Stephens, J.

1. There may be a recovery of damages for mental suffering, humiliation, or embarrassment resulting from a physical injury of which they are inseparable components. The ease of Chapman v. Western Union Telegraph Co., 88 Ga. 763 (15 S. E. 901, 17 L. R. A. 430, 30 Am. St. R. 183), and eases following it, are distinguishable.

2. Any unlawful touching of a person’s body, although no actual physical hurt may ensue therefrom, yet, since it violates a personal right, constitutes a physical injury to that person. See, in this connection, Civil Code (1910), § 4423; Goodrum v. State, 60 Ga. 509. The unlawful touching need not be direct, but may be indirect, as by the precipitation upon the body of a person of any material substance.

3. Since the right 'to recover for a mental condition induced by the tortious act of another is dependent upon the existence of a physical injury, a person suffering a mental condition dependent upon an injury to the person may, in suing to recover damages for the injury, limit the damages to the mental suffering alone, and it is not essential to his right to the recovery of damages for mental suffering that the physical injury out of which the mental suffering arose was productive of any actual physical hurt or damage, or that he should seek a recovery for such actual physical hurt or damage.

4. Where a petition alleged that the plaintiff was an unmarried while lady, and that while in attendance as a guest of the defendant at a circus performance given by the defendant, and while seated in one of the seats provided by the defendant for the defendant’s guests at the circus, a horse, which was going through a dancing performance immediately in front of where the plaintiff was sitting, was by the defendant’s servant, who was riding upon the horse, caused to back towards the plaintiff, and while in this situation the horse evacuated his-bowels into her lap, that this occurred in full view of many people, some of whom were the defendant’s employees, and all of whom laughed at the occurrence, that as a result thereof the plaintiff was caused much embarrassment, mortification, and mental pain and suf*582fering, to her damage in a certain amount, that the damage alleged was due entirely to the defendant’s negligence and without any fault on the part of the plaintiff, the petition set out a cause of action and was good as against a general demurrer.

Decided September 15, 1928.

G. W. Worrill, A. L. Miller, for plaintiff in error.

P. D. Rich, L. B. West, H. G. Rawls, contra.

5. Whether an amendment to the declaration in attachment, which alleged the plaintiff’s damage in a sum larger than the damage claimed in the affidavit as the basis for the- attachment, was or was not properly allowed, its allowance was harmless to the defendant since the amount recovered by the plaintiff was not greater than the amount claimed in the affidavit for attachment, and the verdict for the plaintiff is allowed to stand.

6. A charge that, under a hypothetical state of facts, an inference of negligence on the part of the defendant is authorized does not exclude the idea that a duty rests upon the plaintiff to exercise ordinary care to avoid the consequences of the defendant’s negligence.

7. Where the court instructed the jury that the duty rested upon the plaintiff to exorcise ordinary care, it was not error, in the absence of a special request and in the absence of a plea setting up the defense, for the court to fail to instruct the jury that the duty rested upon the plaintiff to exercise ordinary care to avoid the consequences of the defendant’s negligence.

8. The court having properly instructed the jury as to the relative rights of the parties under the pleadings and the evidence, it was not error to fail to give in charge the definition of a tort as contained in the Civil Code (1910), § 4423.

9. The court, fairly to the defendant, submitted all the issues presented. The evidence authorized the inference that the plaintiff was damaged, by reason of humiliation and embarrassment, in the sum of $500, and the verdict found for her in that amount was authorized.

10. It does not appear that the case was brought to this court for the purpose of delay only, and therefore the motion of the defendant in error to be allowed damages for delay is denied.

Judgment affirmed.

Jenlwns, P. J., and Bell, J., concur.

MELVIN, J.

O. P. Bindley and his wife, Lillian S. Bindley, sued defendant for damages on account of personal injuries, alleged to have been sustained by Mrs. Bindley because of fright occasioned by the appearance and acts of a chimpanzee owned by Knowlton. The complaint contained allegations that the animal was so negligently kept by defendant that it escaped from restraint and entered the dwelling-house of plaintiffs, where Mrs. Bindley and her two little children were at the time; that it attacked the* two children successively, choking one of them severely; that the mother successfully, though with great effort, contended with the chimpanzee, rescuing her children from it, although the beast weighed about 165 pounds; and that in consequence of the said animal entering the house and seizing the children Mrs. Bindley was greatly frightened, shocked, and made sick in body and mind. It was averred that as a consequence her nervous system was disordered; she was rendered hysterical and caused to suffer pain and mental anguish; and that she was confined to her bed for many months as a result of the permanent injuries to her physical health and mind and nervous system. The proof offered tended to sustain these allegations. A verdict was given in favor of plaintiffs for two thousand dollars; judgment was entered accordingly, and defendant appeals from said judgment.

Appellant contends that the court erred in refusing to give certain instructions involving the following propositions: (1) No recovery may be had unless the fright occasioned by defendant was accompanied by some personal and bodily injury; (2) The injury must be a physiological one; and (3) No recovery may be had on account of fright produced by apprehended danger or peril to a third person.

The court did tell the jurors that no verdict might be given for plaintiffs unless Mrs. Bindley received injuries which were the natural consequences of fright caused as. alleged in the complaint. They were told that unless the evidence showed, by a preponderance thereof, that the occurrence recited in the complaint had taken place and was “the efficient, proximate, and producing cause of the injuries complained *300of or of the conditions of ill health, if any, on the part of the plaintiff, Lillian S. Lindley, or some of said conditions or. injuries,” their verdict, must be for,the defendant. Another instruction was to the effect that they might consider Mrs. Lindley’s previous physical condition in determining whether the results of which she complained were or were not the consequences of general ill health. The instructions were full and fair, and the refusal to give those offered by defendant was not error.

Conceding the full force of appellant’s first contention that no damages may be given for mere fright, we are of the opinion that the court sufficiently covered this matter in the instructions to which we have alluded. The complaint was not drawn upon the theory that the lady had merely suffered the mental discomfort of fear, but was based upon a claim of damages for permanent, physical disorders proximately arising from the occurrences set forth in the pleading; and the court carefully instructed the jury that no verdict for plaintiffs should be returned unless under the issues of the case both the fright and the alleged physical consequences thereof were proven by a preponderance of the evidence. The law upon the subject of fright and its consequences has been long settled in California, and settled in a way which disposes of appellant’s contention that the physical injury for which damages may be given must accompany the fright. In Sloane v. Southern California Ry. Co., 111 Cal. 668, 681, [32 L. R A. 193, 44 Pac. 320], in the opinion prepared by Mr. Justice Harrison, quotation is made from Bell v. Great Northern Ry. Co., L. R 26 Ir. 428, a case in which the contention was made that the jury should be told that unless fright was accompanied by physical injury, even though there might be nervous shock occasioned by the fright, such damages would be too remote. The quotation adopted by this court from the opinion in the Bell case was as follows:

“It is admitted that as the negligence caused fright, if the fright contemporaneously caused physical injury, the damage would not be too remote. The distinction insisted upon is --—***' one of time only. The proposition is that, although if an act of negligence produces such an effect upon particular structures of the body as at the moment to afford palpable evidence of physical injury, the relation of proximate cause and effect exists between such negligence and the injury, yet such *301relation cannot in law exist in the casé of a similar act producing upon the same structures an effect which, at a subsequent time—say a week, a fortnight, or a month—must result without any intervening cause in the same physical injury. As well might it be said, that a death caused by poison is not to be attributed to the person who administered it, because the mortal effect is not produced contemporaneously with its administration. ’ ’

And the whole matter is most admirably epitomized in the language of Mr. Justice Harrison in the Sloane case: “Whatever may be the influence by which the nervous system is affected, its action under that influence is entirely distinct from the mental process which is set in motion by the brain. The nerves and nerve centers of the body are a part of the physical system, and are not only susceptible of lesion from external causes, but are also liable to he weakened and destroyed from causes primarily acting upon the mind. If these nerves or the entire nervous system is thus affected, there is a physical injury thereby produced, and, if the primal cause of this injury is tortious, it is immaterial whether it is direct, as by a blow, or indirect through some action upon the mind.”-

The rule which appellant seeks to invoke is only applicable in cases in which fright alone is made the gravamen of action. (Easton v. United Trade School Contracting Co., 173 Cal. 199, [L. R A. 1917A, 394, 159 Pac. 597].) In the case at bar physical detriment was pleaded and there was evidence tending strongly to sustain the allegations of the complaint.

The above quoted and cited authorities fully uphold the action of the court in refusing to give the proffered instructions in two of the classes indicated by defendant. It remains for us to examine the contention that the court should have informed the jury that no recovery may be had on account of fright produced by apprehended danger or peril to a third person. Appellant insists that the authorities arc uniform in upholding this rule. But there is excellent authority to the contrary. (Hill v. Kimball, 76 Tex. 210, [7 L. R A. 618, 13 S. W. 59]; Wilkinson v. Downton, L. R. [1897], 2 Q. B. 57; Cohn v. Ansonia Realty Co., 162 App. Div. 791, [148 N. Y. Supp. 39].) It is not necessary, however, to discuss any conflict of authority on this subject, because in this calse, as in Easton v. United Trade School Con-tracting *302 Co., supra, fear for another was not the only cause of injury. While, of course, Mrs. Lindley was greatly and perhaps, chiefly concerned for her children, for whom she’ fought so valiantly and successfully, there is nothing in the testimony to indicate that she was not concerned for her own safety. All of the circumstances connected with the unexpected appearance of the animal, its attacks upon her children, and her own conflict with the chimpanzee, make it impossible that she should have been devoid of fear for herself. Therefore, under the authority last cited, the court was fully justified in refusing to give the requested instruction on the subject of fears for another person.

No other questions are discussed in the brief of appellant, and we find no others in the record meriting analysis.

The judgment is affirmed.

Wilbur, J., and Lorigan, J., concurred.

HERRMANN, Justice:

The question before us for decision is this: May the plaintiff recover for the physical consequences of fright caused by the negligence of the defendant, the plaintiff being within the immediate zone of physical danger created by such negligence, although there was no contemporaneous bodily impact?

Considering the record in the light most favorable to the plaintiff, the facts may be thus summarized:

A private lane leading to the home of the plaintiff, Dixie B. Robb, was intersected by a railroad right-of-way leased to the defendant, The Pennsylvania Railroad Company. On March 11, 1961, *456the plaintiff was driving an automobile up the lane toward her home when the vehicle stalled at the railroad grade crossing. A rut about a foot deep had been negligently permitted by the defendant to form at the crossing. The rear wheels of the automobile lodged in the rut and, although the plaintiff tried to move the vehicle for several minutes, she was unable to do so. While thus engaged in attempting to move the vehicle, the plaintiff saw the defendant’s train bearing down upon her. With only seconds to spare, she jumped from the stalled vehicle and fled for her life. Immediately thereafter, the locomotive collided with the vehicle, hurled it into the air and demolished it. The pfaintiff was standing within a few feet of the track when the collision occurred and her face was covered with train soot and dirt. However — and this is the nub of the problem — she was not touched by the train; there was no bodily impact; and she suffered no contemporaneous physical injury. Nevertheless, the plaintiff was greatly frightened and emotionally disturbed by the accident as the result of which she sustained shock to her nervous system. The fright and nervous shock resulted in physical injuries including cessation of lactation which interfered with the plaintiffs ability to nurse and otherwise care for her infant child. Her nervous and general physical condition resulting from the accident also obliged the plaintiff to abandon a horse breeding business and an article which she had been engaged to write for substantial compensation.

The defendant moved for summary judgment taking the position that, assuming the defendant’s negligence and its proximate causation of the plaintiffs fright and nervous shock, she may not recover because there was no “impact” and contemporaneous physical injury. The trial judge agreed and granted summary judgment in the defendant’s favor, stating: “In spite of a modern trend to the contrary in other jurisdictions, I feel compelled to follow the ‘impact theory’ in this matter by reason of well established precedents in this State.” The plaintiff appeals, asserting that there are no such governing precedents in Delaware.

I.

The question is still an open one in this State. Two reported Delaware cases and one unreported case border upon the field of *457inquiry, but none really enter it.

In Boyle v. Chandler, 3 W.W. Harr. 323, 138 A. 273 (1927), the Superior Court ruled that there was no right of recovery for mental anguish of surviving relatives arising from the negligent failure of an undertaker to handle the body of the deceased in accordance with instructions, where no physical consequences of such mental suffering were shown. The case of Larrimore v. Homeopathic Hospital Association of Delaware, Del. 181 A.2d 573 (1962), affirming Del. Super., 176 A.2d 362 (1961), involved an action against a hospital for pain and suffering resulting from the alleged mistake of a nurse in injecting a drug by needle instead of orally as instructed by the attending physician. There, in considering the hospital’s contention that no recovery for pain and suffering may be had because there was no actionable impact causing the pain and suffering, this court concluded that it did not reach, and was not required to pass upon, the question of the applicability of the “impact rule” because the pain and suffering were the direct result of the injection. The unreported Delaware case to which reference has been made is Williamson v. Wilmington Housing Authority (Superior Court of New Castle County, No. 1627 C.A. 1960) in which the Superior Court ruled that a mother may not recover for mental anguish she suffered when she came upon the accident scene and observed her child who had just been injured by a railroad train, the mother herself not having been in the path of danger.

It is obvious that the question here presented remains unresolved in this State. The instant case requires us to determine the matter.

II.

The many decisions on the question are collected in the Annotations at 11 A.L.R. 1119, 40 A.L.R. 983, 76 A.L.R. 681, 98 A.L.R. 402 and 64 A.L.R.2d 100. The cases and their underlying principles have been discussed by distinguished scholars in this field of the law, including Goodrich, “Emotional Disturbance as Legal Damage”, 20 Mich.L.Rev. 497; Smith, “Relation of Emotions to Injury and Disease”, 30 Va.L.Rev. 193; Green, “Fright Cases”, 27 Ill.L.Rev. *458761; Magrader, “Mental and Emotional Disturbance in the Law of Torts”, 49 Harv.L.Rev. 1033; Hallen, “Damages for Physical Injuries Resulting from Fright or Shock”, 19 Va.L.Rev. 253; Bohlen, “Right to Recover for Injury Resulting from Negligence Without Impact”, 41 Am. Law Reg. 141; Throckmorton, “Damages for Fright”, 34 Harv.L.Rev. 260; Pollock on Torts (14th Ed.) 38;Prosser on Torts (3d Ed.) pp. 346, 350-352; and 2 Harper and James, The Law of Torts, Sec. 18.4, p. 1033.

There is sharp diversity of judicial opinion as to the right to recover for the physical consequences of fright in the absence of an impact and contemporaneous physical injury. The disparity is strikingly illustrated by the fact that the courts of our neighboring States of Maryland and Pennsylvania have reached, and continue to adhere to, opposite conclusions on the question. See Bowman v. Williams, 164 Md. 397, 165 A.182(1923); Bosley v. Andrews, 393 Pa. 161, 142 A.2d 263 (1958).

Two facets of the question are herewith eliminated from further consideration: First, it is accepted as settled that there can be no recovery for fright alone, not leading to bodily injury or sickness, arising from the negligence of another. See Boyle v. Chandler, supra; 2 Harper and James, The Law of Torts, p. 1031; 64 A.L.R.2d 100, 115, et seq. The plaintiff here concedes that proposition, stating however that she does not seek to recover for fright alone but for the physical consequences thereof. Secondly, we are not here concerned with the situation, such as existed in the Williamson case, wherein fright arose from the peril of another and the plaintiff was not in the path of the danger created by the negligence asserted. That segment of the problem has likewise given rise to contrariety of opinion. See Bowman v. Williams, supra; Annotations at 18 A.L.R.2d 220 and 64 A.L.R.2d 100, 148. We lay that question aside for another day, interesting as it may be, because the instant case does not require us to decide it.

The two schools of thought in the matter at hand evolved from two lines of cases originating about the turn of the century. The impact rule was established in America by the leading cases of Ewing v. *459 Pittsburgh, etc. R. Co., 147 Pa. 40, 23 A. 340, 14 L.R.A. 666 (1892); Mitchell v. Rochester R. Co., 151 N.Y. 107, 45 N.E. 354, 34 L.R.A. 781 (1896); and Spade v. Lynn & Boston R. Co., 168 Mass. 285, 47 N.E. 88, 38 L.R.A. 512 (1897). These cases reflected the influence of the earlier English case of Victorian Railways Commissioners v. Coultas, 13 App. Cas. 222 (1888), recognized generally as the first notable case to espouse the impact rule. The Coultas case was quickly overruled, however by Dulieu v. White & Sons, 2 K.B. 669 (1901) which settled the law in England from then on in favor of recovery for physical injuries resulting from nervous shock induced by negligence, without actual impact. Nevertheless, the trend favoring the impact rule had attained a head-start .in America by reason of the Ewing, Mitchell and Spade cases and it spread to numerous other jurisdictions under the influence of those cases. The doctrine denying recovery was not accepted universally, however. In Purcell v. St. Paul, etc., Ry. Co., 48 Minn. 134, 50 N.W. 1034, 16 L.R.A. 203 (1892) and Mack v. South Bound R. Co., 52 S.C. 323, 29 S.E. 905, 40 L.R.A. 679 (1897) the contrary rule was adopted; and, following those two leading cases, which represented the minority view for a long time, the courts of an increasing number of jurisdictions have been adopting the rule allowing recovery for injury due to fright induced by negligence without impact; until today the latter is recognized as the majority rule. See 2 Harper and James, The Law of Torts, p. 1034.

The impact rule is based, generally speaking, upon three propositions expounded in the Mitchell and Spade cases:

1) It is stated that since fright alone does not give rise to a cause of action, the consequences of fright will not give rise to a cause of action. This is now generally recognized to be a non-sequitur, want of damage being recognized as the reason that negligence causing mere fright is not actionable. It is now generally agreed, even in jurisdictions which have adopted the impact rule, that the gist of the action is the injury flowing from the negligence, whether operating through the medium of physical impact or nervous shock. See Comstock v. Wilson, 257 N.Y. 231, 177 N.E. 431, 76 A.L.R. 676 (1931); Alabama Fuel & *460 Iron Co. v. Baladoni, 15 Ala.App. 316, 73 So. 205 (1916).

2) It is stated that the physical consequences of fright are too remote and that the requisite causal connection is unprovable. See, e.g., Ward v. West Jersey & S. R. Co., 65 N.J.L. 383, 47 A. 561 (1900). The fallacies of this ground of the impact rule, viewed in the light of growing medical knowledge, were well stated by Chief Justice Maltbie in Orlo v. Connecticut Co., 128 Conn. 231,21 A.2d 402 (1941). It was there pointed out that the early difficulty in tracing a resulting injury back through fright or nervous shock has been minimized by the advance -of medical science; and that the line of cases permitting recovery for serious injuries resulting from fright, where there has been but a trivial impact in itself causing little or no injury, demonstrate that there is no insuperable difficulty in tracing causal connection between the wrongdoing and the injury via the fright. See also Comstock v. Wilson, supra.

3) It is stated that public policy and expediency demand that there be no recovery for the physical consequences of fright in the absence of a contemporaneous physical injury. See, e.g., Mitchell v. Rochester R. Co., supra; Huston v. Freemansburg Borough, 212 Pa. 548, 61 A. 1022, 3 L.R.A., N.S., 49 (1905); Bosley v. Andrews, supra. In recent years, this has become the principal reason for denying recovery on the basis of the impact rule. In support of this argument, it is said that fright is a subjective state of mind, difficult to evaluate, and of such nature that proof by the claimant is too easy and disproof by the party charged too difficult, thus making it unsafe as a practical matter for the law to deal with such claims. This school of thought concludes that to permit recovery in such cases would open a “Pandora’s Box” of fictitious and fraudulent claims involving speculative and conjectural damages with which the law and medical science cannot justly cope. See Bosley v. Andrews, supra. The expediency ground was termed a matter of “administrative policy” for each jurisdiction in the Restatement of the Law of Torts, Sec. 436, Caveat to Subsection (2). It is noteworthy that this Caveat was removed by the 1948 Supplement to the Restatement (p. 740) in recognition of the accelerating trend of the law away from the impact rule and of the *461proven reliability of medical testimony necessary to establish the causal connection between negligence and an ultimate injury.

In considering the expediency ground, the Supreme Court of Connecticut said in the Orlo case, supra:

“* * * There is hardly more risk to the accomplishment of justice because of disparity in possibilities of proof in such situations than in those where mental suffering is allowed as an element of damage following a physical injury or recovery is permitted for the results of nervous shock provided there be some contemporaneous slight battery or physical injury. Certainly it is a very questionable position for a court to take, that because of the possibility of encouraging fictitious claims compensation should be denied those who have actually suffered serious injury through the negligence of another.”

On the same point, the Supreme Court of Maryland had this to say in the Bowman case, supra:

“* * * These considerations undeniably tend to multiply fictitious or speculative claims, and to open to unscrupulous litigants a wide field for exploitation, but these difficulties are common, are surmountable, and so should not prevent the operation of the general and fundamental theory of the common law that there is a remedy for every substantial wrong. * * *”

And in Battalia v. State, 10 N.Y.2d 237 (219 N.Y.S.2d 34, 176 N.E.2d 729 (1961), the Court of Appeals of New York finally completed the repudiation of the Mitchell case, one of the original leading proponents of the impact rule, stating as to the public policy argument:

“* * * Although fraud, extra litigation and a measure of speculation are, of course, possibilities, it is no reason for a court to eschew a measure of its jurisdiction. ‘The argument from mere expediency cannot commend itself to a Court of justice, resulting in the denial of a logical legal right and remedy in all cases because in some a *462fictitious injury may be urged as a real one.’ Green v. T. A. Shoemaker & Co., 111 Md. 69, 81, 73 A. 688, 692, 23 L.R.A., N.S., 667.”

III.

It is our opinion that the reasons for rejecting the impact rule far outweigh the reasons which have been advanced in its support.

