be indulged in favor of the validity of an act, and it is only when invalidity appears so clearly as to leave no room for reasonable doubt that it violates some provision of the Constitution that a court will refuse to sustain its validity.” Cady v Detroit, 289 Mich 499, 505; 286 NW 805 (1939). “We exercise the power to declare a law unconstitutional with extreme caution . . ..” Phillips v Mirac, Inc, 470 Mich 415, 422; 685 NW2d 174 (2004). Therefore, “every statute passed by the Legis*209lature is presumed to be constitutional, and a reviewing court should find an act invalid only when there is no reasonable interpretation which will sustain it.” State Treasurer v Wilson, 423 Mich 138, 146; 377 NW2d 703 (1985). “Indeed, although the presumption is not conclusive, it is powerful enough to permit even a strained construction when necessary to save constitutionality.” Williams v Hofley Mfg Co, 430 Mich 603, 613; 424 NW2d 278 (1998) (citations omitted); see also Osborn v Charlevoix Circuit Judge, 114 Mich 655, 660; 72 NW 982 (1897) (“There is always a presumption in favor of constitutionality, and this presumption justifies a construction which is rather against the natural interpretation of the language used, if necessary to sustain the law.”).

“[Declaring a statute unconstitutional is ‘ “the gravest and most delicate duty that this Court is called on to perform” ’....” People v Lynch, 410 Mich 343, 352; 301 NW2d 796 (1981) (citation omitted). Although I do not necessarily agree that we are obligated to adopt interpretations that are “strained,” Williams, 430 Mich at 613, or “against the natural... language,” Osborn, 114 Mich at 660, I do not believe that the interpretation of MCL 600.2912a(2) set forth in this opinion comes anywhere close to such boundaries. I simply do not think that Chief Justice Taylor’s opinion sufficiently perseveres to avoid the declaration of unconstitutionality that he apparently reaches.21

*210Chief Justice TAYLOR’S opinion concludes that MCL 600.2912a(2) is unenforceable because the two sentences in that provision are inconsistent with one another. Once again, I disagree. Chief Justice TAYLOR states that under the first sentence of MCL 600.2912a(2), a plaintiff must prove that the defendant’s malpractice caused the injury, while under the second sentence, a plaintiff cannot prove that the defendant’s malpractice caused the injury. What he fails to recognize is that in a “lost opportunity” action, the injury is not the death or the physical harm, but the “lost opportunity” to avoid the death or physical harm,22 and that a “lost opportunity” plaintiff does have *211to prove that the defendant’s malpractice more probably than not caused this injury. As we explained in Falcon, 436 Mich at 461 (LEVIN, J.): “We thus see the injury resulting from medical malpractice as not only, or necessarily, physical harm, but also as including the loss of opportunity of avoiding physical harm.” However, even “[u]nder this approach, the plaintiff must establish more-probable-than-not causation.” Id. at 462. That is, the plaintiff “must prove, more probably than not, that the defendant reduced the opportunity of avoiding harm.” Id. Therefore, in both a traditional medical-malpractice action, in which the alleged injury is the death or the physical harm itself, and in a “lost opportunity” action, in which the alleged injury is the “lost opportunity” to avoid the death or the physical harm, the plaintiff must prove that it is more probable than not that the defendant’s malpractice caused the injury.

Contrary to Chief Justice TAYLOR’S contention, then, the two sentences in MCL 600.2912a(2) are not inconsistent. Pursuant to the first sentence, all medical-malpractice plaintiffs must prove that the defendant’s malpractice more probably than not caused the alleged injury. Pursuant to the second sentence, a “lost opportunity” plaintiff must prove that the “lost opportunity” was greater than 50 percent. Therefore, in order to satisfy both sentences, a “lost opportunity” plaintiff must prove that the defendant’s malpractice more probably than not caused the “lost opportunity” and that the “lost opportunity” was greater than 50 percent. There is nothing inconsistent about these sentences.

*212However, there is something inconsistent about Chief Justice Taylor’s opinion. He concludes that the second sentence of MCL 600.2912a(2) is so “substantially incomprehensible” that it is “unenforceable.” Ante at 147, 161, 164. Yet, despite this conclusion, he repeatedly asserts that when the Legislature enacted the second sentence of MCL 600.2912a(2) it “intended” certain things. See, e.g., ante at 158, where the he states that the Legislature “intended” the “lost opportunity” provision to apply to “ situation [s] in which an injury might have occurred anyway, but in which the defendant’s act or omission hastened or worsened it in such a way that the plaintiff suffered more severe physical injury than he or she would have had the negligence not occurred,” and ante at 162, where he states that “the Legislature intended to retain the traditional proximate-cause requirement in effect before Falcon .... ”23 If this provision is so vague — indeed of a constitutional dimension, as Chief Justice TAYLOR’S opinion essentially concludes— how can he be so certain what the Legislature intended by it? Either we know what the Legislature intended by this provision or we do not; Chief Justice TAYLOR cannot have it both ways.