The cause of action and proximate cause grounds for the rule have been discredited in the very jurisdictions which first gave them credence. As stated by Holmes, C. J., for the Supreme Judicial Court of Massachusetts, the Spade decision did not result from “a logical deduction from the general principles of liability in tort, but as a limitation of those principles upon purely practical grounds.” Smith v. Postal Telegraph Cable Co., 174 Mass. 576, 55 N.E. 380, 47 L.R.A. 323 (1899). Or, as stated by the same eminent jurist on another occasion, he deemed exemption from such damages to be “an arbitrary exception, based upon a notion of what is practicable.” Homans v. Boston Elevated R. Co., 180 Mass. 456, 62 N.E. 737, 57 L.R.A. 291 (1902). And, referring to the Mitchell case and the grounds here under consideration, Lehman, J., speaking for the New York Court of Appeals, stated: “Its conclusions cannot be tested by pure logic. The court recognized that its views of public policy to some extent dictated its decision,” Comstock v. Wilson, supra. The repudiation by New York appears clearly in Battalia v. State, supra, where it is recorded that “the unanimous court in Comstock rejected all but the public policy arguments of the Mitchell decision.” Similarly, in the third jurisdiction in which the impact rule had its origin, the cause of action and proximate cause grounds are no longer given as justifications for the doctrine. The Supreme Court of Pennsylvania relied wholly upon stare decisis and the public policy argument in its most recent consideration of the problem. See Bosley v. Andrews, supra.

If more were needed to warrant a declination to follow the cause of action and the proximate cause arguments, reference to the fictional and mechanical ends to which the impact rule has been carried would *463suffice for the purpose. The most trivial bodily contact, itself causing little or no injury, has been considered sufficient to take a case out of the rule and permit recovery for serious physical injuries resulting from the accompanying fright. Token impact sufficient to satisfy the rule has been held to be a slight bump against the seat, Homans v. Boston Elevated R. Co., supra; dust in the eyes, Porter v. Del., L. & W. R. Co., 73 N.J.L. 405, 63 A. 860 (1906); inhalation of smoke, Morton v. Stack, 122 Ohio St. 115, 170 N.E. 869 (1930); a trifling bum, Kentucky Traction & Term. Co. v. Roman’s Guardian, 232 Ky. 285, 23 S.W. 2d 272 (1929); Jostling in an automobile, Israel v. Ulrich, 114 Conn. 599, 159 A. 634 (1922); indeed any degree of physical impact, however slight, Zelinsky v. Chimics, 196 Pa. Super. 312, 175 A. 2d 351 (1961). See especially Christy Bros. Circus v. Turnage, 38 Ga. App. 581, 144 S.E. 680 (1928).

This leaves the public policy or expediency ground to support the impact rule. We think that ground untenable.

It is the duty of the courts to afford a remedy and redress for every substantial wrong. Part of our basic law is the mandate that “every man for an injury done him in his * * * person * * * shall have remedy by the due course of law * * *.” Del. Const. Art. 1, Sec. 9, Del. C. Ann. Neither volume of cases, nor danger of fraudulent claims, nor difficulty of proof, will relieve the courts of their obligation in this regard. None of these problems are insuperable. Statistics fail to show that there has been a “flood” of such cases in those jurisdictions in which recovery is allowed;* but if there be increased litigation, the courts must willingly cope with the task. As to the danger of illusory and fictional claims, this is not a new problem; our courts deal constantly with claims for pain and suffering based upon subjective symptoms only; and the courts and the medical profession have been found equal to the danger. Fraudulent claims may be feigned in a slight-impact case as well as in a no-impact case. Likewise, the problems *464of adequacy of proof, for the avoidance of speculative and conjectural damages, are common to personal injury cases generally and are surmountable, being satisfactorily solved by our courts in case after case.

We are unwilling to accept a rule, or an expediency argument in support thereof, which results in the denial of a logical legal right and remedy in all cases because in some a fictitious injury may be urged or a difficult problem of the proof or disproof of speculative damage may be presented. Justice is not best served, we think, when compensation is denied to one who has suffered injury through the negligence of another merely because of the possibility of encouraging fictitious claims or speculative damages in other cases. Public policy requires the courts, with the aid of the legal and medical professions, to find ways and means to solve satisfactorily the problems thus presented — not expedient ways to avoid them. We recognize that “ [e] xpediency may tip the scales when arguments are nicely balanced,” Woolford Realty Co. v. Rose, 286 U.S. 319, 330, 52 S.Ct. 568, 570, 76 L.Ed. 1128; but, in our view, such nice balance no longer exists as to the subject matter.

Accordingly, we decline to adopt the impact rule, as urged by the defendant in this cause. The impact rule “is almost certainly destined for ultimate extinction, although it displays surprising vitality, and the process may not be a rapid one. * * * it seems clear that the courts which deny all remedy in such cases are fighting a rearguard action.” Prosser on Torts (3d Ed.) pp. 351 — 352.

We hold, therefore, that wtiere negligence proximately caused fright, in one within the immediate area of physical danger from that negligence, which in turn produced physical consequences such as would be elements of damage if a bodily injury had been suffered, the injured party is entitled- to recover under an application of the prevailing principles of law as to negligence and proximate causation. Otherwise stated, where results, which are regarded as proper elements of recovery as a consequence of physical injury, are proximately caused by fright due to negligence, recovery by one in the immediate zone of *465physical risk should be permitted. Compare Restatement of the Law of Torts, Sections 313,436.

This view has the general approval of the writers on the subject and is now distinctly the majority rule. We are satisfied that it is the better rule, supported by reason, logic and fairness.

We conclude, therefore, that the Superior Court erred in the instant case in holding that the plaintiffs right to recover is barred by the impact rule. The plaintiff claims physical injuries resulting from fright proximately caused by the negligence of the defendant. She should have the opportunity to prove such injuries and to recover therefor if she succeeds. The summary judgment granted in favor of the defendant must be reversed and the cause remanded for further proceedings.

Opinion by

Mr. Justice Roberts,

Appellant, Harry Niederman, alleges that on November 4, 1962 he was walking with his son at the corner of 15th and Market Streets in Philadelphia. At that, time, appellant’s complaint asserts, appellee was driving a motor vehicle in a reckless and negligent manner as a result of which the automobile skidded onto the sidewalk and destroyed or struck down a fire hydrant, a litter pole and basket, a newsstand and appellant’s son, who at that time was standing next to appellant. Almost immediately after this destructive path was cut by appellee’s car, appellant claims that he suffered severe chest pain and that upon examination in the hospital, where he was confined for five *403weeks, appellant was diagnosed to have sustained acute coronary insufficiency, coronary failure, angina pectoris, and possible myocardial infarction. Consequently, appellant sought recovery from appellee for both these severe disabilities and the accompanying shock and mental pain.

Appellant’s complaint was reluctantly dismissed on preliminary objections for failing to state a cause of action under the “impact rule” which provides that there can be no recovery for the consequences of fright and shock negligently inflicted in the absence of contemporaneous impact. Appellant admitted that the careering automobile had never struck his person. The judge noted “The impact rule will, no doubt, eventually be rejected as was the formerly well-entrenched rule of charitable immunities. It is regrettable that Harry Niederman, the plaintiff in this action, may not be afforded the opportunity to prove that his injuries are just as real, just as painful, just as disabling as if he had been struck physically by defendant’s motor vehicle. . . . However, we are bound by the law as set forth by the Supreme Court.”

Today the cows come home.1 We decide that on the record before us, appellant may go to trial and if he proves his allegations, recovery may be had from a negligent defendant, despite the fact that appellant’s injuries arose in the absence of actual impact. “It is fundamental to our common law system that one may seek redress for every substantial wrong. ‘The best statement of the rule is that a wrongdoer is responsible for the natural and proximate consequences of his misconduct ....’” Battalla v. State, 10 N.Y. 2d 237, 240, 219 N.Y.S. 2d 34, 36, 176 N.E. 2d 729, 730 (1961). By our holding today Pennsylvania proceeds along the path recently followed by our neighboring jurisdictions,1 see *404 Falzone v. Busch, 45 N.J. 559, 214 A. 2d 12 (1965); Robb v. Pennsylvania Railroad Company, 210 A. 2d 709 (Del. 1965); Battalla v. State, supra, aud removes this ancient roadblock to appellant’s recovery.

Were we to do otherwise, appellant and those who are severely injured in a like manner would be barred from recovery in our courts. But the gravity of appellant’s injury and the inherent humanitarianism of our judicial process and its responsiveness to the current needs of justice dictate that appellant be afforded a chance to present his case to a jury and perhaps be compensated for the injury he has incurred. The Restatement has adopted a view in harmony with this approach: “§436 ... (2) If the actor’s conduct is negligent as creating an unreasonable risk of causing bodily harm to another otherwise than by subjecting him to fright, shock, or other similar and immediately emotional disturbance, the fact that such harm results solely from the internal operation of fright or other emotional disturbance does not protect the actor from liability.” Restatement (Second), Torts §436(2).

We believe that it is not sufficient to perpetuate the old impact rule simply in the name of precedent. Each and every objection raised in the past which would preclude appellant in this case from going to trial can now be answered effectively and persuasively.

An analysis of the prior case law indicates that there have been three basic arguments which in the past would have defeated appellant. The first deals *405with medical science’s difficulty in proving causation between the claimed damages and the alleged fright. The second involves the fear of fraudulent or exaggerated claims. Finally, there is the concern that such a rule will precipitate a veritable flood of litigation. See, e.g., Knaub v. Gotwalt, 422 Pa. 267, 220 A. 2d 646 (1966) (not the view of a majority of the court); Bosley v. Andrews, 393 Pa. 161, 142 A. 2d 263 (1958); Huston v. Freemansburg Borough, 212 Pa. 548, 61 Atl. 1022 (1905); Ewing v. Pittsburgh Railway Co., 147 Pa. 40, 23 Atl. 340 (1892).

The first objection has been variously stated but the quotation set out below is representative of some earlier judicial sentiments. “In most cases, it would be impossible for medical science to prove that these subjective symptoms could not possibly have resulted from or been aggravated or precipitated by fright or nervous tension or nervous shock or emotional disturbance or distress .... Medical science, we repeat, could not prove that these could not have been caused or precipitated, or aggravated by defendant’s alleged negligent act.” Bosley v. Andrews, 393 Pa. at 168-69, 142 A. 2d at 267. (Emphasis supplied.) While we agree that this might have been an appropriate conclusion because of the lack of sophistication in the medical field when the impact doctrine was first announced in 1888,2 it would presently be inappropriate for us to ignore all of the phenomenal advances medical science has achieved in the last eighty years. Today diseases of *406tbe heart, for example, are comprehended much more fully (to the extent that open heart surgery is almost an everyday occurrence), and the effects of hyperemotional states of the human body no longer are shrouded in mystery or myth.

New equipment and research, improved education and diagnostic techniques, and an increased professional understanding of disease in general require us now to give greater credit to medical evidence. Other jurisdictions have also recognized that this advancement in the medical arts should and could be legitimately reflected in changes in the legal field. See, e.g., Battalla, v. State, 10 N.Y. 2d 237, 219 N.Y.S. 2d 34, 176 N.E. 2d 729 (1961) (“we must... rely to an extent on the contemporary sophistication of the medical profession”); Robb v. Pennsylvania Railroad Company, 210 A. 2d 709, 712 (Del. 1965) (“the early difficulty in tracing a resulting injury back through fright or nervous shock has been minimized by the advance of medical science”). Finally, The American Law Institute through a deletion of a caveat from one of its comments,3 has expressed a similar view.

The logical invalidity of this objection to medical proof can be demonstrated further by noting that the rule has only. been applied where there is absolutely no impact whatsoever. Once there is even the slightest *407impact, it has been held that the plaintiff can recover for any damages which resulted from the accompanying fright, even though the impact had no causal connection with the fright-induced injuries. The rule has been stated: “However, where, as here, a plaintiff sustains bodily injuries, even though trivial or minor in character, which are accompanied by fright or mental suffering directly traceable to the peril in which the defendant’s negligence placed the plaintiff, then mental suffering is a legitimate element of damages.” Potere v. Philadelphia, 380 Pa. 581, 589, 112 A. 2d 100, 104 (1955).

It appears completely inconsistent to argue that the medical profession is absolutely unable to establish a causal connection in the case where there is no impact at all, but that the slightest impact (e.g., a bruised elbow and sprained ankle in Potere)4 suddenly bestows upon our medical colleagues the knowledge and facility to diagnose the causal connection between emotional states and physical injuries. It can easily be urged that recent advances in medical science have bestowed this ability upon physicians; but it is illogical to argue that the presence of some slight injury has accomplished the same effect! As the Supreme Court of our neighboring state of Delaware recently said: “. . . the line of cases permitting recovery for serious injuries resulting from fright, where there has been but a trivial impact in itself causing little or no injury, demonstrates that there is no insuperable difficulty in *408tracing cansal connection between the wrongdoing and the injury via the fright.” Robb v. Pennsylvania Railroad Company, 210 A. 2d at 712.

Finally, even if we assume arguendo that a great deal of difficulty still remains in establishing the causal connection, this still does not represent sufficient reason to deny appellant an opportunity to prove his case to a jury. There is no reason to believe that the causal connection involved here is any more difficult for lawyers to prove or for judges and jurors to comprehend than many others which occur elsewhere in the law. “We realize that there may be difficulties in determining the existence of a causal connection between fright and subsequent physical injury and in measuring the extent of such injury. However, the problem of tracing a causal connection from negligence to injury is not peculiar to cases without impact and occurs in all types of litigation ... in any event, difficulty of proof should not bar the plaintiff from the opportunity of attempting to convince the trier of fact of the truth of her claim.” Falzone v. Busch, 45 N.J. 559, 566, 214 A. 2d 12, 15-16 (1965). We recognize the recent view of the New Jersey Supreme Court as representative of current jurisprudence.

The second major objection includes the fear of fictitious injuries and fraudulent claims. It has been expressed with varying degrees of politeness: first, in Huston v. Freemansburg Borough, 212 Pa. 548, 550-51, 61 Atl. 1022, 1023 (1905), the Court indicated its lack of respect for claims like this by observing: “In the last half century, the ingenuity of counsel, stimulated by the cupidity of clients and encouraged by the prejudices of juries, has expanded the action for negligence.

. . . It requires but a brief judicial experience to be convinced of the large proportion of exaggeration and even of actual fraud in the ordinary action for physical injuries from negligence, and if we opened the door *409to this new invention the result would be great danger, if not disaster to the cause of justice.” In recent cases, that concern has been expressed in a more charitable manner but the same denial of recovery for severe injuries has been the result. “For every wholly genuine and deserving claim, there would likely be a tremendous number of illusory or imaginative or ‘faked’ ones.” Bosley v. Andrews, 393 Pa. at 169, 142 A. 2d at 267.

The charge that fraudulent claims will arise is not unique to this Commonwealth. Every court that has been confronted with a challenge to its impact rule has been threatened with the ominous spectre that an avalanche of unwarranted, trumped-up, false and otherwise unmeritorious claims would suddenly cascade upon the courts of the jurisdiction. The virtually unanimous response has been that (1) the danger of illusory claims in this area is no greater than in cases where impact occurs and that (2) our courts have proven that any protection against such fraudulent claims is contained within the system itself—in the integrity of our judicial process, the knowledge of expert witnesses, the concern of juries and the safeguards of our evidentiary standards.

For the first proposition, the New Hampshire Supreme Court provides us with significant support. “From the viewpoint of analogy, allowance for mental pain, and for injury to mind and nerve as well as body, is given as items of damage in all cases of liability for personal injury where there is impact. It would seem practically as easy to pretend them and as difficult to disprove them in such cases as in cases where there is no impact and fright is the intervening agency of transmittal.” Chiuchiolo v. New England Wholesale Tailors, 150 Atl. 540, 543 (N.H. 1930). See Savard v. Cody Chevrolet, Inc., 234 A. 2d 656, 659 (Vt. 1967) (quoting Ghiuehiolo). In addition, it is abundantly clear that in the Potere case, supra, where the injury was slight *410and unrelated, the opportunity for fraud was just as great; yet in that situation recovery was allowed. See Battalla, v. State, 10 N.Y. 2d 237, 241, 219 N.Y.S. 2d 34, 37, 176 N.E. 2d 729, 731 (1961) (“fraudulent accidents and injuries are just as easily feigned in the slight-impact cases”).

Furthermore, we are unable to accept the proposition that our courts and the judicial system in general cannot deal with fraudulent claims when they arise. Factual, legal, and medical charlatans are unlikely to emerge from a trial unmasked. This same thought has been given compelling exposition in recent opinions by the highest courts of our neighboring states, Delaware,5 New Jersey,6 and New York.7 We, of course, join these and other authorities8 in rejecting as patently falla*411cions the argument that would bar actions such as appellant’s because some other litigants might present false or feigned claims. “Public policy requires the courts, with the aid of the legal and medical professions, to find ways and means to solve satisfactorily the problems thus presented—not expedient ways to avoid them.” Robb v. Pennsylvania, Railroad, Company, 210 A. 2d at 714.

The last argument urged by the proponents of the impact rule is that: “If we permitted recovery in a case such as this, our Courts would be swamped by a virtual avalanche of cases for damages for many situations and cases hitherto unrecoverable in Pennsylvania.” Knaub v. Gotwalt, 422 Pa. at 271, 220 A. 2d at 847. However, it is our view that this argument is currently refuted on two grounds. First, it is not at all clear that the flood of litigation has occurred in states without the impact rule. “The truth of the matter is that the feared flood tide of litigation has simply not appeared in states following the majority rule allowing recovery of psychic injuries without impact. The volume of litigation has been heaviest in states following the Mitchell doctrine and its impact rule. See McNiece, Psychic Injury and Tort Liability in New York, 24 St. John’s L. Rev. 132 (1949) . . . .” Lambert, Tort Liability for Psychic Injuries, 41 Boston U. L. Rev. at 592. Even those who do not believe that the amount of litigation is greater in jurisdictions with the impact rule, maintain that there has been no in *412 crease in those states which have abandoned this doctrine. Okrina v. Midwestern Corp., 165 N.W. 2d 259, 263 (Minn. 1969) (“there is no indication that it [the abandonment of the impact rule] has either spawned a flood of litigation or bred a rash of fraudulent claims since its adoption in 1892”); see Smith, Relation of Emotions to Injury and Disease, 30 Va. L. Rev. 193 (1944); Comment, Injuries From Fright Without Contact, 15 Cleve.-Mar. L. Rev. at 336 (1966).

Secondly, and more compelling than an academic debate over the apparent or real increases in the amount of litigation, is the fundamental concept of our judicial system that any such increase should not be determinative or relevant to the availability of a judicial forum for the adjudication of impartial individual rights. “It is the business of the law to remedy wrongs that deserve it, even at the expense of a ‘flood of litigation’; and it is a pitiful confession of incompetence on the part of any court of justice to deny relief upon the ground that it will give the courts too much work to do.” Prosser, Intentional Infliction of Mental Suffering: A New Tort, 37 Mich. L. Rev. 874 (1939). We obviously do not accept the “too much work to do” rationale. We place the responsibility exactly where it should be: not in denying relief to those who have been injured, but on the judicial machinery of the Commonwealth to fulfill its obligation to make itself available to litigants. Who is to say which class of aggrieved plaintiffs should be denied access to our courts because of speculation that the workload will be a burden? Certainly this Court is unwilling to allow such considerations to influence a determination whether a class of litigants will be denied or permitted to seek adjudication of its claims. See Robb v. Pennsylvania Railroad Company, 210 A. 2d at 714 (Del. 1965) (“if there be increased litigation, the courts must willingly cope with the task”); Falzone v. Busch, 214 A. 2d at 16 (N.J. 1965) (“the proper remedy is an *413expansion of the judicial machinery, not a decrease in the availability of justice”); Battalla v. State, 176 N.E. 2d at 731 (N.Y. 1961) (“it is the duty of the courts to willingly accept the opportunity to settle these disputes”).

We have carefully examined the arguments in support of the old impact rule. It seems clear to us that even if these rationales may have had validity in earlier years, in 1969 continued adherence to the rule makes little sense. We believe that our analysis of the underpinnings of the impact doctrine proves that they are now so weak and that the arguments opposing the doctrine are so strong that an overruling of earlier cases is compelled.

We today choose to abandon the requirement of a physical impact as a precondition to recovery for damages proximately caused by the tort in only those cases like the one before us where the plaintiff was in personal danger of physical impact because of the direction of a negligent force against him and where plaintiff actually did fear the physical impact. Since appellant’s complaint alleges facts which if proven will establish that the negligent force was aimed at him and put him in personal danger of physical impact, and that he actually did fear the force, this case must proceed to trial.

The order of the Court of Common Pleas of Philadelphia County is reversed and appellee’s preliminary objections are dismissed.

Dissenting Opinion by

Mr. Chief Justice Bell:

The Majority too often forget that an emotionally appealing or heart-rending claim often produces bad law* and sets a dangerous precedent.

*414Pandora’s Box

The majority Opinion commits three tremendous and grievous errors in overruling Pennsylvania’s “impact rule.” The first regrettable and disastrous error is that they open Pandora’s famous Box, out of which will flow a multiplicity of trespass suits for personal injuries and/or diseases. These will include the most fictitious or false or exaggerated claims that the imagination can conceive—based upon (as the Majority assert) the direction of a negligent force so near a plaintiff that he feared a dangerous physical impact.

A Guessing Game

The second major error of the Majority is that they not only substitute a “medical guessing game” for Pennsylvania’s clear and definite and well-established “impact rule,” but add a “Judicial guessing game.” Few writers* and few States can agree on a clear and definite formula for recovery, and the Majority itself cannot formulate a clear, specific, definite and boundarized rule or standard for recovery in this so-called “impact” field, which the Majority now abolish. It is difficult to imagine stronger reasons for not abandoning Pennsylvania’s clear and well-established impact rule than the jumble of diverse, indefinite and farfetched views set forth in the majority Opinion.

*415Stare Decisis

The third major error of the Majority is that they deal another fatal or near-fatal blow to stare decisis. Once again a majority of the present Supreme Court has cavalierly buried or ignored the basic principle and the fundamental precept upon which the House of Law was built and maintained. Upon this Rock of Gibraltar, all Judges and all public officials, as well as all the people of Pennsylvania, can see and know and rely on their respective rights, their powers, their duties, their obligations and limitations. It is regrettable to be compelled to say that a decision of the present Court of Pennsylvania is good “for this day and this train only.” What a catastrophe, and what a mockery of Law and of Justice!

What this Court said was well-established and sound law as recently as 1966 has today been rendered by the Majority obsolete and worthless by “all of the phenomenal advances medical science has achieved in the last 80 years.” Can anything be more ridiculous than the argument that because of the phenomenal advances of medical science in the last 80 years something has miraculously come to light in this particular medical field in the last three years?

In Knaub v. Gotwalt, 422 Pa. 267, 220 A. 2d 646 (1966), we said (page 270) : “‘The rule is long and well established in Pennsylvania that there can be no recovery of damages for injuries resulting from fright or nervous shock or mental or emotional disturbances or distress, unless they are accompanied by physical injury or physical impact: Koplin v. Louis K. Liggett Co., 322 Pa. 333, 185 A. 744; Ewing v. Pittsburgh C. & St. L. Ry. Co., 147 Pa. 40, 23 A. 340; Fox v. Borkey, 126 Pa. 164; Huston v. Freemansburg Borough, 212 Pa. 548, 61 A. 1022; Morris v. Lackawanna and Wyoming Valley Railroad Co., 228 Pa. 198, 77 A. 445; *416Howarth v. Adams Express Company, 269 Pa. 280, 112 Atl. 536; Hess v. Philadelphia Transportation Co., 358 Pa. 144, 56 A. 2d 89; Potere v. Philadelphia, 380 Pa. 581, 112 A. 2d 100; Gefter v. Rosenthal, 384 Pa. 123, 119 A. 2d 250.’ Bosley v. Andrews, 393 Pa. 161, 164, 142 A. 2d 263.* This rule was reaffirmed as recently as Cucinotti v. Ortmann, 399 Pa. 26, 159 A. 2d 216 [1960].”

In Cucinotti v. Ortmann, 399 Pa., supra, Justice Cohen, speaking for all the members of this Court except Justice Musmanno, said (page 29) : “It is the well-settled rule in Pennsylvania that there can be no recovery of damages for unintentional injuries resulting from fright or nervous shock or mental or emotional disturbances or distress, unless they are accompanied by physical injury or physical impact: Bosley v. Andrews, 393 Pa. 161, 142 A. 2d 263 (1958); Koplin v. Louis K. Liggett Co., 322 Pa. 333, 185 Atl. 744 (1936); Ewing v. Pittsburgh C. & St. L. Ry. Co., 147 Pa. 40, 23 Atl. 340 (1892).”

Mr. Justice Oliver Wendell Holmes repeatedly and eloquently emphasized that “the life of the law has not been logic; it has been [human] experience.” Holmes, The Common Law. In Homans v. Boston El. Ry. Co., 180 Mass. 456, 62 N.E. 737, that Court, speaking through Justice Holmes, reaffirmed the so-called “impact rule,” and aptly said “that [it] prevents a recovery for visible illness resulting from nervous shock alone.”

In Huston v. Freemansburg Borough, 212 Pa. 548, 61 Atl. 1022, Chief Justice Mitchell, speaking for a unanimous Court, stated there can be no recovery of damages for fright or other mental suffering unconnected with physical injury, and said: “It requires but *417 a brief judicial experience to be convinced of the large proportion of exaggeration and even of actual fraud in the ordinary action for physical injuries from negligence, and if we opened the door to this new invention the result would be great danger, if not disaster to the cause of practical justice:* Spade v. Lynn & Boston R. R. Co., 168 Mass. 285; Mitchell v. Rochester Ry. Co., 151 N.Y. 107. If, therefore, the question were new, we should see no reason to reach a different conclusion. But it is settled for this State, and is no longer open to discussion. . . .”

This Court has iterated and reiterated this well-established rule or principle of Stare Decisis based on Judicial experience numerous times before and since Huston, 212 Pa. (1905),** supra.

In Burtt Will, 353 Pa. 217, 44 A. 2d 670, the Court said (pages 231, 232) : “The doctrine of stare decisis still prevails in Pennsylvania. . . . This Court has always rigidly adhered to the rule of stare decisis. . . . All of the cases reciting our policy to adhere strictly to the rule of stare decisis need not be collected and reviewed. What was said by us in a few of the latest cases will suffice: Mr. Chief Justice Maxey said in Monongahela St. Ry. v. Phila. Co. et al., 350 Pa. 603, 616, 39 A. 2d 909, ‘The doctrine of stare decisis is recognized and applied by the courts of this Commonwealth . . and in Davis v. Pennsylvania Co., etc., 337 Pa. 456, at 464, 12 A. 2d 66: ‘An interpretation of law consistently followed by an appellate court over so long a period that it has become fundamentally imbedded *418in the common law of the Commonwealth should not be changed except through legislative enactment, which is a remedy always available and the proper one under our scheme of government. Otherwise the law would become the mere football of the successively changing personnel of the court, and “the knowne certaintie of the law”, which Lord Coke so wisely said “is the safe-tie of all”, would be utterly destroyed.’ ” (Italics in Burtt Will Opinion.)

In Bosley v. Andrews, 393 Pa. 161, 142 A. 2d 263, this Court (in a decision with only two dissents) said (pages 168-169) : “To allow recovery for fright, fear, nervous shock, humiliation, mental or emotional distress—with all the disturbances and illnesses which accompany or result therefrom—where there has been no physical injury or impact, would open a Pandora’s box. . . . For every wholly genuine and deserving claim, there would likely be a tremendous number of illusory or imaginative or Talced’ ones.”

By permitting recovery in cases such as this—for alleged mental, emotional, psychic or physical injuries, without physical impact, the Majority will, we repeat, open wide the doors to an avalanche of fraudulent or emotional or imaginary illness claims which will unfairly delay thousands of meritorious claims, and will swamp our already tremendously overburdened Courts and make a joke out of Justice.

One enormously important problem which the Majority blithely ignore is that while medical science has made tremendous progress in this century, it has not yet reached a stage of knowledge where it can prove with any certainty—or without a tremendous diversity of sincere opinion which would therefore amount to nothing but a guess—both medical and legal causation, especially in the emotional disturbance and heart disease fields.

I will give a few of the very many examples that will occur to everyone: A plaintiff might be-driving *419her car alertly or with her mind preoccupied, when a sudden or unexpected or exceptionally loud noise of hn automobile horn behind or parallel with her car, or a nearby sudden loud and unexpected fire engine bell or siren, or a nearby sudden unexpected frightening buzz-saw noise, or a nearby unexpected explosion from blasting or dynamiting, or a nearby unexpected nerve-wracking noise produced by riveting on a street, or the shrill and unexpected blast of a train at a spot at a nearby crossing, or the witnessing of a nearby horrifying accident, or the approach of a car near or over the middle line, even though it is driven to its own side in ample time to avoid an accident, or any one of a dozen other everyday nearby events—each of these can cause or aggravate fright or nervous shock or emotional distress or nervous tension or mental disturbance and physical ills. If any one of these and other events are compensable, without physical impact, it may cause normal people, as well as nervous persons and persons who are mentally disturbed or mentally ill, to honestly believe that the sudden and unexpected event nearby and believed by them to be threatening, caused them fright or nervous shock or nervous tension with subsequent emotional distress or suffering or pain or heart attack or miscarriage, or some kind of disease or physical injury. In most cases, it would be impossible for medical science to prove that these subjective symptoms could or could not possibly have resulted from or been aggravated or precipitated by fright or nervous shock or nervous tension or emotional disturbance or distress, each of which can in turn produce an ulcer or headaches or fainting spells or, under some circumstances, a heart attack, or a serious disease or other injurious results. Medical science, I repeat, could not prove but could only guess whether these could or could not have been caused or precipitated or aggravated by defendant’s alleged negligent act.

*420Here the plaintiff alleges that he suffered a variety of heart attacks immediately after defendant’s car skidded onto the sidewalk and struck down a fire hydrant, a litter pole and basket, a newsstand, and injured plaintiff’s son who was standing next to the plaintiff when the accident occurred. While the chain of events may have contributed to or caused Mr. Niederman’s heart attacks, there are innumerable other possible situations which could have contributed to plaintiff’s alleged heart attacks but in which no legal causation could be established.* Equally important, it is a matter of universal medical knowledge that numerous people walk the streets and countrysides engaged in their normal daily pursuits who have had heart disease for months or for several years without its having manifested itself.

Should we say to Stare Decisis, Quo Vadis? Or is Stare Decisis like Antaeus, who was lifted from but returned to the earth, or like Mohammed’s coffin, which is suspended between Heaven and earth, with no one knowing when or which way it will rise or fall? Or is it like Nineveh and Tyre, which were destroyed, but every now and then are restored to temporary glory? *421Today, no one knows from week to week or from Court session to Court session what the law is today or yesterday (retroactive decisions) or what it will be tomorrow. How can anyone know today what the law will be tomorrow, or what anyone’s rights, privileges, powers, duties, responsibilities, limitations and liabilities are, or will be?

The basic principle of Stare Decisis which is the bedrock for all our Law is not as immutable as the law of the Medes and the Persians. It may be changed by the Legislature and, under some circumstances, it may be changed by the Courts. I would hold that the principle of Stare Decisis should always be applied, irrespective of the changing personnel of this (or any Supreme) Court, except (1) where the Supreme Court of Pennsylvania is convinced that prior decisions of the Court are irreconcilable; or (2) the application of a rule or principle has undoubtedly created great confusion; or (3) a rule of law has been only fluctuatingly applied; or (4) to correct a misconception in an occasional decision; or (5) in those rare cases where the Supreme Court is convinced that the reason for the law undoubtedly no longer exists, and modern circumstances and Justice combine to require or justify a change, and no one’s present personal rights or vested property interests will be injured by the change. Change of circumstances or modern circumstances does not mean, nor has it ever heretofore been considered as the equivalent of change of personnel in the Court, or the substitution of the social or political philosophy of a Judge for the language of the Constitution or of a written instrument, or for well-settled principles of law.

Mr. Justice Owen J. Roberts, Pennsylvania’s most illustrious member of the Supreme Court of the United States, in a dissenting Opinion in Smith v. Allwright, 321 U.S. 649, 669, thus aptly and strikingly expressed his views concerning the erosion or abolition of the *422principle of Stare Decisis: “The reason for my concern is that the instant decision, overruling that announced about nine years ago, tends to bring adjudications of this tribunal into the same class as a restricted railroad ticket, good for this day and train only. I have no assurance, in view of current decisions, that the opinion announced today may not shortly be repudiated and overruled by justices who deem they have new light on the subject.”

Mr. Justice Frankfurter, in his concurring Opinion in Green v. United States, 356 U.S. 165, 192, said: “To say that everybody on the Court has been wrong for 150 years and that that which has been deemed part of the bone and sinew of the law should now be extirpated is quite another thing. . . . The admonition of Mr. Justice Brandéis that we are not a third branch of the Legislature should never be disregarded.”

Mr. Justice Douglas, who is generally regarded as the leading opponent of Stare Decisis, in an article written for the Columbia Law Review of June 1949, Yol. 49, p. 735, said: “Uniformity and continuity in law are necessary to many activities. If they are not present, the integrity of contracts, wills, conveyances and securities is impaired. And there will be no equal justice under law if a negligence rule is applied in the morning but not in the afternoon. Stare Decisis provides some moorings so that men may trade and arrange their affairs with confidence. Stare Decisis serves to take the capricious element out of law and to give stability to a society. It is a strong tie which the future has to the past.”

Mr. Justice Eagen well expressed the same concern for Stare Decisis in the recent case of Commonwealth v. Woodhouse, 401 Pa. 242, 253, 164 A. 2d 98 (1960) : “Unquestionably, in a republican form of government as we are privileged to enjoy, order, certainty and stability in the law are essential for the safety and pro*423tection of all. Stare Decisis should not be trifled with. If the law knows no fixed principles, chaos and confusion will certainly follow. ... If it is clear that the reason for a law no longer exists and modern circumstances and justice require a change, and no vested rights will be violated, a change should be made.”

What Chief Justice Black said for this Court in McDowell v. Oyer, 21 Pa. 417, 423 (1853), concerning Stare Decisis, is presently most apposite, viz., “It is sometimes said that this adherence to precedent is slavish; that it fetters the mind of the judge, and compels him to decide without reference to principle. But let it be remembered that stare decisis* is itself a principle of great magnitude and importance. It is absolutely necessary to the formation and permanence of any system of jurisprudence. Without it Ave may fairly be said to have no law; for law is a fixed and established rule, * not depending in the slightest degree on the caprice of those who may happen to administer it.”

Moreover, I may add that which is often forgotten by the Majority—it is one of the most important duties of an appellate Court to erect legal signposts with language inscribed thereon so clearly, definitely, Avisely and well that they who read may easily understand. This the Majority have likewise failed to do, in this case.

For the above reasons, I very strongly dissent.

OPINION

NIX, Justice.

At issue in this appeal is the vexing and complex question of when a plaintiff should be allowed to recover damages for negligently caused mental trauma.1 The specific question presented for our review is whether the trial court properly sustained appellee’s demurrer to the fourth count of appellant’s complaint in which she sought to recover damages for physical and mental injuries incurred when she saw her minor daughter struck and killed by an automobile, although the plaintiff herself was not within any zone of personal physical danger and had no reason to fear for her own safety. For the reasons set forth below, we believe the demurrer was improperly sustained and therefore reverse the trial court and order the parties to proceed to trial on the fourth count of the complaint.

It is axiomatic in the law of pleading that preliminary objections in the nature of a demurrer admit as true all well and clearly pleaded material, factual averments and all inferences fairly deducible therefrom. Yania v. Bigan, 397 Pa. 316, 155 A.2d 343 (1959); Byers v. Ward, 368 Pa. 416, 84 A.2d 307 (1951). Conclusions of law and unjustified inferences are not admitted by the pleading. Lerman v. Rudolph, 413 Pa. 555, 198 A.2d 532 (1964). Starting from this point of *150reference the complaint must be examined to determine whether it sets forth a cause of action which, if proved, would entitle the party to the relief sought. If such is the case, the demurrer may not be sustained. On the other hand, where the complaint fails to set forth a cause of action, a preliminary objection in the nature of a demurrer is properly sustained. Finally, where the propriety of an order sustaining a demurrer is being reviewed by a court of last resort, the fact that the theory for recovery relied upon has not been previously sanctioned, is not conclusive. It must be remembered that “[ejvery cause of action . . ., however, was once a novel claim, and the absence of Pennsylvania authority for appellant’s proposition is not an end to the issue.” Papieves v. Kelly, 437 Pa. 373, 376-77, 263 A.2d 118, 120 (1970).

The averred facts are as follows. Appellant JoAnne Marie Sinn lived with her husband and two minor children in Elizabeth Township, Allegheny County. On June 12, 1975, at approximately 5:53 p. m., the deceased, Lisa Sinn, and her sister, Deborah, were standing by the Sinn’s mail box located along side the Greenock-Buena Vista Road, approximately 36 feet from the nearest intersection. An automobile operated by the appellee struck Lisa and hurled her through the air, causing injuries which resulted in her death. Deborah was not struck by the vehicle, although it narrowly missed her. Appellant witnessed the accident from a position near the front door of her home. The Sinns filed a four-count trespass complaint against appellee on June 3, 1976. The first and second counts were brought under the Wrongful Death and Survival acts, respectively. The third count was brought for Deborah for psychological damages she sustained as a result of watching her sister die.2 *151The fourth count was brought by appellant for damages she sustained from the emotional stress of witnessing her daughter’s death. It states, inter alia :

22. Plaintiff, JoANNE MARIE SINN, is the mother of LISA ANNE SINN, deceased, and resides in the Township of Elizabeth, County of Allegheny, Pennsylvania.

* * * * * *

24. Defendant’s vehicle did not strike Plaintiff.

25. At the time of the aforesaid accident, the Plaintiff was observing the deceased from a position at or near the front door of her home.

26. The Plaintiff became hysterical, unnerved, and emotionally shattered as she viewed the Defendant’s automobile strike and kill her daughter, LISA ANNE SINN.

27. As a result of watching the aforementioned accident, the Plaintiff suffered a shock to her nerves and nervous system, and sustained grievous mental pain and suffering resulting in severe depression and an acute nervous condition.

28. As a result of the foregoing, Plaintiff was required to expend money for medicines and/or tranquilizers, and may be required to expend considerable sums for the treatment of her resulting injuries and mental suffering in the future.3

*152Appellee filed preliminary objections in the nature of a demurrer to the third and fourth counts claiming that the complaint failed to aver that Deborah and appellant were in personal danger of physical impact, that they feared such physical impact, or that they suffered physical injury as a result of the emotional distress caused by the accident. The Allegheny County Court of Common Pleas Civil Division, sitting en bane, overruled the demurrer as to the third count but sustained it as to the fourth. Based on its reading of Niederman v. Brodsky, 436 Pa. 401, 261 A.2d 84 (1970), and subsequent Superior Court decisions, that court ruled that while Deborah was within the zone of danger and hence could proceed with her action, appellant was not within the zone of danger. Appellant appealed to the Superior Court which affirmed without opinion. Sinn v. Burd, 253 Pa.Super. 627, 384 A.2d 1003 (1978). We granted allocatur.

I.

Prior to the beginning of this decade, this state was a firm adherent to the “impact rule” regulating recovery for dam*153ages in tort. See, e. g., Knaub v. Gotwalt, 422 Pa. 267, 270, 220 A.2d 646, 647 (1966) and cases cited therein.4 This rule prevented the complaining party from recovering damages for injuries resulting from fright, nervous shock, or mental or emotional disturbances, unless this distress was accompanied by physical impact — i. e., physical injury — upon the person of the complaining party. Our cases applied this rule with obstinate rigidity5 in that recovery was denied not only when the complaining party was a nearby witness, but also to the actual victim of the tortfeasor’s negligent or frightening conduct. See, e. g, Bosley v. Andrews, 393 Pa. 161, 142 A.2d 263 (1958).

In the first month of this decade, this Court joined the ranks of forward-looking jurisdictions and abandoned the impact rule in Niederman v. Brodsky, 436 Pa. 392, 261 A.2d 84 (1970) (Niederman ). In Niederman, an automobile skidded onto a sidewalk, narrowly missed the plaintiff, but struck his son who was standing beside him. The plaintiff, although untouched by the automobile, suffered a heart attack which required hospitalization. The trial court dismissed plaintiff’s complaint for its failure to allege any physical impact. In an opinion by Mr. Justice Roberts, this Court reversed the dismissal, abandoned the impact rule, and adopted the zone of danger theory.» That is, “where the plaintiff was in personal danger of physical impact because of the direction of a negligent force against him and where plaintiff actually did fear the physical impact,” Niederman at 413, 261 A.2d at 90, he could recover for the shock, mental pain, and physical injuries attendant to the negligent incident even though he was not struck by the negligent force.

*154In so doing, we recognized that our decision was compelled by the “inherent humanitarianism of our judicial process.” Id., 436 Pa. at 404, 261 A.2d at 85. Furthermore, the three basic arguments supporting the impact rule had been eroded away by societal and technological advancements. We consequently rejected the arguments that medical science would be unable to prove a causal nexus between the claimed damages and the alleged fright or mental distress, id., 436 Pa. at 405-08, 261 A.2d at 86-87; that the possibility of recovery in such cases would encourage fictitious injuries and fraudulent claims, id., 436 Pa. at 408-11, 261 A.2d at 87-89; and that the courts would be swamped by a virtual avalanche of cases, id., 436 Pa. at 411-13, 261 A.2d at 89.

It was not until mid-decade that the appellate courts of this state were presented with the question of whether a bystander outside the zone of physical danger could recover for physical or mental injury caused by viewing the serious injury or death of a loved one. In Scarf v. Koltoff, 242 Pa.Super. 294, 363 A.2d 1276 (1976), a husband, while crossing the street was struck and injured by a vehicle negligently driven by the defendant. The victim’s wife witnessed the accident and as a result of the shock of the experience, she suffered a myocardial infarction or aggravation of a pre-existing cardiac condition, and died two months later. The man survived his injuries and brought survival and wrongful death actions based upon the death of the wife. These actions were dismissed by the trial court and the Superior Court affirmed, citing the failure of the complaint to allege that the wife was herself in danger of physical impact or that she feared such impact. The Superior Court recognized that our Niederman decision required such a possibility of fear of physical impact as a predicate to successful recovery on the part of the wife’s estate. Additionally, that court found two policy reasons against extending coverage to bystanders such as the wife: the problem of unlimited and unduly burdensome liability, and the difficulty of reasonably circumscribing the area of liability. See 242 Pa.Super. at 299, 363 A.2d at 1279. In so ruling, the Superior Court *155relied heavily upon the New York case of Tobin v. Grossman, 24 N.Y.2d 609, 301 N.Y.S.2d 554, 249 N.E.2d 419 (1969).

Building upon the Scarf and Niederman decisions, the Superior Court found that the plaintiff was within the zone of danger in Bowman v. Sears, Roebuck & Co., 245 Pa.Super. 530, 369 A.2d 754 (1976). Ms. Bowman and her two adult daughters were shopping in a Sears store when Ms. Bowman saw five men employed by the store accost and forcibly remove her daughters from the shopping area. The daughters were detained for thirty minutes and upon their return, found their mother in a state of great anxiety which led to her suffering a heart attack. Ms. Bowman’s complaint for damages alleged that her injury resulted not only from the mental anguish and shock of seeing the assault upon her daughters, but also from her own fear of physical attack by the same store employees. The Superior Court found that the mother had pleaded a claim within the zone of danger theory and thus presented a triable question of fact for the jury.

II.

In Niederman we stated that:

[i]t is fundamental to our common law system that one may seek redress for every substantial wrong. The best statement of the rule is that a wrong-doer is responsible for the natural and proximate consequences of his misconduct.