IV RESPONSE TO JUSTICE CAVANAGH

In his opinion, Justice CAVANAGH concludes that the second sentence of MCL 600.2912a(2) requires only that the patient’s premalpractice chance to obtain a better result be greater than 50 percent. As explained *213earlier, I agree with him that the phrase “the opportunity” in MCL 600.2912a(2) refers back to the language “loss of an opportunity.”24 However, I disagree with his conclusion that “loss of an opportunity” refers to the patient’s premalpractice chance to obtain a better result. Instead, I believe that “loss of an opportunity” clearly refers to the opportunity that the patient actually lost as a consequence of the defendant’s malpractice. MCL 600.2912a(2) states that “the plaintiff cannot recover for loss of an opportunity .. . unless the opportunity was greater than 50%. ” (Emphasis added.) That is, the opportunity that MCL 600.2912a(2) refers to is the “lost opportunity” for which the plaintiff may “recover.” The plaintiff cannot necessarily recover for the entire premalpractice chance to obtain a better result; instead, he or she can only recover for the portion of the premalpractice chance that was actually lost. Justice CAVANAGH’s opinion states that “the opportunity alleged to have been lost must be the premalpractice opportunity.” Ante at 174 (emphasis added). This is plainly incorrect. Instead, the chance alleged to have been lost may be the entire premalpractice chance; however, it may also be only a portion of the premalpractice chance, as in the instant case in which plaintiffs opportunity to obtain a better result was reduced from 99 percent to 95 percent. Justice CAVANAGH seems to recognize this, because he states that “the premalpractice opportunity ... is the opportunity that is lost in some measure . . . .” Ante at 174 (emphasis added). In fact, at one point, he seems to reach the same conclu*214sion that I do — “a plaintiff cannot recover for the loss of an opportunity unless the opportunity — the premalpractice opportunity that was allegedly lost in some measure — was greater than 50 percent.” Ante at 174 (emphasis in original). That is, the portion of the premalpractice opportunity that was lost must be greater than 50 percent. However, at other points, he states inconsistently that the word “opportunity” refers only to the premalpractice opportunity. Ante at 174.

Justice CAVANAGH’s opinion also contends that “MCL 600.2912a(2) cannot limit recovery for the loss of an opportunity to cases in which the loss was greater than 50 percent, because any plaintiff who satisfied that condition would have a traditional medical-malpractice claim for the death or physical harm itself.” Ante at 175-176. Justice CAVANAGH similarly contends that Dr. Waddell’s “formula would preclude true lost-opportunity plaintiffs from bringing claims and provide medical-malpractice claimants with lost-opportunity causes of action for which they have no need.” Ante at 182-183. These contentions, I believe, are incorrect. For example, in the instant case, although, pursuant to Dr. Waddell’s formula, plaintiff suffered the loss of an 80 percent opportunity to achieve a better result, i.e., no amputation, plaintiff cannot prove that defendants’ malpractice caused the amputation, as he would be required to do in a traditional medical-malpractice action. He cannot prove that defendants’ malpractice caused the amputation because there was at least a 1 percent chance that plaintiff would have suffered an amputation even with proper treatment. However, plaintiff did prove that defendants’ malpractice caused him to suffer the loss of an 80 percent opportunity to achieve a better result, i.e., no amputation. Therefore, contrary to Justice CAVANAGH’s contention, it is possible to have a situation in which the “lost opportunity” *215exceeds 50 percent, but the plaintiff cannot satisfy the requirements of a traditional medical-malpractice action, and Dr. Waddell’s formula identifies those plaintiffs who cannot satisfy the requirements of a traditional medical-malpractice action but who can satisfy the “lost opportunity” requirements of MCL 600.2912a(2).25

*217In order to satisfy traditional medical-malpractice action requirements, there must be no question that the proper treatment would have resulted in a good outcome (at least with regard to the specific injury suffered by the patient), because if there is any chance that a patient who received proper treatment might nevertheless have suffered the specific bad outcome ultimately suffered by the patient, it cannot be proved that the improper treatment caused the bad outcome. If there is any chance that the proper treatment could have resulted in the bad outcome, the chances of a good outcome with proper treatment and the chances of a good outcome with improper treatment must be compared. That is, under those circumstances, although the plaintiff cannot prove that the defendant’s malpractice caused the bad outcome because the bad outcome might have occurred even with proper treatment, the plaintiff may be able to prove that the defendant’s malpractice increased the patient’s chances of obtaining a bad outcome and, thus, caused him or her to suffer a “lost opportunity” to achieve a better result. This is the only coherent concept of a “lost opportunity” cause of action under MCL 600.2912a(2).26

*218v CONCLUSION

A “lost opportunity” action is one in which it is possible that the bad outcome would have occurred even if the patient had received proper treatment. On the other hand, if there is no question that the proper treatment would have resulted in a good outcome and the patient has suffered a bad outcome, the plaintiff possesses a traditional medical-malpractice action. In order for a traditional medical-malpractice plaintiff to prevail, the plaintiff must prove that the bad outcome was more probably than not caused by the defendant’s malpractice. In order for a “lost opportunity” plaintiff to prevail, the plaintiff must prove that the “lost opportunity” to achieve a better result was more probably than not caused by the defendant’s malpractice and that the “lost opportunity” was greater than 50 percent. In order to determine whether the “lost opportunity” was greater than 50 percent, the postmalpractice chance of obtaining a better result must be subtracted from the premalpractice chance; the postmalpractice chance must then be subtracted from 100; the former number must be divided by the latter number; and then this quotient must be multiplied by 100 to obtain a percentage. The calculation can be summarized as follows:

(Premalpractice chance) - (Postmalpractice chance) x 100 - (Postmalpractice chance)

*219If this percentage is greater than 50, the plaintiff may be able to prevail; if this percentage is 50 or less, then the plaintiff cannot prevail.

Because it is possible that the bad outcome in this case, i.e., amputation, would have occurred even if plaintiff had received proper treatment, the instant case is a “lost opportunity” action. Because plaintiffs “lost opportunity” was greater than 50 percent, I would affirm the result of the Court of Appeals.

Stone v. Williamson
482 Mich. 144

Case Details

Name
Stone v. Williamson
Decision Date
Jul 24, 2008
Citations

482 Mich. 144

Jurisdiction
Michigan

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