Niederman at 403, 261 A.2d at 85.

The zone of danger concept was our attempt to provide meaningful redress for damages caused by mental distress.

Since the Niederman decision, experience has taught us that the zone of danger requirement can be unnecessarily restrictive and prevent recovery in instances where there is no sound policy basis supporting such a result.6 It has ' unquestionably not been effective in every instance of assur*156ing that one may “seek redress for every substantial wrong.” The restrictiveness of the zone of danger test is glaringly apparent where it is allowed to deny recovery to a parent who has suffered emotional harm from witnessing a tortious assault upon the person of his or her minor child. A majority of the commentators and a growing number of jurisdictions have considered this problem in recent years and have concluded that it is unreasonable for the zone of danger requirement to exclude recovery in such cases.7

This new awareness of the unfairness of the zone of danger requirement in these cases is based upon the implicit *157acceptance that the emotional impact upon a parent witnessing the killing of a minor child is at least as great and as legitimate as the apprehension that is inspired by a plaintiff being personally within the zone of danger. Dissatisfaction with the zone of danger concept was explained in this manner by one commentator:

Insofar as the “field of danger” test in third party cases was designed to serve the general policies of (1) protecting the court system against fraudulent or trivial claims by frustrating suits instituted by uninvolved bystanders who merely happen to witness an accident, and (2) protecting defendants from liability for an injury which results more from the particular emotional makeup of plaintiff than from the nature of defendant’s actions, court reluctance to impose liability for emotional harm to eyewitnesses in general is understandable. In at least one instance, however, the rule fails to serve these policy objectives. A severe emotional injury to a parent who witnesses the negligent killing of his or her child is certainly foreseeable. An emotional injury claim in such an instance would hardly be frivolous or trivial, nor would it be unjust to defendant.

♦ * * * * *

In cases involving peril or harm to another, the “field of danger” test is unnecessary to protect the integrity of the judicial system or to avoid burdening defendant with unforeseeable injuries in cases where plaintiff witnesses harm to an immediate family member.

Comment, 1977 Wisc.L.Rev. 1089, 1096 (1977) (footnotes omitted).

Applications of the zone of danger test to situations where the death or serious injury of a child is witnessed by a parent creates the very evil that the test was designed to eliminate, i. e., arbitrariness. It would bar recovery depending upon the position of the plaintiff at the time of the event, and ignores that the emotional impact was most probably influenced by the event witnessed — serious injury *158to or death of the child — rather than the plaintiff’s awareness of personal exposure to danger.8

Our cases have recognized five policy arguments relevant to bystander recovery. They are medical science’s supposed difficulty in proving causation between the claimed damages and the alleged fright, the fear of fraudulent or exaggerated claims, the concern that to allow such a recovery will precipitate a veritable flood of litigation, the problem of unlimited and unduly burdensome liability, and the difficulty of reasonably circumscribing the area of liability. We will discuss them seriatim.

Medical science is able to supply a causal link between the psychic damage suffered by the bystander and the shock or fright attendant to having witnessed the accident.

It has long been assumed that medical science is unable to establish that the alleged psychic injuries in fact resulted from seeing a gruesome accident. See, e. g., Huston v. Freemansburg Boro., 212 Pa. 548, 550, 61 A. 1022 (1905), describing a cause of action for mental disturbance as being intangible, untrustworthy, illusory, and speculative.9 Ad*159vancements in medical and psychiatric science throughout this century have discredited these hoary beliefs. Niederman, 436 Pa. at 405 — 08, 261 A.2d at 86-87.10 One commentor concisely answered this question in 63 Geo.L.J. 1179, 1184-85 (1975):

The growing competence of medical science in the field of psychic injuries has diminished the problems of proof in mental distress cases. The development of psychiatric tests and the refinement of diagnostic techniques has led some authorities to conclude that science can establish with reasonable medical certainty the existence and severity of psychic harm. In cases involving negligently inflicted mental distress, however, changes in the law have not kept pace with the increased sophistication of psychiatry. Special rules created to deal with problems of proof that were a legitimate concern in mental distress cases 50 years ago have restricted modern courts in their handling of these claims, (footnotes omitted.)

Additionally, as we stated in the Niederman case:

*160Finally, even if we assume arguendo that a great deal of difficulty still remains in establishing the causal connection, this still does not represent sufficient reason to deny appellant an opportunity to prove his case to a jury. There is no reason to believe that the causal connection involved here is any more difficult for lawyers to prove or for judges and jurors to comprehend than many others which occur elsewhere in the law . . . [I]n any event, difficulty of proof should not bar the plaintiff from the opportunity of attempting to convince the trier of fact of the truth of her claim.

Niederman at 408, 261 A.2d at 87 (emphasis in the original).

Advancements in modern science lead us to further conclude that psychic injury is capable of being proven despite the absence of a physical manifestation of such injury. Some courts in abandoning the impact rule permit recovery for emotional distress only where the plaintiff can prove that the psychic injury caused her to suffer physical damage as well. See, e. g., Dziokonski v. Babineau, 380 N.E.2d 1295 (Mass.1978); Hughes v. Moore, 214 Va. 27, 197 S.E.2d 214 (1973) . This requirement of resulting physical injury is another synthetic device to guarantee the genuineness of the claim. Leong v. Takasaki, 55 Haw. 398, 520 P.2d 758, 763 (1974); Bystander’s Recovery for Negligently Inflicted Mental Distress, 29 Ark.L.Rev. 562, 564 (1976). We agree with the Leong court that

[bjecause other standards exist to test the authenticity of plaintiff’s claim for relief, the requirement of resulting physical injury, like the requirement of physical impact, should not stand as another artificial bar to recovery, but merely be admissible as evidence of the degree of mental or emotional distress suffered.

Leong v. Takasaki, 520 P.2d at 762.

Bystander recovery will not open the courthouse door to fictitious injuries and fraudulent claims.

Courts upholding and those courts denying bystander recovery agree that concern over fraud is without justifica*161tion. See, e. g., Tobin v. Grossman, 24 N.Y.2d 609, 615, 249 N.E.2d 419, 422, 301 N.Y.S.2d 554, 558-59 (1969) (denying recovery); Dillon v. Legg, 68 Cal.2d 728, 69 Cal.Rptr. 72, 77, 441 P.2d 912 (1968) (allowing recovery). The commentators are in accord with the judicial rejection of this argument.11 One medicolegal expert takes the view that with the development of medical and psychiatric understanding of methods of ascertaining psychic injury, “[v]ery rarely, today, can a malingerer recover damages.” Cantor, Psychosomatic Injury, Traumatic Psychoneurosis, and Law, 6 Cleve.-Mar.L.Rev. 428, 435 (1957). See also, id., at 435-37.

The reasons that compelled us to reject this argument in Niederman are equally valid today:

[W]e are unable to accept the proposition that our courts and the judicial system in general cannot deal with fraudulent claims when they arise. Factual, legal, and medical charlatans are unlikely to emerge from a trial unmasked. This same thought has been given compelling exposition in recent opinions by the highest courts of our neighboring states, Delaware, New Jersey, and New York. We, of course, join these and other authorities in rejecting as patently fallacious the argument that would bar actions such as appellant’s because some other litigants might present false or feigned claims. “Public policy requires the courts, with the aid of the legal and medical profes*162sions, to find ways and means to solve satisfactorily the problems thus presented — not expedient ways to avoid them.” Robb v. Pennsylvania Railroad Company, 210 A.2d (709) at 714.

Neiderman, 436 Pa. at 410-11, 261 A.2d at 88-89 (footnotes omitted).

The fear of a flood of similar litigation is an insufficient reason to deny bystander recovery.

This consideration focuses upon the belief that to grant recovery in the instant case would cause our courts to “be swamped by a virtual avalanche of cases.” Knaub v. Gotwalt, 422 Pa. at 271, 220 A.2d at 647. Again, commentators and courts on both sides of the recovery issue agree that this fear is specious.12 As we stated in Niederman:

*163[T]he fundamental concept of our judicial system [is] that any [caseload] increase should not be determinative or relevant to the availability of a judicial forum for the adjudication of impartial individual rights. “It is the business of the law to remedy wrongs that deserve it, even at the expense of a ‘flood of litigation’; and it is a pitiful confession of incompetence on the part of any court of justice to deny relief upon the ground that it will give the courts too much work to do.” Prosser, Intentional Infliction of Mental Suffering: A New Tort, 37 Mich.L.Rev. 874 (1939). We obviously do not accept the “too much work to do” rationale. We place the responsibility exactly where it should be: not in denying relief to those who have been injured, but on the judicial machinery of the Commonwealth to fulfill its obligation to make itself available to litigants. Who is to say which class of aggrieved plaintiffs should be denied access to our courts because of speculation that the workload will be a burden? Certainly this Court is unwilling to allow such considerations to influence a determination whether a class of litigants will be denied or permitted to seek adjudication of its claims. See Robb v. Pennsylvania Railroad Company, 210 A.2d at 714 (Del.1965) (“if there be increased litigation, the courts must willingly cope with the task”); .

Niederman, 436 Pa. at 412, 261 A.2d at 89 (footnotes omitted).

Bystander recovery would not present a problem of unlimited or unduly burdensome liability.

This is the heart of the controversy raised by the instant appeal. Under either the impact theory which required a “battery” to the plaintiff, or the later developed zone of danger concept which required an “assault” upon the plaintiff, the courts remained securely ensconced within traditionally recognized areas of tort responsibility. Here the appellant is seeking recovery for injuries sustained as a result of witnessing a “battery” upon another. In consider*164ing the wisdom of extending civil liability for tortious conduct, courts have been inclined to impose a duty where public policy demands that “as between the tortfeasor who started the chain of circumstances resulting in the injury and the entirely innocent plaintiff, the tortfeasor should suffer the consequences.” Bystander Recovery for Mental Distress, 37 Fordham L.Rev. 429, 449 (1969) quoting McNiece, Psychic Injury and Tort Liability, 24 St. John’s L.Rev. 1, 77 (1949).

The more complex and interwoven societal relations become the greater the responsibility one must accept for his or her conduct. In determining the existence of a duty of care, it must be remembered that the concept of duty amounts to no more than “the sum total of those considerations of policy which led the law to say that the particular plaintiff is entitled to protection” from the harm suffered. Leong v. Takasaki, 55 Haw. 398, 520 P.2d 758, 764 (1974). To give it any greater mystique would unduly hamper our system of jurisprudence in adjusting to the changing times. The late Dean Prosser expressed this view as follows:

These are shifting sands, and no fit foundation. There is a duty if the court says there is a duty; the law, like the Constitution, is what we make it. Duty is only a word with which we state our conclusion that there is or is not to be liability; it necessarily begs the essential question. When we find a duty, breach and damage, everything has been said. The word serves a useful purpose in directing attention to the obligation to be imposed upon the defendant, rather than the causal sequence of events; beyond that it serves none. In the decision whether or not there is a duty, many factors interplay: The hand of history, our ideas of morals and justice, the convenience of administration of the rule, and our social ideas as to where the loss should fall. In the end the court will decide whether there is a duty on the basis of the mores of the community, “always keeping in mind the fact that we endeavor to make a rule in each case that will be practical and in keeping with the general understanding of mankind.” *165Prosser, Palsgraf Revisited, 52 Mich.L.Rev. 1, 14-15 (1953).13

The Rhode Island Supreme Court recently examined the questions of duty and the demands of public policy in D’Ambra v. United States, 114 R.I. 643, 338 A.2d 524 (1975), a case factually similar to the one now before us.14 In permitting the bystanding mother to recover, that court found that the defendant did owe a duty of care to the bystander. In analyzing the policies underpinning this duty, the court stated:

The scope of potential liability commonly finds theoretical expression in such concepts as duty and proximate cause. These are, however, exceedingly elastic notions which, instead of dictating an answer to whether the plaintiff has stated a cause of action against the defend*166ant, merely reformulate the question. They are, indeed, merely reductions of the multi-faceted mores of the community, easily expressible formuli for the core problem of whether the law will countenance a shifting of the burden of loss. As Professor Prosser has noted:

“ * * * the problem of duty is as broad as the whole law of negligence, and that no universal test for it ever has been formulated. It is a shorthand statement of a conclusion, rather than an aid to analysis in itself. * * But it should be recognized that ‘duty’ is not sacrosanct in itself, but only an expression of the sum total of those considerations of policy which lead the law to say that the particular plaintiff is entitled to protection”. Prosser, Torts § 53 (4th ed. 1971).

Likewise, Justice Andrews, in his famous dissent in Palsgraf v. Long Island R. R., 248 N.Y. 339, 162 N.E. 99 (1928) wrote:

“What we do mean by the word ‘proximate’ is that, because of convenience, of public policy, of a rough sense of justice, the law arbitrarily declines to trace a series of events beyond a certain point. This is not logic. It is practical politics.”

Id., at 526-27

The leading decision espousing denial of recovery in these instances is that of Tobin v. Grossman, 24 N.Y.2d 609, 301 N.Y.S.2d 554 (1969).15 The New York Court in Tobin argued *167that the extension of liability for damages sustained by third parties beyond the zone of danger would represent the creation of a new duty and that “there are no new technological, economic, or social developments” which would warrant the recognition of a new cause of action. Id. at 615, 301 N.Y.S.2d at 558. First, we suggest that the Tobin court overstates the nature of the request for recovery in these cases. The conduct which is offered as supporting the liability — i. e., in this case the negligent operation of the vehicle — is of the kind which has traditionally been held to have been actionable by plaintiffs who had sustained provable damages. The departure that is being urged is as to the scope of damages that will be recognized as flowing from that conduct. In this context, we are satisfied that the developments in the fields of medical science and psychiatry do provide the impetus for expanding our legal recognition of the consequences of the negligent act. To arbitrarily refuse to recognize a now demonstrable injury flowing from a negligent act would be wholly indefensible.

The Tobin court further attempted to bolster its position by raising the specter of future extensions that may be urged if we depart from the zone of danger theory.16 We find this attempt to resort to the logical “gimmick” of reduetio ad absurdum to be of little value in resolving the legitimate questions presented. Under the facts that we are being called upon to decide, the emotional impact upon a mother witnessing the sudden and violent death of her small child is unquestionably as traumatic as would have been the case if the mother had also been within the zone of danger. Recorded history is replete with instances where a mother would willingly have given her own life for that of her child. Thus to attempt to justify ignoring this legitimate and natural response to tortious conduct by positing situations *168not presented would mock justice and arbitrarily turn a deaf ear upon a compelling claim for relief.

In an attempt to still the concerns of those troubled by “the fear of unlimited liability” the Supreme Court of Hawaii suggested the limiting of recovery “to claims of serious mental distress.” Leong v. Takasaki, 520 P.2d at 764. We believe this is a reasonable response to the concern. We agree that it would be unreasonable to hold the defendant responsible for the mental distress that may be experienced by the most timid or sensitive members of the community:

Certainly the law should not compensate for every minor psychic shock incurred in the course of daily living; it should not reinforce the neurotic patterns of our society. At some point, however, a person threatened by severe mental injury should be able to enforce his claim to reasonable psychological tranquillity.

D'Ambra v. United States, 338 A.2d at 529 (footnote omitted).

The Leong court attempted to achieve an objective standard by defining serious mental distress as being properly found where a reasonable person “normally constituted, would be unable to adequately cope with the mental stress engendered by the circumstances” of the event. Id. Such a test focuses upon the situation producing the emotional stress and requires it to be a nature that would be likely to produce a response in a person of average sensitivities. In this determination factors such as the context in which the trauma occurred, the development of physical ramifications, and the duration and severity of the emotional distress are available to make the judgment an objective — as opposed to a subjective — one.

The second level of the argument posited by the New York court in Tobin concerns the possibility of unduly burdensome liability. That court viewed this possibility as:

. a kind of dollars-and-cents argument. It does not vanish, however, by reference to widespread or compulsory insurance. Constantly advancing insurance costs can become an undue burden as well, and the aggregate *169recoveries in a single accident of this kind are not likely to stay within ordinary, let alone, compulsory insurance liability limits.

Tobin v. Grossman, 24 N.Y.2d at 617, 301 N.Y.S.2d at 559-60, 249 N.E.2d at 423.

This view was forcefully attacked in a dissenting opinion written by the late Judge Kenneth B. Keating. Judge Keating pointed out that “[n]ot one piece of evidence is offered to prove that the ‘dollar-and-cents’ problem will have the dire effects claimed.” Id., at 620, 301 N.Y.S.2d at 562, 249 N.E.2d at 525 (dissenting opinion). He further contended that:

Ever since MacPherson v. Buick Motor Co., 217 N.Y. 382, 111 N.E. 1050, L.R.A.1916F, 696, was decided more than a half century ago, there has been an expanding recognition that the argument concerning unlimited liability is of no merit, yet the aberrations persist. One would imagine that we were here involved with a catastrophic loss. There have already been decisions imposing liability of far greater dimension than can ever arise if we should embark upon a search for “essential justice” in the bystander class of cases.

Id., 301 N.Y.S.2d at 563, 249 N.E.2d at 525.

The Rhode Island Supreme Court also found this “dollars- and-cents” argument unpersuasive. D’Ambra v. United States, 338 A.2d at 530.

It is possible to reasonably circumscribe the area of liabiliÍX*

This issue raises the question of the extent to which bystander recovery will be permitted.17 We are confident *170that the application of the traditional tort concept of foreseeability will reasonably circumscribe the tortfeasor’s liability in such cases. Foreseeability enters into the determination of liability in determining whether the emotional injuries sustained by the plaintiff were reasonably foreseeable to the defendant.18

In the seminal Dillon case, the California Supreme Court identified three factors determinative of whether the injury to the Plaintiff was reasonably foreseeable:

(1) Whether plaintiff was located near the scene of the accident as contrasted with one who was a distance away from it. (2) Whether the shock resulted from a direct *171emotional impact upon plaintiff from the sensory and contemporaneous observance of the accident, as contrasted with learning of the accident from others after its occurrence. (3) Whether plaintiff and the victim were closely related, as contrasted with an absence of any relationship or the presence of only a distant relationship.

Dillon v. Legg, 69 Cal.Rptr. at 80, 441 P.2d at 920 In elaborating upon these factors, the court stated:

The evaluation of these factors will indicate the degree of the defendant’s foreseeability: obviously defendant is more likely to foresee that a mother who observes an accident affecting her child will suffer harm than to foretell that a stranger witness will do so. Similarly, the degree of foreseeability of the third person’s injury is far greater in the case of his contemporaneous observance of the accident than that in which he subsequently learns of it. The defendant is more likely to foresee that shock to the nearby, witnessing mother will cause physical harm than to anticipate that someone distant from the accident will suffer more than a temporary emotional reaction. All these elements, of course, shade into each other; the fixing of obligation, intimately tied into the facts, depends upon each case.

In light of these factors the court will determine whether the accident and harm was reasonably foreseeable. Such reasonable foreseeability does not turn on whether the particular defendant as an individual would have in actuality foreseen the exact accident and loss; it contemplates that courts, on a case-to-case basis, analyzing all the circumstances, will decide what the ordinary man under such circumstances should reasonably have foreseen. The courts thus mark out the areas of liability, excluding the remote and unexpected.

Id., at 80-81, 441 P.2d at 920-21 (emphasis in the original). Applying this standard to the case before it, the California court reversed the summary judgment awarded the defendants on facts almost identical with those now before us. A negligently driven automobile struck and killed Erin Dillon, *172an “infant” as she crossed a road. Her sister Cheryl, also an infant, was standing close to her and witnessed the accident. Their mother, standing a little distance away, witnessed the accident and sustained great emotional disturbance and shock. The trial court ruled that Cheryl was within the zone of danger and that an action for mental distress begun on her behalf could be brought, but ruled that Mrs. Dillon was outside the zone of danger and was not owed a duty of care by the driver of the car. The California Supreme Court reversed, and, applying the factors above, held that Mrs. Dillon was within a zone of emotional harm and could bring her action for psychic distress.

The Dillon factors and large parts of that opinion were adopted verbatim by the court in D’Amicol v. Alvarez Shipping Co., Inc., 31 Conn.Super. 164, 326 A.2d 129 (1973). That court upheld the right of a father and mother to recover damages for the shock and fright they incurred from witnessing the death of their young son in a traffic accident. The parents and the child were riding in the same car at the time of the accident.19

III.

In summary, we conclude that we cannot accept the callous view of the Tobin court that the possibility of a sudden and violent termination of a young life is a risk assumed in child rearing and does not require recovery where mental distress results from the witnessing of such an *173event.20 We are satisfied that public policy demands that we not permit the application of the zone of danger concept to deny recovery merely because of the nature of the damage. We are also satisfied that by the proper application of the tort concept of foreseeability the area of liability may be reasonably circumscribed.

In applying the preceding discussion to the facts presented in the instant appeal, it is apparent that the trial court prematurely sustained preliminary objections to the fourth count of the complaint on the basis that it did not state a cause of action. Since we have determined that a tortfeasor’s liability for mental distress is not to be denied solely because the plaintiff was beyond the zone of physical danger, we must examine whether the injuries sustained by appellant were reasonably foreseeable. It is clear that appellant’s injuries were of a nature reasonably foreseeable under the circumstances alleged. Where the bystander is a mother who witnessed the violent death of her small child and the emotional shock emanated directly from personal observation of the event, we hold as a matter of law that the mental distress and its effects is a foreseeable injury.21

Regardless of whether Mrs. Sinn will be ultimately successful in recovering the damages she sustained, we believe:

*174the gravity of appellant’s injury and the inherent humanitarianism of our judicial process and its responsiveness to the current needs of justice dictate that appellant be afforded a chance to present [her] case to a jury and perhaps be compensated for the injury [she] has incurred Niederman, 436 Pa. at 404, 261 A.2d at 85 (emphasis in the original).

The order of the Court of Common Pleas sustaining the appellee’s demurrer to Count IV of the complaint is hereby reversed. The case is remanded to the Court of Common Pleas for proceedings consistent with this opinion.

EAGEN, C. J., filed a concurring opinion.

LARSEN, J., concurred in the result.

ROBERTS, J., filed a dissenting opinion in which O’BRIEN, J., joined.

EAGEN, Chief Justice,

concurring.

The various positions and views have been extensively discussed in the scholarly opinions of Mr. Justice Roberts and Mr. Justice Nix and need no further explication by me. Needless to say, the problems presented instantly are extremely difficult. In the hope of rendering justice and at the same time not imposing any unreasonable burdens, I have reached the following conclusions. Recovery should be permitted in cases of this nature even where the plaintiff is beyond the scope of danger if (1) the plaintiff is closely related to the injured party, such as a mother, father, husband or wife; (2) the plaintiff is near the scene of and views the accident; (3) the plaintiff suffers serious mental distress as a result of viewing the accident and physical injury or suffers serious mental distress and there is a severe physical manifestation of this mental distress.

Justice mandates that the plaintiff be given the opportunity of proving that she meets the foregoing requirements. Hence, I concur in the order remanding the case for a new trial.

*175ROBERTS, Justice,

dissenting.

“Rachael weeping for her children refused to be comforted: because they were not.” Jeremiah, xxxi, 15.

The depth and inconsolable nature of a parent’s loss at the death of a child is unique in human experience. And where that death is caused by another’s irresponsible act, it is not unexpected that parents turn to the law to seek redress for the harm done to them.

“The law of torts ... is concerned with the allocation of losses arising out of human activities. . ‘The purpose of the law of torts is to adjust these losses, and to afford compensation for injuries sustained by one person as the result of the conduct of another.’ ”

Prosser on Torts, 4th ed. § 1 (1971) quoting Wright, “Introduction to the Law of Torts,” 8 Camb.L.J. 238 (1944).

Yet even the law must recognize that not every human loss arising out of another’s conduct constitutes a legal injury for which compensation shall be available. Prosser, supra, § 1. The ineluctable fact is that among all the jurisdictions which have addressed the question now before us, in only one, Hawaii, is judicial redress provided for appellant’s injury. This is not explained, as Mr. Justice Nix would suggest, by a national judicial indifference to the emotional distress caused either by the death of a loved one or the shock, for anyone, of immediately perceiving a violent death. It is explained, rather, by the foundational jurisprudential wisdom that recovery justified only by arbitrary rules and distinctions must be avoided. This is true not only because arbitrary distinctions are fundamentally unfair, but also because, of course, they defy rational application in future cases, the cornerstone of the law. Because Mr. Justice Nix’s opinion can rest only on arbitrary distinctions, I must dissent.

The crux of appellant’s injuries is described in paragraphs 26, 27 & 28 of the Fourth Count of the Complaint:

“26. The Plaintiff became hysterical, unnerved, and emotionally shattered as she viewed the Defendant’s automobile strike and kill her daughter, Lisa Anne Sinn.

*17627. As a result of watching the aforementioned accident, the Plaintiff suffered a shock to her nerves and nervous system, and sustained grievous mental pain and suffering resulting in severe depression and an acute nervous condition.

28. As a result of the foregoing, Plaintiff was required to expend money for medicines and/or tranquilizers, and may be required to expend considerable sums for the treatment of her resulting injuries and mental suffering in the future.”

While Mr. Justice Nix summarizes appellant’s complaint as seeking damages for physical and mental injuries, the complaint reveals only a claim for emotional injuries. See Restatement (Second) Torts, § 436 A, comment c (1965).1 Further, the complaint seeks, in addition to compensation for emotional injuries, damages for future mental suffering. Thus, the novel issue truly presented by this complaint is whether a plaintiff-parent whose safety is never at risk, who suffers no physical injury, but who witnesses a fatal accident involving her children should be allowed to recover from the tortfeasor for negligent infliction of emotional distress and future mental suffering.

I

Mr. Justice Nix, announcing the judgment of the Court, asserts that there is “no sound policy basis” upon which to distinguish this case from Neiderman v. Brodsky, 436 Pa. 401, 261 A.2d 84 (1970). Reason, as well as the overwhelm*177ing weight of authority, demonstrates that the majority is in error.

In Neiderman, recovery was sought for physical injuries. The issue there was whether those injuries could be proximately traced to the tortfeasor’s negligence when the physical injury followed emotional distress caused by the tortfeasor, rather than a physical impact. We held that physical injuries such as the heart attack suffered by the Neiderman plaintiff clearly could be proximately caused by emotional distress or fear for one’s own safety and that one who puts another in risk of physical safety is liable for the physical injuries caused as a result. Thus, in Neiderman, recovery was permitted for physical injuries suffered as a result of emotional distress brought on by another’s negligent threat to the plaintiff’s physical safety.

Here, there was no threat to plaintiff’s physical safety and plaintiff has suffered no physical injury. Plaintiff seeks recovery only for mental distress caused by the defendant’s negligent interference with another’s safety. Since in Neiderman, the plaintiff sought recovery for his physical injuries and for the pain and suffering which accompanied those injuries, but not for the emotional distress which caused the injury, that case in no way controls today’s decision. Indeed, there is nothing inconsistent in recognizing that physical injuries may be caused by mental distress but not awarding damages for mental distress suffered without physical consequence. Further, there is nothing inconsistent about permitting recovery where the distress for one’s own safety causes physical injury, but denying recovery where one is distressed only for another’s safety.

No one could seriously deprecate the severity of the emotional shock plaintiff here claims to have sustained. But the distinctions between recovery in Neiderman and recovery here cannot be ignored. Here, if there is no reasonable measure of plaintiff’s pain, then any recovery will be essentially speculative. Then, too, the nature of our society requires of each of us a remarkable degree of emotional fortitude. It is not unreasonable to draw the line between *178that degree which is required and that which is not by reference to that emotional distress which causes serious physical injury or harm. And it cannot be denied that if not the genuineness, then at least the intensity and thus the nature of the injury, may be difficult to assess where it causes no physical injury.

Even the Restatement (Second) of Torts, supra, distinguishes between recovery for physical harm caused by mental distress, and recovery for mental distress, permitting recovery only in the first instance.2 Compare §§ 436 & 436 A.

Similarly, the Supreme Court of California has repeatedly reaffirmed that Dillon v. Legg, 68 Cal.2d 728, 69 Cal.Rptr. 72, 440 P.2d 912, 29 A.L.R.3d 1316 (1968) (in bank), upon which Mr. Justice Nix places heavy reliance, permits recovery only where the emotional shock of witnessing an accident causes physical injuries. “[T]he traumatic shock which plaintiff suffers must result in some form of physical injury.” Krouse v. Graham, 19 Cal.3d 59, 137 Cal.Rptr. 863, 871, 562 P.2d 1022, 1030 (1977) (in bank). Accord Hoyem v. Manhattan Beach City School District, 22 Cal.3d 508, 150 Cal.Rptr. 1, 585 P.2d 851 (1978); Justus v. Atchison, 19 Cal.3d 564, 139 Cal.Rptr. 97, 565 P.2d 122 (1977) (in bank). So, too, where emotional distress has not caused physical injury recovery has been denied by the Illinois Supreme Court, Neuberg v. Michael Reese Hospital & Medical Center, 60 Ill.App.3d 679, 18 Ill.Dec. 62, 377 N.E.2d 215 (1978), the Massachusetts Supreme Judicial Court, Dzionkonski v. Babineau, 380 N.E.2d 1295, (1975) the Rhode Island Supreme *179Court, D’Ambra v. United States, 338 A.2d 524 (1975) and the Arizona Supreme Court, Keck v. Jackson, 593 P.2d 668 (1979) (en banc). D'Amicol v. Alvarez Shipping Co., 31 Conn.Super. 164, 326 A.2d 129 (1973), cited by the majority appears to have been reconsidered, McGovern v. Piccolo, 33 Conn.Super. 225, 372 A.2d 989 (1976) (court applies zone of danger rule and questions whether recovery permitted even for emotional distress of mother when caused by witnessing injury to child, and mother within zone of danger). In any event, DAmicol, unlike here, involved a physical injury to the plaintiff caused by emotional distress.

The Tennessee Supreme Court continues to limit recovery to those suffering physical injury as a result of fear for one’sown safety when in zone of danger. Shelton v. Russell Pipe & Foundry Co., 570 S.W.2d 861 (1978). Vermont, too, has adopted this rule. Guilmette v. Alexander, 128 Vt. 116, 259 A.2d 12 (1969). Even Washington, one of the most liberal states in awarding damages for emotional distress requires some physical symptoms of the emotional distress for recovery. Hunsley v. Giard, 87 Wash.2d 424, 553 P.2d 1096 (1976). Hawaii stands completely alone in permitting recovery in the absence of any physical harm. Leong v. Takasaki, 55 Haw. 398, 520 P.2d 758 (1974).

Thus with the overwhelming majority of these courts, I would' reject permitting recovery for one whose safety was never at risk and whose emotional distress caused no physical injury.

II

Mr. Justice Nix erroneously assumes that the only causation problem which could possibly arise here is the same kind as we have already held unproblematic in Neiderman, supra. But here, to permit recovery, we must find not that physical harm can be proximately caused by mental distress but that it is possible to distinguish between that emotional distress caused appellant by witnessing the accident and that caused *180by the natural grief and loss which accompanies the death of a child.

As the Court of Appeals of New York foresaw a decade ago:

“In this very case, as already noted, the eyewitness limitation provides no rational practical boundary for liability. The distance from the scene and time of notice of the accident are quite inconsequential for the shock more likely results from the relationship with the injured party than what is seen of the accident. The age of the child, always assumed to be relevant, is difficult to define or limit. Indeed, it may be callous to assess as lesser the loss or injury of an older child than a younger one. Nor can the father, the grandparents, the siblings and other relatives, or even others in loco parentis, be excluded on any acceptable rational basis, although, to be sure, distinctions can be made and verbalized. It is quite significant, too, that the now discarded caveat in the first Restatement referred to spouses as possibly being entitled to recover for shock and its consequences. Indeed, whichever way one turns in permitting a theory of recovery one is entangled in the inevitable ramifications which will not stay defined or limited. There are too many factors and each too relative to permit creation of only a limited scope of liability or duty.

“Beyond practical difficulties there is a limit to attaining essential justice in this area. While it may seem that there should be a remedy for every wrong, this is an ideal limited perforce by the realities of this world. Every injury has ramifying consequences, like the ripplings of the waters, without end. The problem for the law is to limit the legal consequences of wrongs to a controllable degree. The risks of indirect harm from the loss or injury of loved ones is pervasive and inevitably realized at one time or another. Only a very small part of that risk is brought about by the culpable acts of others. This is the risk of living and bearing children. It is enough that the *181law establishes liability in favor of those directly or intentionally harmed.”

Tobin v. Grossman, 24 N.Y.2d 609, 618-19, 301 N.Y.S.2d 554, 561-62, 249 N.E.2d 419, 424 (1969). See Scarf v. Koltoff, 242 Pa.Super. 294, 363 A.2d 1276 (1976) (Spaeth, J.) (quoting Tobin, supra.) In fact, one may wonder whether it is not less injurious to a parent’s mental state to see the accident which causes the death of his child than never to know exactly its circumstances. Neither the opinion of Mr. Justice Nix nor the parties cite us to any medical or psychological authority on this issue. And a common sense compels the conclusion that no jury could evaluate the difference between the damages due to the emotional distress of actually witnessing the accident from those due to learning of and living with the fact that one’s child suffered an accidental and violent death. This is especially true with respect to “future mental suffering” for which appellant also seeks recovery.

Mr. Justice Nix demonstrates his failure to grasp the special causation problems here present with his assertion that those courts which have limited recovery to cases where emotional distress caused some physical injury have imposed the “device” of physical injury merely to “guarantee the genuineness of the claim.” The problem of isolating the damages caused by the injury complained of here is so great that without physical harm courts would be at a loss to know how to relate damages to injury:

“Despite the admitted artificiality of linking recovery for mental distress to the possibility of physical injury, this limitation does reflect the core notion of some reasonable relation or nexus between the negligent conduct and the injury sued upon.”

D’Ambra, supra, 338 A.2d at 530.

“The problems in finding causation in fact should not be minimized. . . . [Tjhere is no escaping the problem of whether the injuries sued on should be attributed to the *182shock of witnessing the accident or to the fact of the victim’s death.”

Id. 338 A.2d at 529, n. 5.

Ill

The central problem this kind of action brings before the courts is not that of the genuineness of the emotional distress, but that of rationally limiting defendant’s liability. The opinion of Mr. Justice Nix disingenuously would have us believe that today we need not consider whether it is possible to limit recovery solely to plaintiff’s class. If, however, there is no principled means of distinguishing this plaintiff from any other, then to decide her case is to decide the question the majority claims is not before us. One can say that question is not before us only by assuming its answer.

Mr. Justice Nix asserts that he sufficiently limits liability by narrowing recovery to “foreseeable injuries.” But what constitutes a foreseeable injury is the conclusion of legal analysis, not its principal tool. Indeed there is remarkable disagreement about how to distinguish the “foreseeable” from the “unexpected.” In Massachusetts one who does not witness an accident to a third party may still suffer foreseeable emotional distress from learning of the death. Dzionkonski, supra. In Hawaii, such injuries are not foreseeable. Kelly v. Kokua Sales & Supply, 56 Haw. 204, 532 P.2d 675 (1975). In Connecticut, seeing an accident will foreseeably cause emotional distress, while hearing one will not. Compare D’Amicol, supra, and McGovern, supra. In California, witnessing a negligent stillbirth does not create a foreseeable injury, Justus, supra, while coming upon an already injured victim may, Archibald v. Braverman, 275 Cal.App.2d 253, 79 Cal.Rptr. 723 (1969).

In Rhode Island a mother may recover, DAmbra, supra, but not a close personal friend. In Arizona, anyone who was a close friend of the victim may suffer a foreseeable injury. Keck, supra. In Hawaii, not every one who is close will *183suffer a foreseeable injury, but a step-grandson’s emotional distress is foreseeable. This variety of rules “limiting” recovery is eloquent testimony that there is no natural non-arbitrary way to limit liability for this injury.

“A mother who sees her child suffer and die an hour, a day or even a week after an accident is no less traumatized than one who comes upon the scene ‘immediately’ after an accident. And what of the woman who learns of her child’s accidental death at some time and place distant from the scene of the accident or who learns of her cousin’s death under like circumstances?”

McGovern, supra, 372 A.2d at 989.

All the injuries which courts have compensated have been, in Mr. Justice Nix’s terms, “legitimate emotional responses.” Even Prosser, a firm supporter of recovery in these cases, admits that foreseeability does not limit liability. He limits liability to immediate relatives suffering physical harm because he realizes some line must be drawn.

“It would be an entirely unreasonable burden on all human activity if the defendant who has endangered one man were to be compelled to pay for the lacerated feelings of every other person disturbed by reason of it, including every bystander shocked at an accident, and every distant relative or the person injured, as well as his friends.”

Prosser, supra, § 54 at 334. But as Justice Joslin noted in dissent in D’Ambra, supra, limiting a defendant’s liability to members of the injured person’s immediate family who observed the accident is adopting a rule which

“cannot be applied even-handedly and . . . will therefore lead to admittedly arbitrary results . It would . . . frustrate a basic purpose and policy underlying the scope of liability rules, namely, to achieve consistently just results by providing for even and predictable resolutions of private disputes . . . . I fear that arbitrary case-by-case determinations will result in more injustice over time than would the uniform denial of *184recovery to those who do not reasonably fear for their own safety. For these reasons I agree with the great weight of authority1 and answer the certified question in the negative.”

338 A.2d at 536 (Note 1: Most of the cases can be found in Annot. 18 A.L.R.2d 220 et seq. (1951) and Annot. 29 A.L.R.3d 1337 et seq. (1970). The American Law Institute, which in 2 Restatement Torts § 313 (1934) in a caveat refrains from expressing any opinion on the question, in 2 Restatement (Second) Torts § 313 (1965), strikes that caveat and on facts substantially identical to those of the certified question substitutes a rule of nonliability.)

Mr. Justice Nix’s foreseeable injury “test,” adopted from Dillon, predicates recovery upon plaintiff’s (1) witnessing an accident, (2) close-up (3) in which a “close” relative is injured. This test, ostensibly simple, will produce monumental problems both of application and fair limitation. If recovery is extended in the present case, can the law close its eyes to the emotional distress of bystanders who recently witnessed the traumatic amputation of a young woman’s hand by a subway car? Does the majority’s “rule” give us any principle at all in the following situation? Three siblings get off a bus. Two attempt to cross the street. The third begins to walk away from them down the block. A moment later he hears screeching car brakes, screams and one of his siblings yelling, “My God, Jim is dead.” Does the brother have a foreseeable injury? Is there any way to judge whether his emotional distress “resulted from a direct emotional impact upon the plaintiff from the sensory and contemporaneous observance of the accident” or from “learning of the accident from others after its occurrence?” How many steps down the street distinguish immediate observation from indirect learning? As Judge Spaeth has noted, “The criteria suggested by Prosser and adopted in Dillon are not reasoned but arbitrary, for they are unsupported on any policy capable of uniform application.”. Scarf, supra, 242 Pa.Super. at 299-300, 363 A.2d at 1276 (footnotes omitted).

*185IV

Perhaps most telling is the consideration that Mr. Justice Nix’s allowance of a cause of action here, in reality, permits circumvention of the Commonwealth’s wrongful death statute, Act of April 15, 1851, P.L. 669, § 19; Act of April 26, 1855, P.L. 309, § 1, as amended, 12 P.S. §§ 1601 et seq. This legislation specifically provides recovery to a mother injured by the tortfeasor’s negligent killing of her child.

“The law was in 1855 altered, and the right to sue was conferred on parents for the loss of children. . This right was a new and independent right given by positive law — not cast upon them by survivorship as for an injury to the decedent. It is for the wrong done to them.”

The Pennsylvania R.R. Co. v. Zebe, 33 Pa. 318, 329 (1858). Thus, the Act of 1855 already provides a cause of action for a tortfeasor’s direct injury to the plaintiff, for the wrong done to her by his negligence. As the Connecticut court in McGovern noted, to permit additional recovery where the plaintiff is closely related to the victim, “raises serious policy questions. The defendant in such a case is already liable in one tort action for wrongful death.” 372 A.2d at 989.

Damages under wrongful death in Pennsylvania have always been limited to pecuniary damages and nothing is recoverable for “the mental suffering occasioned to the survivors by the death and nothing may be allowed as solatium, that being incapable of pecuniary estimate. . . ” Zebe, supra at 328. Recovery here only undermines over a century’s adherence to the legislative policy that compensation for damages suffered by the class of individuals to which plaintiff belongs is through the wrongful death statute.

I would affirm the order of the Superior Court affirming the order of the court of common pleas sustaining appellee’s preliminary objections in the nature of a demurrer to Count 4 of appellant’s complaint.

O’BRIEN, J., joins in this dissenting opinion.

Hanley, J.

The sole issue before this court is whether one can recover for mental anguish and emotional distress *222which is the result of another’s negligence and which is not manifested by, or causative of, any physical injury.

One of the earliest cases involving mental distress is Summerfield v. Westen Union Telegraph Co. (1894), 87 Wis. 1, 2, 57 N. W. 973. There this court denied recovery to one who, due to the defendant’s negligence, did not receive word of his mother’s illness until after her death. The plaintiff alleged that as a result he was “. . . ‘mortified, grieved, hurt, and shocked, and suffered intense anguish of body and mind, and was thereby thrown into a state of nervous excitement and tremor, which rendered him sick and impaired his health and strength, and that he still suffers from the effect of the same.’ ”

In denying recovery the court stated that “. . . for mental distress alone . . . damages are not recoverable, ...” 1 but then recognized, at pages 8 and 9, the following situations wherein damages for the infliction of mental suffering would be recoverable:

“. . . ‘(1) Where, by the merely negligent act of the defendant, physical injury has been sustained; and in this class of cases they are compensatory, and the reason given for their allowance is that the one cannot be separated from the other. (2) In actions for breach of the contract of marriage. (3) In cases of wilful wrong, espe*223cially those affecting the liberty, character, reputation, personal security, or domestic relations of the injured party.’ . . .”

Later, in Gatzow v. Buening (1900), 106 Wis. 1, 81 N. W. 1003, recovery was sought for mental suffering and distress caused by a conspiracy to deprive the plaintiff of the hearse in which his deceased child was to be driven to the cemetery. There again the court noted that no physical injury had been inflicted upon the plaintiff and stated, at page 20:

“. . . [This] case does not fall within the few exceptions to the rule, — which prevails in this state and in most jurisdictions, — that mental distress alone is too remote and difficult of measurement to be the subject of an assessment of damages. . . .”

In Ford v. Schliessman (1900), 107 Wis. 479, 83 N. W. 761, it was held that one could recover for mental suffering caused by a direct assault upon her person even though the defendant neither touched her nor caused her physical injury. The court, however, denied recovery because the evidence was insufficient to establish that the defendant had actually assaulted the plaintiff or attempted to have carnal intercourse with her.

Subsequently, in Pankopf v. Hinkley (1909), 141 Wis. 146, 123 N. W. 625, an action to recover for physical injuries resulting from “severe fright and shock” was considered by this court. As a result of the defendant’s negligence, the plaintiff was thrown from her carriage and later suffered physical injuries in the form of a miscarriage due to fright and shock caused by the accident. In allowing recovery this court ruled that:

“The principle here decided is that when physical injury flows directly from extreme fright or shock, caused by the ordinary negligence of one who owes the duty of care to the injured person, such fright or shock is a link *224in the chain of proximate causation as efficient as physical impact from which like results flow.” Pankopf v. Hinkley, supra, at page 149.

This ruling was later affirmed in Sundquist v. Madison Railways Co. (1928), 197 Wis. 83, 221 N. W. 392, wherein the plaintiff, although sustaining no immediate physical injuries following an automobile accident, was allowed to recover for paralysis which later resulted from the fear and shock caused by such accident.

In Waube v. Warrington (1935), 216 Wis. 603, 258 N. W. 497, however, recovery for physical injuries resulting from “. . . fright, shock and excessive sudden emotional disturbances” was denied because the plaintiff’s fear was not for her own safety, but for the safety of her daughter whom she had seen killed through the defendant’s negligent operation of a motor vehicle.2 The requirement that physical injuries resulting from fear be caused by fear for one’s own safety was later affirmed and illuminated in Klassa v. Milwaukee Gas Light Co. (1956), 273 Wis. 176, 77 N. W. 2d 397, and Colla v. Mandella (1957), 1 Wis. 2d 594, 85 N. W. 2d 345.

In Klassa it was held that one must not only be within “ ‘the range of ordinary physical peril’ ” but must actually be in fear for his own safety. In Colla the defendant had parked his truck atop a hill overlooking the house of the plaintiff’s deceased husband. When the truck rolled down the hill striking his house, he became extremely excited and later suffered a fatal heart attack. Although the truck had not actually struck the plaintiff’s deceased husband, recovery was allowed for his death which had been caused by his excitement and fear. In allowing recovery this court removed any doubt of its having *225abandoned the requirement that there be direct physical impact upon the plaintiff before allowing recovery for physical injuries resulting from shock or fear for one’s own safety.

From the foregoing cases, it is clear that, while this jurisdiction has abandoned the requirement of physical impact, doubt remains as to when physical injuries which manifest emotional or mental disturbances are required as a prerequisite to recovery for negligent infliction of such disturbances.

The defendant-appellant takes the position that recovery is not allowed under the circumstances of this case. While he is correct in his contention, his reliance upon Alsteen v. Gehl (1963), 21 Wis. 2d 349, 124 N. W. 2d 312, is for the most part misplaced. Alsteen, unlike the instant case, was an action to recover damages for intentionally inflicted emotional distress. This court, not having previously considered such a case at length,3 there set forth four prerequisites to recovery for the intentional infliction of psychological injury. It did not, however, as urged by the appellant, require intent in all cases and thereby totally eliminate recovery for the negligent infliction of emotional distress. Had such been the court’s intent, it would have expressly overruled earlier case law to the contrary. An examination of such cases, however, indicates that psychological or emotional damage caused by negligence is, in limited circumstances, com-pensable.

In Alsteen, supra, the plaintiff sought recovery from one who had contracted to repair her house. This court there recognized that due to difficulties of proof it had previously been reluctant to allow recovery for emotional distress in the absence of attendant physical injuries which manifest such distress. However, it then noted that the factual basis for denying recovery in such cases *226has changed and announced, at page 359, that . . we now possess the tools whereby we can intelligently evaluate claims of emotional injury. . . .”

The question now is whether such announcement is to be limited to cases involving intentional infliction of injury or also to be applied to negligent infliction of emotional distress.

In answering this question it can be argued with perfect logic that if we possess tools to intelligently evaluate claims which may be spurious, such tools are capable of such evaluation regardless of whether they are caused intentionally or through negligence. However, from the very prerequisites to recover set forth in Alsteen, swpra, it is apparent that such tools are considered adequate only when the prerequisites are in fact present.

In Alsteen, supra, this court stated, at pages 359, 360, and 361:

“. . . Four factors must be established for an injured plaintiff to recover:

“(1) The plaintiff must show that the defendant’s conduct was intentional; that is to say, the defendant behaved as he did for the purpose of causing emotional distress for the plaintiff.

“(2) In addition to being intentional, the defendant’s conduct must be extreme and outrageous. . . .

“ (3) The plaintiff must demonstrate that the defendant’s conduct was a cause-in-fact of his injury. . . .

“ (4) The plaintiff must demonstrate that he suffered an extreme disabling emotional response to the defendant’s conduct. . . .”

In regard to number (2) above, the court stated:

“. . . The requirement that the conduct be extreme and outrageous reflects our concern with the difficulties surrounding proof of the existence of severe emotional harm, and proof of a causal relationship between the injury and the defendant’s conduct. If the conduct is gross and extreme it is more probable that the plaintiff did, in fact, suffer the emotional distress alleged. . . .”

*227In regard to number (4) above, the court stated:

“. . . The severity of the injury is not only relevant to the amount of recovery, but is a necessary element to any recovery. The plaintiff must demonstrate that he was unable to function in his other relationships because of the emotional distress caused by defendant’s conduct. Temporary discomfort cannot be the basis of recovery.”

The above statements indicate that emotional stress must be manifested by physical injuries in actions based on negligence rather than intentional conduct.

The decision in Alsteen, supra, insofar as it eliminates resulting physical injury as a prerequisite to recovery for emotional distress, is limited to cases wherein the above four factors are present.

In Riehl v. De Quaine (1964), 24 Wis. 2d 23, 127 N. W. 2d 788, this court held that damages for traumatic neurosis, when associated with physical injury, are recoverable in personal injury actions in this state. In the instant case no physical injury which manifested the alleged mental anguish was alleged in the complaint.

We conclude the demurrer was improperly overruled and the trial court’s order must be reversed.

Since the case is here on demurrer, there is not an adequate record to establish whether the plaintiffs can allege additional facts sufficient to constitute a cause of action. We think that the plaintiffs should be afforded the right to plead over. Plaintiffs may file an amended complaint within twenty days after the return of the record to the circuit court.

By the Court. — Order reversed.

Wilkie, J.

(dissenting). I respectfully dissent. The majority opinion, as I understand it, would permit the plaintiff to continue his lawsuit if he had only alleged in his complaint that as a result of the emotional distress he suffered due to defendant’s negligence, he became *228physically ill. In other words, the majority give controlling importance to a physical manifestation.

The majority correctly point out that in Alsteen v. Gehl 1 we recognized that in a proper situation, a plaintiff could recover damages for intentionally inflicted emotional distress regardless of whether this emotional distress was subsequently physically manifested. We should now extend this protection to situations involving the negligent infliction of emotional distress regardless of whether a physical manifestation is attendant.

There is no longer any reason in logic or in fact to distinguish between intentional or negligent infliction of emotional distress. Both are equally difficult to prove. Both should compel recovery if injury results, be it purely emotional or partly physical. There is no reason to distinguish the form of the consequences produced by emotional distress. The damage is equally real whatever name is applied.

In recognizing a cause of action of this type there will undoubtedly be questions as to whether the plaintiff did in fact suffer the emotional distress complained of, or whether, if suffered, it was produced by defendant’s acts or some other cause. These are fact questions which can be answered only in the light of the evidence, including medical testimony, of the given case.

For this court to recognize a cause of action for negligent infliction of emotional distress without accompanying physical injury would not be as revolutionary as the majority opinion assumes. There have been some Wisconsin decisions which have paved the way.

For example, in Vinicky v. Midland Mut. Casualty Ins. Co., 2 this court affirmed a jury award of $2,000 for injury to a twelve-year-old boy where:

“. . . The side of his face was swollen and his eye was nearly shut. However, his principal claim for damages is *229based upon emotional injuries and mental distress that he suffered at the time of the accident and subsequent thereto.” 3

Also, in Ritter v. Coca-Cola Co., 4 this court affirmed a jury verdict of $2,500 in favor of a plaintiff who, when drinking from a bottle of coke, saw a partially decomposed mouse in the bottle. As a result she suffered great mental distress but chemical tests indicated that she sustained no toxic or physical injury other than vomiting from drinking the contaminated coke. In that case the issue of her right to recover was not raised and we decided the case on the issue of the admissibility of certain medical testimony.

These two cases implicitly, at least, recognize that a plaintiff who suffers great emotional distress is entitled to recover damages for the negligent infliction of such distress. The absence of a physical manifestation of such distress should not change this result since severe mental disturbances are almost always characterized by some type of physical reaction and frequently it is only an accident of pleading that the adverse consequences complained of are characterized as mental rather than physical.

I would affirm the order of the trial court.5

I am authorized to state that Mr. Chief Justice Hallows and Mr. Justice Heffernan join in this dissent.

BERDON, J.

In this appeal we must determine whether a parent and a sibling can recover damages for the emotional anguish they sustained by witnessing the parent’s other young child being fatally injured as a result of an accident caused by the negligence of the defendant. We conclude that, because certain conditions have been satisfied, both the parent and the sibling of the tort victim may recover damages for the negligent infliction of emotional distress.

In the third count of a three count1 complaint, the plaintiffs Mary A. Clohessy (Clohessy) and her son Liam Clohessy (Liam),2 respectively, the mother and brother of the decedent, Brendan P. Clohessy (Brendan), sought damages for the severe emotional distress they allegedly suffered as a result of observing an automobile *33operated by the defendant Kenneth L. Bachelor3 strike Brendan, resulting in Brendan’s death. After the trial court granted the defendant’s motion to strike the third count of the plaintiffs’ complaint on the ground that it failed to state a cause of action,4 judgment was rendered against Clohessy and Liam on that count.5 We reverse the trial court’s judgment and remand the case for further proceedings.

The facts alleged in, and to be inferred reasonably from, the third count of the complaint are as follows. On March 22, 1993, Brendan, a seven year old child, left St. Mary’s Church on Hillhouse Avenue in New Haven with his mother, Clohessy, and his brother, Liam, and attempted to cross Hillhouse Avenue at the intersection of Trumbull Street within a marked crosswalk. Liam was immediately to the right of Clohessy and Brendan was immediately to her left. The defendant was operating an automobile on Trumbull Street at an excessive speed when the exterior side view mirror of his vehicle struck Brendan’s head, hurling Brendan onto the road.6 Both Clohessy and Liam witnessed the impact *34and went to Brendan’s assistance, holding him as he experienced pain and suffering from his fatal head injuries. They suffered serious injuries as a result of the emotional shock and mental anguish of witnessing the accident that eventually led to Brendan’s death.

I

In granting the defendant’s motion to strike the plaintiffs’ third count seeking damages for emotional distress suffered by a bystander, the trial court relied upon our decisions in Strazza v. McKittrick, 146 Conn. 714, 156 A.2d 149 (1959), Amodio v. Cunningham, 182 Conn. 80, 438 A.2d 6 (1980), and Maloney v. Conroy, 208 Conn. 392, 545 A.2d 1059 (1988). We therefore begin our analysis with a review of those cases.

In Strazza, the defendant negligently drove his truck onto the porch of the plaintiffs house. “The impact shook the house, causing the plaintiff to drop the dishes [she was holding], lose her balance, and lean against the sink. . . . The plaintiff screamed with fright and became hysterical, thinking of disaster by earthquake. . . . Sometime after the impact, her husband inquired about [their seven year old child], and the plaintiff, thinking that the boy had been on the porch, became fearful that he had been injured. This fear aroused a new anxiety.” Strazza v. McKittrick, supra, 146 Conn. 716-17. The plaintiffs only medical treatment was for a nervous condition that resulted from the fear of injury to her child. The court concluded that the plaintiff, because she “was within the range of ordinary danger,” could recover damages for the emotional distress she experienced as a result of her being put in fear for her own safety, even though she had sustained no consequential physical injury. Id., 718. In reaching its conclusion, the court relied on Orlo v. Connecticut Co., 128 Conn. 231, 239, 21 A.2d 402 (1941), which held that “where it is proven that negligence proximately caused *35fright or shock [with respect to the person’s own safety] in one who is within the range of ordinary physical danger from that negligence, and this in turn produced injuries such as would be elements of damage had a bodily injury been suffered, the injured party is entitled to recover.”

In Strazza, however, the court did not permit the plaintiff to recover for the fright she had suffered from mistakenly believing that her child had been on the porch and had been injured. Relying upon the decisions of the courts of other states prior to 1959, which universally denied recovery for bystander emotional distress, the court held that the plaintiff “cannot recover for injuries occasioned by fear of threatened harm or injury to the person or property of another. . . . Such injuries are too remote in the chain of causation to permit recovery. . . . Even where a plaintiff has suffered physical injury in the accident, there can be no recovery for nervous shock and mental anguish caused by the sight of injury or threatened harm to another. [Annot.] 18 A.L.R.2d 220, 224, 234; 38 Am. Jur. 660, § 18; 67 C.J.S. 761, § 55.” (Citations omitted.) Strazza v. McKittrick, supra, 146 Conn. 719.

In Amodio, the plaintiff mother sought damages for emotional distress sustained as a result of the defendant physician’s alleged medical malpractice that she claimed caused the death of her daughter. The plaintiff urged this court to recognize a cause of action for bystander emotional distress as set forth in Dillon v. Legg, 68 Cal. 2d 728, 441 P.2d 912, 69 Cal. Rptr. 72 (1968). The California Supreme Court in Dillon, relying on established principles of negligence, focused on foreseeability, and held that “[s]ince the chief element in determining whether [a] defendant owes a duty or an obligation to [a] plaintiff is the foreseeability of the risk, that factor will be of prime concern in every case. Because it is inherently intertwined with foreseeability *36such duty or obligation must necessarily be adjudicated only upon a case-by-case basis.” Id., 740. The Dillon court then set forth three factors to consider in determining whether the emotional injury to the bystander is reasonably foreseeable: “(1) Whether [the] plaintiff was located near the scene of the accident as contrasted with one who was a distance away from it. (2) Whether the shock resulted from a direct emotional impact upon [the] plaintiff from the sensory and contemporaneous observance of the accident, as contrasted with learning of the accident from others after its occurrence. (3) Whether [the] plaintiff and the victim were closely related, as contrasted with an absence of any relationship or the presence of only a distant relationship.” Id., 740-41.

The Dillon court went on to state that “[t]he evaluation of these factors will indicate the degree of the defendant’s foreseeability: obviously [the] defendant is more likely to foresee that a mother who observes an accident affecting her child will suffer harm than to foretell that a stranger witness will do so. Similarly, the degree of foreseeability of the third person’s injury is far greater in the case of his contemporaneous observance of the accident than that in which he subsequently learns of it. The defendant is more likely to foresee that shock to the nearby, witnessing mother will cause physical harm than to anticipate that someone distant from the accident will suffer more than a temporary emotional reaction. All these elements, of course, shade into each other; the fixing of obligation, intimately tied into the facts, depends upon each case.” Id., 741.

The court in Amodio recognized that a “growing number of jurisdictions, beginning in 1968 with the California decision in Dillon . . . have recently recognized a cause of action for emotional distress in favor of a bystander to the negligently caused injury of another party.” Amodio v. Cunningham, supra, 182 Conn. 87. *37The court also observed that under Dillon “the requirement of ‘sensory and contemporaneous observance’ does not require a visual perception of the impact although it does require that the plaintiff bystander otherwise apprehend the event.” Id., 89-90. Without rejecting the foreseeability approach, the Amodio court held that the plaintiff mother could not recover under Dillon because she did not have a contemporaneous sensory perception of the doctor’s acts of negligence. “Merely observing the consequences of the defendant’s negligence towards another person without perceiving the actual negligent behavior, however, is insufficient to maintain a cause of action for emotional distress to a bystander.” Id., 90.

This court again addressed the question of bystander emotional distress based upon medical malpractice in Maloney v. Conroy, supra, 208 Conn. 392, where the tort victim was the plaintiffs mother. After Amodio, but before Maloney was decided, however, California, in Ochoa v. Superior Court, 39 Cal. 3d 159, 703 P.2d 1, 216 Cal. Rptr. 661 (1985), relaxed Dillon's contemporaneous sensory perception requirement in the context of a medical malpractice case. In Ochoa, as in Maloney, the plaintiff observed the effects of the medical malpractice over a period of time. The Supreme Court of California concluded that “the ‘sudden occurrence’ requirement is an unwarranted restriction on the Dillon guidelines”; id., 168; and that the contemporaneous perception of the negligent act requirement for a medical malpractice case was satisfied “when there is observation of the defendant’s conduct and the child’s injury and contemporaneous awareness the defendant’s conduct or lack thereof is causing harm to the child . . . .” Id., 170.

In Maloney, this court, again leaving the door open for the foreseeability rule as set forth in Dillon, rejected the California Supreme Court’s reasoning in Ochoa. *38“Whatever may be the situation in other contexts where bystander emotional disturbance claims arise, we are convinced that, with respect to such claims arising from malpractice on another person, we should return to the position we articulated in Strazza that there can be no recovery for nervous shock and mental anguish caused by the sight of injury or threatened harm to another.” (Internal quotation marks omitted.) Maloney v. Conroy, supra, 208 Conn. 402.

When this court decided Strazza in 1959, the nearly unanimous weight of authority refused, as previously stated, to recognize a cause of action for bystander emotional injuries. Indeed, even with respect to fear of injury to oneself, many courts required that there be actual physical impact with the plaintiffs person in order for there to be recovery for emotional distress. W. Prosser, Torts (4th Ed. 1971) § 54, p. 333; annot., 18 A.L.R.2d 220 (1951). If, however, there was “impact some [courts] have been willing to allow damages due in part to fear for another.” W. Prosser, supra, p. 333. “Until 1968 the only cases allowing recovery for mental disturbance at the peril of another were old ones in intermediate courts, which were ambiguous, and probably to be explained on the basis of threatened physical injury to the plaintiff herself.” Id., p. 334.

Since this court decided Strazza, two principal schools of thought have emerged in support of allowing bystanders a cause of action for emotional distress — “zone of danger” and “reasonable foreseeability.” We now examine the respective merits of each of these schools of thought.

A

In 1965, six years after Strazza and three years before Dillon, the American Law Institute adopted §§313 and *39436 of the Restatement (Second) of Torts (1965),7 which generally allow recovery for emotional distress suffered by a bystander under the zone of danger theory. Simply stated, the zone of danger rule “allows one who is himself or herself threatened with bodily harm in consequence of the defendant’s negligence to recover for emotional distress resulting from viewing the death or serious physical injury of a member of his or her immediate family . . . .” Bovsun v. Sanperi, 61 N.Y.2d 219, *40228, 461 N.E.2d 843, 473 N.Y.S.2d 357 (1984). The rule is premised on the “concept that by unreasonably endangering the plaintiffs physical safety the defendant has breached a duty owed to him or her for which he or she should recover all damages sustained including those occasioned by witnessing the suffering of an immediate family member who is also injured by the defendant’s conduct.” Id., 229; 2 Restatement (Second), supra, § 313.8 Although permitting recovery for damages on a claim of bystander emotional distress, advocates of the zone of danger rule argued that “[u]se of the [rule] . . . mitigates the possibility of unlimited recovery ... by restricting liability in a much narrower fashion than does the Dillon rule.”9 Bovsun v. Sanperi, supra, 229. The New York Court of Appeals has further restricted liability under the zone of danger rule by holding that “[Recovery of damages by bystanders for the negligent infliction of emotional distress should be limited only to the immediate family.” Trombetta v. Conkling, 82 N.Y.2d 549, 551, 626 N.E.2d 653, 605 N.Y.S.2d 678 (1993).

*41Prior to the adoption of § 313 of the second Restatement of Torts, the first Restatement suggested, in its comments, a reasonable foreseeability rule. Indeed, as the Supreme Judicial Court of Massachusetts pointed out, the addition of the zone of danger test in § 313 (2) of the Restatement (Second) of Torts “was recommended with reluctance by the Reporter (Dean Prosser) and the advisers (Restatement [Second] of Torts 9-11 [Tent. Draft No. 5, I960]), but the recommendation was thought to be compelled by the absence of then recent authority in support of a contrary view. . . . As a result of adding § 313 (2), a caveat appearing in the first Restatement of Torts was deleted. That caveat had left open the question whether a person might be liable ‘to the parent or spouse who witnesses the peril or harm of the child or spouse and thereby suffers anxiety or shock’ causing bodily harm to the parent or spouse. Restatement of Torts § 313, at 851 (1934).” (Citation omitted.) Dziokonski v. Babineau, 375 Mass. 555, 563, 380 N.E.2d 1295 (1978).

B

Dillon was decided three years after the American Law Institute had adopted the zone of danger limitation on bystander emotional distress set forth in §§ 313 and 436 of the Restatement (Second), supra. Dillon changed the landscape for claims of bystander emotional distress. As previously noted, the California Supreme Court decided Dillon based upon general principles of foreseeability, with its limitations to be decided on a case-by-case basis. The three factors in Dillon were not conditions or limitations, but, rather, circumstances to consider in determining whether the emotional injury was reasonably foreseeable. In 1989, however, a majority of the California Supreme Court in Thing v. La Chusa, 48 Cal. 3d 644, 771 P.2d 814, 257 Cal. Rptr. 865 (1989), found that reeoveiy of bystander emotional distress based upon “reasonable foreseeability” *42required limitations. The court in Thing was concerned with the broad scope of liability under the foreseeability rule: “[I]t is clear that foreseeability of the injury alone is not a useful ‘guideline’ or a meaningful restriction on the scope of the [bystander emotional distress] action. The Dillon experience confirms, as one commentator observed, that ‘[f]oreseeability proves too much. . . . Although it may set tolerable limits for most types of physical harm, it provides virtually no limit on liability for nonphysical harm.’ Rabin, [‘Tort Recovery for Negligently Inflicted Economic Loss: A Reassessment,’ 37 Stan. L. Rev. 1513, 1526 (1985)]. It is apparent that reliance on foreseeability of injury alone in finding a duly, and thus a right to recover, is not adequate when the damages sought are for an intangible injury. In order to avoid limitless liability out of all proportion to the degree of a defendant’s negligence, and against which it is impossible to insure without imposing unacceptable costs on those among whom the risk is spread, the right to recover for negligently caused emotional distress must be limited.” Thing v. La Chusa, supra, 663-64. The California Supreme Court concluded that “drawing arbitrary lines is unavoidable if we are to limit liability and establish meaningful rules for application by litigants and lower courts.” Id., 666.

Accordingly, in Thing, the court held “that a plaintiff may recover damages for emotional distress caused by observing the negligently inflicted injury of a third person if, but only if, said plaintiff: (1) is closely related to the injury victim; (2) is present at the scene of the injury-producing event at the time it occurs and is then aware that it is causing injury to the victim; and (3) as a result suffers serious emotional distress — a reaction beyond that which would be anticipated in a disinterested witness and which is not an abnormal response to the circumstances.” Id., 667-68.

*43A number of jurisdictions have adopted the Thing guidelines in an effort to limit the scope of the defendant’s duty to third party bystanders. See Cameron v. Pepin, 610 A.2d 279, 284 (Me. 1992) (“defendant’s duty should be limited to the emotional vulnerability that arises in parents upon actually witnessing their child receiving an injury”); Nugent v. Bauermeister, 195 Mich. App. 158, 161, 489 N.W.2d 148 (1992) (limited recovery to immediate family members as opposed to close friends); Marchetti v. Parsons, 638 A.2d 1047, 1052 (R.I. 1994) (“[w]e find the reasoning of the California Supreme Court [in Thing] persuasive and follow its lead in modifying the Dillon standard that we [previously] followed”); Heldreth v. Marrs, 188 W. Va. 481, 488, 425 S.E.2d 157 (1992) (“[hjaving the benefit of the Thing court’s hindsight, we too adopt the requirement that a plaintiff in a negligent infliction of emotional distress action be present at the scene of the injury-producing event at the time it occurs and [be] aware that it is causing injuiy to the victim”).

Nevertheless, a number of jurisdictions continue to apply the foreseeability rule as set forth in Dillon, rejecting completely or in part the limitations subsequently established by the court in Thing. See Beck v. Dept. of Transportation & Public Facilities, 837 P.2d 105, 110 (Alaska 1992) (retained liberal interpretation of Dillon guidelines and rejected restrictive approach taken by court in Thing regarding contemporaneous observation requirement); Dunphy v. Gregor, 136 N.J. 99, 106-108, 642 A.2d 372 (1994) (noting that it previously narrowed Dillon, the court rejected “a departure from our accustomed application of the traditional principles of tort law” or adoption of “hastily-drawn ‘bright line’ distinction[s]”); Gain v. Carroll Mill Co., 114 Wash. 2d 254, 260-61, 787 P.2d 553 (1990) (applied foreseeability analysis similar to that set forth in Dillon, with exception that court requires physical presence at *44scene of accident or arrival shortly thereafter); Contreras v. Carbon County School District 1, 843 P.2d 589, 594 (Wyo. 1992) (rejected Thing in favor of “broader immediacy rule, which allows the plaintiff to recover if she observes the injury shortly after it occurs without material change in the attendant circumstances”).

Although we discussed Dillon at length in both Amodio and Maloney, in neither case did the factual scenario present the court with an opportunity to make a definitive ruling on whether to recognize a cause of action for bystander emotional distress. Central to this court’s concern in Amodio and Maloney was that “the etiology of emotional disturbance is usually not readily apparent as that of a broken bone following an automobile accident . . . .” Maloney v. Conroy, supra, 208 Conn. 397. The problem is compounded when the underlying act of negligence with respect to the victim is medical malpractice because there generally is no significant observable sudden traumatic event by which the effect upon the bystander can be judged. For this precise reason most courts have recognized that a cause of action for bystander emotional distress must be confined in order to avoid limitless liability. “Without such perception, the threat of emotional injury is lessened and the justification for liability is fatally weakened.” Portee v. Jaffee, 84 N.J. 88, 99, 417 A.2d 521 (1980).

C

This case affords us with an opportunity to reexamine this court’s holding in Strazza in light of Amodio and Maloney and the law regarding bystander emotional distress that has developed over the last four decades. Strazza did not provide this court with an analysis for rejecting bystander emotional distress; rather, the court relied on the state of the law in other jurisdictions at that time in arriving at its conclusion.

*45Our first inquiry is to determine whether a tortfeasor may owe a legal duty to a bystander. “Duty is a legal conclusion about relationships between individuals, made after the fact, and imperative to a negligence cause of action. The nature of the duty, and the specific persons to whom it is owed, are determined by the circumstances surrounding the conduct of the individual. . . . Although it has been said that no universal test for [duty] ever has been formulated . . . our threshold inquiry has always been whether the specific harm alleged by the plaintiff was foreseeable to the defendant. The ultimate test of the existence of the duty to use care is found in the foreseeability that harm may result if it is not exercised. ... By that is not meant that one charged with negligence must be found actually to have foreseen the probability of harm or that the particular injury which resulted was foreseeable, but the test is, would the ordinary [person] in the defendant’s position, knowing what he knew or should have known, anticipate that harm of the general nature of that suffered was likely to result? . . . Thus, initially, if it is not foreseeable to a reasonable person in the defendant’s position that harm of the type alleged would result from the defendant’s actions to a particular plaintiff, the question of the existence of a duty to use due care is foreclosed, and no cause of action can be maintained by the plaintiff.

“A simple conclusion that the harm to the plaintiff was foreseeable, however, cannot by itself mandate a determination that a legal duty exists. Many harms are quite literally ‘foreseeable,’ yet for pragmatic reasons, no recovery is allowed. ... A further inquiry must be made, for we recognize that ‘duty’ is not sacrosanct in itself, but is only an expression of the sum total of those considerations of policy which lead the law to say that the plaintiff is entitled to protection. . . . While it may seem that there should be a remedy for every wrong, *46this is an ideal limited perforce by the realities of this world. Every injury has ramifying consequences, like the ripplings of the waters, without end. The problem for the law is to limit the legal consequences of wrongs to a controllable degree. . . . The final step in the duty inquiry, then, is to make a determination of the fundamental policy of the law, as to whether the defendant’s responsibility should extend to such results.” (Citations omitted; internal quotation marks omitted.) RK Constructors, Inc. v. Fusco Corp., 231 Conn. 381, 385-86, 650 A.2d 153 (1994).

We believe the time is ripe to recognize a cause of action for bystander emotional distress. Under certain circumstances, which are hereinafter delineated, we conclude that a tortfeasor may owe a legal duty to a bystander. Consequently, a tortfeasor who breaches that duty through negligent conduct may be liable for a bystander’s emotional distress proximately caused by that conduct. Accordingly, we now overrule Strazza to the extent that it conflicts with our opinion in this case.

We first conclude, as indicated below with respect to our justification for adopting the reasonable foreseeability theory, that bystander emotional distress is reasonably foreseeable. We further conclude that public policy requires that we recognize this duty owed by a tortfeasor to a bystander. See Bohan v. Last, 236 Conn. 670, 678, 236 A.2d 670 (1996) (change in public policy guided this court in recognizing cause of action against purveyors of alcohol to minors at bar who subsequently cause injury to innocent third parties). In drawing this conclusion, we have carefully weighed various public policy factors, including social and financial costs associated with recognizing this cause of action. We concur with the statement of the New Jersey Supreme Court that “the interest in personal emotional stability is worthy of legal protection against unreasonable conduct. The emotional harm following the perception of the *47death or serious injury to a loved one is just as foreseeable as the injury itself, for few persons travel through life alone. Ultimately we must decide whether protecting these emotional interests outweighs an interest against burdening freedom of conduct by imposing a new species of negligence liability. We believe that the interest in emotional stability we have described is sufficiently important to warrant this protection. At the same time we are confident that limiting judicial redress to harm inflicted on intimate emotional bonds by the death or serious injury of a loved one serves to prevent liability from exceeding the culpability of [a] defendant’s conduct.” Portee v. Jaffee, supra, 84 N.J. 101.

In recognizing this cause of action, we adopt the “reasonable foreseeability” rule subject to the conditions set forth in this opinion. We do so for two principal reasons. First, an important consideration in determining whether a duty exists under our law of negligence has been the rule of foreseeability. RK Constructors, Inc. v. Fusco Corp., supra, 231 Conn. 385-86. We have long held that the “ultimate test of the existence of a duty to use care is found in the foreseeability that harm may result if it is not exercised. ... By that is not meant that one charged with negligence must be found actually to have foreseen the probability of harm or that the particular injuiy which resulted was foreseeable, but the test is, would the ordinary man in the defendant’s position, knowing what he knew or should have known, anticipate that harm of the general nature of that suffered was likely to result?” (Citations omitted; internal quotation marks omitted.) Frankovitch v. Burton, 185 Conn. 14, 20-21, 440 A.2d 254 (1981). On the basis of this concept of foreseeability, we concluded more than fifty years ago that it is “well within the logic of the law that where results which are regarded as proper elements of recovery as a consequence of physical injuiy are caused by fright or nervous shock due *48to negligence, recovery should be permitted.” Orlo v. Connecticut Co., supra, 128 Conn. 238. Although in Orlo the plaintiff sought damages as a result of being fearful for his own safety, the sight of a loved one being injured can result in an emotional injury that is no less foreseeable than that experienced as the fear of injury to oneself. “Thus, we see no good reason why the general rules of tort law, including concepts of negligence, proximate cause and foreseeability, long applied to all other types of injury, should not govern . . . .” Dillon v. Legg, supra, 68 Cal. 2d 746.

Second, although the zone of danger test has an inherent limitation on liability that is relatively easy to determine, application of that doctrine could result in anomalous situations. For example, varying the factual allegations of this case slightly, assume that Clohessy stayed behind on the steps of the church watching her children, Brendan and Liam, proceed to cross Hillhouse Avenue, when Brendan was struck by the automobile being driven by the defendant. In that situation, Liam could recover, because he was in the zone of danger with his brother, but Clohessy could not. Her emotional trauma, however, would not be any less. Such was the situation in Dillon, wherein the court responded: “In the first place, we can hardly justify relief to the [sibling] for trauma which she suffered upon apprehension of the child’s death and yet deny it to the mother merely because of a happenstance that the [sibling] was some few yards closer to the accident. The instant case exposes the hopeless artificiality of the zone-of-danger rule.” Id., 733. Recognizing this artificiality, the Supreme Court of Pennsylvania in Sinn v. Burd, 486 Pa. 146, 157, 404 A.2d 642 (1979), concluded that the zone of danger requirement “creates the very evil that the test was designed to eliminate, i.e., arbitrariness,” and therefore abandoned it for the foreseeability rule.10

*49In addition to noting the arbitrariness of the zone of danger rule, the Sinn court found a basic flaw in the rule: “[Ejxperience has taught us that the zone of danger requirement can be unnecessarily restrictive and prevent recovery in instances where there is no sound policy basis supporting such a result. It has unquestionably not been effective in every instance of assuring that one may ‘seek redress for every substantial wrong.’ The restrictiveness of the zone of danger test is glaringly apparent where it is allowed to deny recovery to a parent who has suffered emotional harm from witnessing a tortious assault upon the person of his or her minor child. A majority of the commentators and a growing number of jurisdictions have considered this problem in recent years and have concluded that it is unreasonable for the zone of danger requirement to exclude recovery in such cases. This new awareness of the unfairness of the zone of danger requirement in these cases is based upon the implicit acceptance that the emotional impact upon a parent witnessing the killing of a minor child is at least as great and as legitimate as the apprehension that is inspired by a plaintiff being personally within the zone of danger.” Id., 155-57.

We therefore conclude, on the basis of sound public policy and principles of reasonable foreseeability, that a plaintiff should be allowed to recover, within certain limitations, for emotional distress as a result of harm done to a third party. In doing so, we join the courts of other jurisdictions that have adopted the rule of foreseeability in various forms.11

*50We are aware that the application of pure rules of foreseeability could lead to unlimited liability. “[TJhere are ample policy concerns for setting limits or administrative boundaries establishing the permissible instances of recoveiy. There are fears of flooding the courts with ‘spurious and fraudulent claims’; problems of proof of the damage suffered; exposing the defendant to an endless number of claims; and economic burdens on industry.” Lejeune v. Rayne Branch Hospital, 556 So. 2d 559, 566 (La. 1990). For example, “[i]t would be an entirely unreasonable burden on all human activity if the defendant who has endangered one person were to be compelled to pay for the lacerated feelings of every other person disturbed by reason of it, including every bystander shocked at an accident, and every distant relative of the person injured, as well as all his friends.” W. Prosser & P. Keeton, Torts (5th Ed. 1984) § 54, p. 366; Thing v. La Chusa, supra, 48 Cal. 3d 666-67.12

*51With these considerations in mind, and borrowing from the experience of other jurisdictions, we agree that specific limitations must be imposed upon the reasonable foreseeability rule. We recognize that those limitations, albeit somewhat arbitrary, are “necessary in order not to leave the liability of a negligent defendant open to undue extension by the verdict of sympathetic juries, who under our system must define and apply any general rule to the facts of the case before them. . . . Prosser, Torts (4th Ed.) § 54, p. 335.” (Internal quotation marks omitted.) Amodio v. Cunningham, supra, 182 Conn. 93 n.11; Thing v. La Chusa, supra, 48 Cal. 3d 666. Accordingly, for a cause of action for bystander emotional distress, we adopt the reasonable foreseeability rule subject to the following conditions.13

*52First, we hold that in order to recover for emotional distress, the bystander must be “closely related to the injury victim.” Thing v. La Chusa, supra, 48 Cal. 3d 667. In this case, the relationship of the parent and the sibling to the victim satisfies this condition. “The class of potential plaintiffs should be limited to those who because of their relationship suffer the greatest emotional distress. When the right to recover is limited in this manner, the liability bears a reasonable relationship to the culpability of the negligent defendant.” Id. This court has previously recognized the importance of such relationships within the framework of our tort law. For example, the court recognized in the context of loss of consortium between husband and wife that “the mental and emotional anguish caused by seeing a healthy, loving, companionable mate turn into a shell of a person is undeniably a real injury.” Hopson v. St. Mary’s Hospital, 176 Conn. 485, 493, 408 A.2d 260 (1979). We leave to another day the question of what other relationships may qualify.

Second, the bystander’s emotional injury must be caused by the contemporaneous sensory perception of the event or conduct that causes the injury; Thing v. La Chusa, supra, 48 Cal. 3d 668; Cameron v. Pepin, supra, 610 A.2d 284; Portee v. Jaffee, supra, 84 N.J. 99; Marchetti v. Parsons, supra, 638 A.2d 1052; Kinard v. Augusta Sash & Door Co., 286 S.C. 579, 583, 336 S.E.2d 465 (1985); Heldreth v. Marrs, supra, 188 W. Va. 488; or by viewing the victim immediately after the injury causing event if no material change has occurred with respect to the victim’s location and condition. Gain v. Carroll Mill Co., supra, 114 Wash. 2d 261 (“A defendant has a duty to avoid the negligent infliction of emotional distress. However, this duty does not extend to those plaintiffs who have a claim for mental distress caused by the negligent bodily injury of a family member, unless they are physically present at the scene of the accident *53or arrive shortly thereafter. Mental distress where the plaintiffs are not present at the scene of the accident and/or arrive shortly thereafter is unforeseeable as a matter of law.”); Gates v. Richardson, 719 P.2d 193, 198-99 (Wyo. 1986) (plaintiff who observes infliction of serious bodily harm or death, or observes serious bodily harm or death shortly after its occurrence but without material change in condition or location of victim can recover under tort of negligent infliction of emotional distress); see Tommy’s Elbow Room, Inc. v. Kavorkian, 727 P.2d 1038 (Alaska 1986); Masaki v. General Motors Corp., 71 Haw. 1, 780 P.2d 566 (1989); Lejeune v. Rayne Branch Hospital, supra, 556 So. 2d 559; Dziokonski v. Babineau, supra, 375 Mass. 555;14 James v. Lieb, 221 Neb. 47, 375 N.W.2d 109 (1985); Corso v. Merrill, 119 N.H. 647, 406 A.2d 300 (1979); General Motors Corp. v. Grizzle, 642 S.W.2d 837 (Tex. App. 1982); Bowen v. Lumbermens Mutual Casualty Co., 183 Wis. 2d 627, 517 N.W.2d 432 (1994).

Third, the injury to the victim must be substantial, resulting in either death or serious physical injury. Lejeune v. Rayne Branch Hospital, supra, 556 So. 2d 570 *54(“[t]he direct victim of the traumatic injury must suffer such harm that it can reasonably be expected that one in the plaintiffs position would suffer serious mental anguish from the experience”). Any injury to one who is closely related to the bystander has an emotional impact. To a sensitive parent, witnessing a minor injury to his or her child could produce an emotional response and result in serious injury. Nevertheless, under those circumstances, a cause of action for bystander emotional distress will not he. “While any harm to a spouse or a family member causes sorrow, we are here concerned with a more narrowly confined interest in mental and emotional stability. When confronted with accidental death [or serious injury] the reaction to be expected of normal persons ... is shock and fright.” (Citations omitted; internal quotation marks omitted.) Portee v. Jaffee, supra, 84 N.J. 100. Although the tortfeasor takes his victim as he finds him or her; Hopson v. St. Mary's Hospital, supra, 176 Conn. 493; D. Wright, J. Fitzgerald & W. Ankerman, Connecticut Law of Torts (3d Ed. 1991) § 171, p. 485; it is essential that the liability for bystander emotional distress be circumscribed.

Finally, the plaintiff bystander must have sustained a serious emotional injury — that is, “a reaction beyond that which would be anticipated in a disinterested witness and which is not an abnormal response to the circumstance.” Thing v. La Chusa, supra, 48 Cal. 3d 668; see Ramirez v. Armstrong, 100 N.M. 538, 542, 673 P.2d 822 (1983); Paugh v. Hanks, 6 Ohio St. 3d 72, 78, 451 N.E.2d 759 (1983); Sinn v. Burd, supra, 486 Pa. 168. This injury may be purely emotional and need not manifest itself physically. See Delott v. Roraback, 179 Conn. 406, 409, 426 A.2d 791 (1980) (“[a] plaintiff may recover damages in a personal injury action for pain and suffering even when such pain and suffering is evidenced exclusively by the plaintiffs subjective complaints”); Leong v. Takasaki, 55 Haw. 398, 408, 520 P.2d *55758 (1974) (serious emotional distress may properly be found where reasonable person “ ‘normally constituted, would be unable to adequately cope with the mental stress engendered by the circumstances’ ”); Folz v. State, 110 N.M. 457, 470, 797 P.2d 246 (1990) (illogical to require “as a threshold element the presence of physical injury to manifest the emotional trauma induced by the contemporaneous sensory perception of the death or physical injury of a close loved one”); Sorrells v. M.Y.B. Hospitality Ventures of Asheville, 334 N.C. 669, 672, 435 S.E.2d 320 (1993) (“plaintiff must show an ‘emotional or mental disorder, such as, for example, neurosis, psychosis, chronic depression, phobia, or any other type of severe and disabling emotional or mental condition which may be generally recognized and diagnosed by professionals trained to do so’ ”); Paugh v. Hanks, supra, 78 (“serious emotional distress may be found where a reasonable person, normally constituted, would be unable to cope adequately with the mental distress engendered by the circumstances of the case”); Sinn v. Burd, supra, 168 (in agreement with Leong court); Boyles v. Kerr, 855 S.W.2d 593, 598 (Tex. 1993) (“[w]e also are not imposing a requirement that emotional distress manifest itself physically to be compensable”); Heldreth v. Marrs, supra, 188 W. Va. 490 (“Serious emotional distress which results from witnessing a closely related person critically injured or killed can be, in some cases, as debilitating and as severe as a physical injury. More importantly, serious emotional distress can be diagnosed even in the absence of any physical manifestation, and can be proven with medical and psychiatric evidence.”); Culbert v. Sampson’s Supermarkets, Inc., 444 A.2d 433, 438 (Me. 1982) (“proof of physical manifestations of the mental injury is no longer required”); Bowen v. Lumbermens Mutual Casualty Co., supra, 183 Wis. 2d 653 (plaintiff “need not prove physical manifestation of severe emotional *56distress”). “Serious emotional distress, of course, goes well beyond simple mental pain and anguish. Compensation for mental pain and anguish over injury to a third person should only be allowed where the emotional injury is both severe and debilitating. ... A non-exhaustive list of examples of serious emotional distress includes neuroses, psychoses, chronic depression, phobia and shock.” (Citation omitted; internal quotation marks omitted.) Lejeune v. Rayne Branch Hospital, supra, 556 So. 2d 570.

To summarize, we conclude that a bystander may recover damages for emotional distress under the rule of reasonable foreseeability if the bystander satisfies the following conditions: (1) he or she is closely related to the injury victim, such as the parent or the sibling of the victim; (2) the emotional injury of the bystander is caused by the contemporaneous sensory perception of the event or conduct that causes the injury, or by arriving on the scene soon thereafter and before substantial change has occurred in the victim’s condition or location; (3) the injury of the victim must be substantial, resulting in his or her death or serious physical injury; and (4) the bystander’s emotional injury must be serious, beyond that which would be anticipated in a disinterested witness and which is not the result of an abnormal response.

The allegations of the third count of the complaint seeking damages for bystander emotional distress fall within the reasonable foreseeability rule subject to the limitations we have delineated. From the allegations in the third count, a fact finder reasonably could conclude that Clohessy and Liam were closely related to Brendan, that their emotional injury was caused by the contemporaneous sensory perception of the defendant’s alleged negligence, that Brendan died as a result of the defendant’s alleged negligence, and that the emotional distress of Clohessy and Liam was severe. We conclude that *57the allegations of the third count of the complaint allege a cause of action for bystander emotional distress, a cause of action that we recognize.

II

The defendants argue that if we adopt a cause of action for bystander emotional distress, it should be applied prospectively only because they were not put on notice that we would recognize such a duty. Traditionally, however, in cases of civil tort liability in which new causes of action are recognized, the new theory of liability is applied to the parties in the case.15 See Bohan v. Last, supra, 236 Conn. 670; Hopson v. St. Mary’s Hospital, supra, 176 Conn. 485.

Moreover, this cause of action was clearly foreshadowed. Although in Strazza v. McKittrick, supra, 146 Conn. 714, this court stated that a bystander, under the facts of that case, could not recover, the statement is dictum with respect to this case. The plaintiff in Strazza did not meet all of the conditions that we have concluded are necessary for a defendant to be liable to a bystander. Furthermore, our decision in Amodio v. Cunningham, supra, 182 Conn. 80, decided fourteen years before the events in this case occurred, wherein we discussed Dillon v. Legg, supra, 68 Cal. 2d 728, at length, contained language that was sufficient to put the defendants on notice that bystander emotional distress was not foreclosed in Connecticut. Finally, the trial courts of this state, prior to the events of this case, had recognized an action for bystander emotional distress. See, e.g., Glendening v. Weis, 41 Conn. Sup. 165, 166-68, 560 A.2d 995 (1988); see also Kearney v. Philips Industries, Inc., 708 F. Sup. 479, 483 (D. Conn. 1989) (“Several judges of the Connecticut Superior Court have ruled on bystander emotional distress claims in accident situ*58ations not involving medical malpractice. The majority of these judges have refused to strike such claims from the complaint, applying the three criteria of DiUon . . . .”). Accordingly, we reject the defendants’ claim that the cause of action for bystander emotional distress should be applied prospectively only and conclude that it has full application to this case.

The judgment is reversed and the case is remanded for further proceedings.

In this opinion the other justices concurred.

Justice Breyer

delivered the opinion of the Court.

The basic question in this case is whether a railroad worker negligently exposed to a carcinogen (here, asbestos) but without symptoms of any disease can recover under the *427Federal Employers’ Liability Act (FELA or Act), 35 Stat. 65, as amended, 45 U. S. C. § 51 et seq., for negligently inflicted emotional distress. We conclude that the worker before us here cannot recover unless, and until, he manifests symptoms of a disease. We also consider a related claim for medical monitoring costs, and we hold, for reasons set out below, that the respondent in this case has not shown that he is legally entitled to recover those costs.

Respondent, Michael Buckley, works as a pipefitter for Metro-North, a railroad. For three years (1985-1988) his job exposed him to asbestos for about one hour per working day. During that time Buckley would remove insulation from pipes, often covering himself with insulation dust that contained asbestos. Since 1987, when he attended an “asbestos awareness” class, Buckley has feared that he would develop cancer — and with some cause, for his two expert witnesses testified that, even after taking account of his now-discarded 15-year habit of smoking up to a pack of cigarettes per day, the exposure created an added risk of death due to cancer, or to other asbestos-related diseases, of either 1% to 5% (in the view of one of plaintiff’s experts), or 1% to 3% (in the view of another). Since 1989, Buckley has received periodic medical checkups for cancer and asbestosis. So far, those checkups have not revealed any evidence of cancer or any other asbestos-related disease.

Buckley sued Metro-North under the FELA, a statute that permits a railroad worker to recover for an “injury . . . resulting . .. from” his employer’s “negligence.” 45 U. S. C. § 51. He sought damages for his emotional distress and to cover the cost of future medical checkups. His employer conceded negligence, but it did not concede that Buckley had actually suffered emotional distress, and it argued that the FELA did not permit a worker like Buckley, who had suffered no physical harm, to recover for injuries of either sort. *428After hearing Buckley’s case, the District Court dismissed the action. The court found that Buckley did not “offer sufficient evidence to allow a jury to find that he suffered a real emotional injury.” App. 623. And, in any event, Buckley suffered no “physical impact”; hence any emotional injury fell outside the limited set of circumstances in which, according to this Court, the FELA permits recovery. Id., at 620; see Consolidated Rail Corporation v. Gottshall, 512 U. S. 532 (1994). The District Court did not discuss Buckley’s further claim for the costs of medical monitoring.

Buckley appealed, and the Second Circuit reversed. 79 F. 3d 1337 (1996). Buckley’s evidence, it said, showed that his contact with the insulation dust (containing asbestos) was “massive, lengthy, and tangible,” id., at 1345, and that the contact “would cause fear in a reasonable person,” id., at 1344. Under these circumstances, the court held, the contact was what this Court in Gottshall had called a “physical impact” — a “physical impact” that, when present, permits a FELA plaintiff to recover for accompanying emotional distress. The Second Circuit also found in certain of Buckley’s workplace statements sufficient expression of worry to permit sending his emotional distress claim to a jury. Finally, the court held that Buckley could recover for the costs of medical checkups because the FELA permits recovery of all reasonably incurred extra medical monitoring costs whenever a “reasonable physician would prescribe ... a monitoring regime different than the one that would have been prescribed in the absence of” a particular negligently caused exposure to a toxic substance. 79 F. 3d, at 1347 (internal quotation marks omitted).

We granted certiorari to review the Second Circuit’s holdings in light of Gottshall.

II

The critical question before us in respect to Buckley’s “emotional distress” claim is whether the physical contact with insulation dust that accompanied his emotional distress *429amounts to a “physical impact” as this Court used that term in Gottshall. In Gottshall, an emotional distress case, the Court interpreted the word “injury” in FELA § 1, a provision that makes “[ejvery common carrier by railroad . . . liable in damages to any person suffering injury while . . . employed” by the carrier if the “injury” results from carrier “negligence.” 45 U. S. C. § 51. In doing so, it initially set forth several general legal principles applicable here. Gott-shall described FELA’s purposes as basically “humanitarian.” Gottshall, supra, at 542; see also, e. g., Urie v. Thompson, 337 U. S. 163 (1949). It pointed out that the Act expressly abolishes or modifies a host of common-law doctrines that previously had limited recovery. See, e. g., 45 U. S. C. §§ 51, 53, and 54. It added that this Court has interpreted the Act’s language “liberally” in light of its humanitarian purposes. Gottshall, supra, at 543. But, at the same time, the Court noted that liability under the Act rests upon “negligence” and that the Act does not make the railroad “‘the insurer’” for all employee injuries. 512 U. S., at 543 (quoting Ellis v. Union Pacific R. Co., 329 U. S. 649, 653 (1947)). The Court stated that “common-law principles,” where not rejected in the text of the statute, “are entitled to great weight” in interpreting the Act, and that those principles “play a significant role” in determining whether, or when, an employee can recover damages for “negligent infliction of emotional distress.” 512 U. S., at 544. See also id., at 558 (Souter, J., concurring) (Court’s duty “in interpreting FELA ... is to develop a federal common law of negligence ... informed by reference to the evolving common law”); Atchison, T. & S. F. R. Co. v. Buell, 480 U. S. 557 (1987).

The Court also set forth several more specific legal propositions. It recognized that the common law of torts does not permit recovery for negligently inflicted emotional distress unless the distress falls within certain specific categories that amount to recovery-permitting exceptions. The law, *430for example, does permit recovery for emotional distress where that distress accompanies a physical injury, see, e. g., Simmons v. Pacor, Inc., 543 Pa. 664, 678, 674 A. 2d 232, 239 (1996); Restatement (Second) of Torts § 924(a) (1977), and it often permits recovery for distress suffered by a close relative who witnesses the physical injury of a negligence victim, e. g., Dillon v. Legg, 68 Cal. 2d 728, 441 P. 2d 912 (1968); Gottshall, 512 U. S., at 549, n. 10 (citing cases). The Court then held that FELA § 1, mirroring the law of many States, sometimes permitted recovery “for damages for negligent infliction of emotional distress,” id., at 550, and, in particular, it does so where a plaintiff seeking such damages satisfies the common law’s “zone of danger” test. It defined that test by stating that the law permits “recovery for emotional injury” by

“those plaintiffs who sustain a physical impact as a result of a defendant’s negligent conduct, or who are placed in immediate risk of physical harm by that conduct.” Id., at 547-548 (emphasis added).

The case before us, as we have said, focuses on the italicized words “physical impact.” The Second Circuit interpreted those words as including a simple physical contact with a substance that might cause a disease at a future time, so long as the contact was of a kind that would “cause fear in a reasonable person.” 79 F. 3d, at 1344. In our view, however, the “physical impact” to which Gottskall referred does not include a simple physical contact with a substance that might cause a disease at a substantially later time— where that substance, or related circumstance, threatens no harm other than that disease-related risk.

First, Gottskall cited many state cases in support of its' adoption of the “zone of danger” test quoted above. And in each case where recovery for emotional distress was permitted, the case involved a threatened physical contact that caused, or might have caused, immediate traumatic harm. *431 Keck v. Jackson, 122 Ariz. 114, 593 P. 2d 668 (1979) (car accident); Towns v. Anderson, 195 Colo. 517, 579 P. 2d 1163 (1978) (gas explosion); Robb v. Pennsylvania R. Co., 58 Del. 454, 210 A. 2d 709 (1965) (train struck car); Rickey v. Chicago Transit Authority, 98 Ill. 2d 546, 457 N. E. 2d 1 (1983) (clothing caught in escalator choked victim); Shuamber v. Henderson, 579 N. E. 2d 452 (Ind. 1991) (car accident); Watson v. Dilts, 116 Iowa 249, 89 N. W. 1068 (1902) (intruder assaulted plaintiff’s husband); Stewart v. Arkansas Southern R. Co., 112 La. 764, 36 So. 676 (1904) (train accident); Purcell v. St. Paul City R. Co., 48 Minn. 134, 50 N. W. 1034 (1892) (near streetcar collision); Bovsun v. Sanperi, 61 N. Y. 2d 219, 461 N. E. 2d 843 (1984) (car accident); Kimberly v. Howland, 143 N. C. 398, 55 S. E. 778 (1906) (rock from blasting crashed through plaintiffs’ residence); Simone v. Rhode Island Co., 28 R. I. 186, 66 A. 202 (1907) (streetcar collision); Mack v. South-Bound R. Co., 52 S. C. 323, 29 S. E. 905 (1898) (train narrowly missed plaintiff); Gulf, C. & S. F. R. Co. v. Hayter, 93 Tex. 239, 54 S. W. 944 (1900) (train collision); Pankopf v. Hinkley, 141 Wis. 146, 123 N. W. 625 (1909) (automobile struck carriage); Garrett v. New Berlin, 122 Wis. 2d 223, 362 N. W. 2d 137 (1985) (car accident). Cf. Deutsch v. Shein, 597 S. W. 2d 141 (Ky. 1980) (holding that exposure to X rays was “physical contact” supporting recovery for emotional suffering where immediate physical harm to fetus was suspected).

Second, Gottshall’s language, read in light of this precedent, seems similarly limited. 512 U. S., at 555 (“zone of danger test ... is consistent with FELA’s central focus on physical perils”); id., at 556 (quoting Lancaster v. Norfolk & Western R. Co., 773 F. 2d 807, 813 (CA7 1985)) (FELA seeks to protect workers “ ‘from physical invasions or menaces’ ”), cert. denied, 480 U. S., 945 (1987); 512 U. S., at 556 (employer should be liable for “emotional injury caused by the apprehension of physical impact”); id., at 547-548 (quoting Pearson, Liability to Bystanders for Negligently Inflicted Emotional Harm — A Comment on the Nature of Arbitrary Rules, *43234 U. Fla. L. Rev. 477, 488-489 (1982)) (“ ‘[T]hose within the zone of danger of physical impact’ ” should be able to “ ‘recover for fright’ ” because “ ‘a near miss may be as frightening as a direct hit’ ”).

Taken together, language and cited precedent indicate that the words “physical impact” do not encompass every form of “physical contact.” And, in particular, they do not include a contact that amounts to no more than an exposure — an exposure, such as that before us, to a substance that poses some future risk of disease and which contact causes emotional distress only because the worker learns that he may become ill after a substantial period of time.

Third, common-law precedent does not favor the plaintiff. Common-law courts do permit a plaintiff who suffers from a disease to recover for related negligently caused emotional distress, see supra, at 429, and some courts permit a plaintiff who exhibits a physical symptom of exposure to recover, see, e. g., Herber v. Johns-Manville Corp., 785 F. 2d 79, 85 (CA3 1986); Mauro v. Owens-Corning Fiberglas Corp., 225 N. J. Super. 196, 542 A. 2d 16 (App. Div. 1988). But with only a few exceptions, common-law courts have denied recovery to those who, like Buckley, are disease and symptom free. E. g., Burns v. Jacquays Mining Corp., 156 Ariz. 375, 752 P. 2d 28 (Ct. App. 1987), review dism’d, 162 Ariz. 186, 781 P. 2d 1373 (1989); Mergenthaler v. Asbestos Corp. of Am., 480 A. 2d 647 (Del. 1984); Eagle-Picher Industries, Inc. v. Cox, 481 So. 2d 517 (Fla. App. 1985), review denied, 492 So. 2d 1331 (Fla. 1986); Capital Holding Corp. v. Bailey, 873 S. W. 2d 187 (Ky. 1994); Payton v. Abbott Labs, 386 Mass. 540, 437 N. E. 2d 171 (1982); Simmons v. Pacor, Inc., 543 Pa. 664, 674 A. 2d 232 (1996); Ball v. Joy Technologies, Inc., 958 F. 2d 36 (CA4 1991); Deleski v. Raymark Industries, Inc., 819 F. 2d 377 (CA3 1987) (Pennsylvania and New Jersey law); Adams v. Johns-Manville Sales Corp., 783 F. 2d 589 (CA5 1986) (Louisiana law); Wisniewski v. Johns-Manville Corp., 759 F. 2d 271 (CA3 1985) (Pennsylvania law); In re Hawaii Federal *433 Asbestos Cases, 734 F. Supp. 1563 (Haw. 1990) (Hawaii law); Arriendola v. Kansas City So. R. Co., 699 F. Supp. 1401 (WD Mo. 1988) (FELA); see also Potter v. Firestone Tire & Rubber Co., 6 Cal. 4th 965, 863 P. 2d 795 (1993) (in banc) (no recovery for fear of cancer in a negligence action unless plaintiff is “more likely than not” to develop cancer).

Fourth, the general policy reasons to which Gottskall referred — in its explanation of why common-law courts have restricted recovery for emotional harm to cases falling within rather narrowly defined categories — militate against an expansive definition of “physical impact” here. Those reasons include: (a) special “difficulty] for judges and juries” in separating valid, important claims from those that are invalid or “trivial,” Gottshall, 512 U. S., at 557; (b) a threat of “unlimited and unpredictable liability,” ibid.; and (c) the “potential for a flood” of comparatively unimportant, or “trivial,” claims, ibid.

To separate meritorious and important claims from invalid or trivial claims does not seem easier here than in other cases in which a plaintiff might seek recovery for typical negligently caused emotional distress. The facts before us illustrate the problem. The District Court, when concluding that Buckley had failed to present “sufficient evidence to allow a jury to find ... a real emotional injury,” pointed out that, apart from Buckley’s own testimony, there was virtually no evidence of distress. App. 623-625. Indeed, Buckley continued to work with insulating material “even though ... he could have transferred” elsewhere, he “continued to smoke cigarettes” despite doctors’ warnings, and his doctor did not refer him “either to a psychologist or to a social worker.” Id., at 624. The Court of Appeals reversed because it found certain objective corroborating evidence, namely, “workers’ complaints to supervisors and investigative bodies.” 79 F. 3d, at 1346. Both kinds of “objective” evidence — the confirming and disconfirming evidence — seem only indirectly related to the question at issue, the existence *434and seriousness of Buckley’s claimed emotional distress. Yet, given the difficulty of separating valid from invalid emotional injury claims, the evidence before us may typify the kind of evidence to which parties and the courts would have to look.

The Court in Gottshall made a similar point:

“[Tjesting for the ‘genuineness’ of an injury alone . . . would be bound to lead to haphazard results. Judges would be forced to make highly subjective determinations concerning the authenticity of claims for emotional injury, which are far less susceptible to objective medical proof than are their physical counterparts. To the extent the genuineness test could limit potential liability, it could do so only inconsistently.” 512 U. S., at 552.

And Justice Ginsburg, too, in her opinion concurring in the judgment in part and dissenting in part, seems to recognize this problem, for she would limit recovery in emotional injury cases to those who can show more objective evidence than simply having expressed fear and concern to supervisors. See post, at 445.

More important, the physical contact at issue here — a simple (though extensive) contact with a carcinogenic substance — does not seem to offer much help in separating valid from invalid emotional distress claims. That is because contacts, even extensive contacts, with serious carcinogens are common. See, e. g., Nicholson, Perkel, & Selikoff, Occupational Exposure to Asbestos: Population at Risk and Projected Mortality—1980-2030, 3 Am. J. Indust. Med. 259 (1982) (estimating that 21 million Americans have been exposed to work-related asbestos); U. S. Dept. of Health and Human Services, 1 Seventh Annual Report on Carcinogens 71 (1994) (3 million workers exposed to benzene, a majority of Americans exposed outside the workplace); Pirkle, et al., Exposure of the U S Population to Environmental Tobacco Smoke, 275 JAMA 1233, 1237 (1996) (reporting that 43% of *435American children lived in a home with at least one smoker, and 37% of adult nonsmokers lived in a home with at least one smoker or reported environmental tobacco smoke at work). They may occur without causing serious emotional distress, but sometimes they do cause distress, and reasonably so, for cancer is both an unusually threatening and unusually frightening disease. See Statistical Abstract of United States 94 (1996) (23.5% of Americans who died in 1994 died of cancer); American Cancer Society, Cancer Facts & Figures — 1997, p. 1 (half of all men and one-third of all women will develop cancer). The relevant problem, however, remains one of evaluating a claimed emotional reaction to an increased risk of dying. An external circumstance — exposure — makes some emotional distress more likely. But how can one determine from the external circumstance of exposure whether, or when, a claimed strong emotional reaction to an increased mortality risk (say, from 23% to 28%) is reasonable and genuine, rather than overstated — particularly when the relevant statistics themselves are controversial and uncertain (as is usually the case), and particularly since neither those exposed nor judges or juries are experts in statistics? The evaluation problem seems a serious one.

The large number of those exposed and the uncertainties that may surround recovery also suggest what Gottshall called the problem of “unlimited and unpredictable liability.” Does such liability mean, for example, that the costs associated with a rule of liability would become so great that, given the nature of the harm, it would seem unreasonable to require the public to pay the higher prices that may result? Cf. Priest, The Current Insurance Crisis and Modern Tort Law, 96 Yale L. J. 1521, 1585-1587 (1987). The same characteristics further suggest what Gottshall called the problem of a “flood” of cases that, if not “trivial,” are comparatively less important. In a world of limited resources, would a rule permitting immediate large-scale recoveries for widespread emotional distress caused by fear of future disease *436diminish the likelihood of recovery by those who later suffer from the disease? Cf. J. Weinstein, Individual Justice in Mass Tort Litigation 10-11, 141 (1995); Schuck, The Worst Should Go First: Deferral Registries in Asbestos Litigation, 15 Harv. J. L. & Pub. Pol’y 541 (1992).

We do not raise these questions to answer them (for we do not have the answers), but rather to show that general policy concerns of a kind that have led common-law courts to deny recovery for certain classes of negligently caused harms are present in this case as well. That being so, we cannot find in GottshalVs underlying rationale any basis for departing from Gottshall’s language and precedent or from the current common-law consensus. That is to say, we cannot find in Gottshall’s language, cited precedent, other common-law precedent, or related concerns of policy a legal basis for adopting the emotional distress recovery rule adopted by the Court of Appeals.

Buckley raises several important arguments in reply. He points out, for example, that common-law courts do permit recovery for emotional distress where a plaintiff has physical symptoms; and he argues that his evidence of exposure and enhanced mortality risk is as strong a proof as an accompanying physical symptom that his emotional distress is genuine.

This argument, however, while important, overlooks the fact that the common law in this area does not examine the genuineness of emotional harm case by case. Rather, it has developed recovery-permitting categories the contours of which more distantly reflect this, and other, abstract general policy concerns. The point of such categorization is to deny courts the authority to undertake a case-by-case examination. The common law permits emotional distress recovery for that category of plaintiffs who suffer from a disease (or exhibit a physical symptom), for example, thereby finding a special effort to evaluate emotional symptoms warranted in that category of cases — perhaps from a desire to make a *437physically injured victim whole or because the parties are likely to be in court in any event. In other cases, however, falling outside the special recovery-permitting categories, it has reached a different conclusion. The relevant question here concerns the validity of a rule that seeks to redefine such a category. It would not be easy to redefine “physical impact” in terms of a rule that turned on, say, the “massive, lengthy, [or] tangible” nature of a contact that amounted to an exposure, whether to contaminated water, or to germ-laden air, or to carcinogen-containing substances, such as insulation dust containing asbestos. But, in any event, for the reasons we have stated, supra, at 430-436, we cannot find that the common law has done so.

Buckley also points to a series of common-law cases that he believes offer him support. Many of these cases, however, find that the plaintiff at issue fell within a category where the law already permitted recovery for emotional distress. E. g., Marchica v. Long Island R. Co., 31 F. 3d 1197 (CA2 1994) (traumatic injury); Clark v. Taylor, 710 F. 2d 4 (CA1 1983) (intentional infliction of harm); Laxton v. Orkin Exterminating Co., 639 S. W. 2d 431, 433-434 (Tenn. 1982) (nuisance claim); Lavelle v. Owens-Coming Fiberglas Corp., 30 Ohio Misc. 2d 11, 507 N. E. 2d 476 (Ct. Common Pleas, Cayahoga Cty. 1987) (emotional distress damages sought by ' asbestosis-afflicted plaintiff). We have found only three asbestos-related cases, all involving state law, that support Buckley directly. Watkins v. Fibreboard Corp., 994 F. 2d 253, 259 (CA5 1993) (Texas law) (recognizing cause of action for emotional distress based on exposures to asbestos in the absence of physical symptoms); In re Moorenovich, 634 F. Supp. 634 (Me. 1986) (Maine law) (same); Gerardi v. Nuclear Utility Services, Inc., 149 Misc. 2d 657, 566 N. Y. S. 2d 1002 (Westchester Cty. 1991) (same). None of them was decided by the highest court of the relevant State. And we do not find that minority view a sufficient basis for reaching Buckley’s proposed conclusion.

*438Finally, Buckley argues that the “humanitarian” nature of the FELA warrants a holding in his favor. We do not doubt that the FELA’s purpose militates in favor of recovery for a serious and negligently caused emotional harm. Cf. Gottskall, 512 U. S., at 550. But just as courts must interpret that law to take proper account of the harms suffered by a sympathetic individual plaintiff, so they must consider the general impact, on workers as well as employers, of the general liability rules they would thereby create. Here the relevant question concerns not simply recovery in an individual case, but the consequences and effects of a rule of law that would 'permit that recovery. And if the common law concludes that a legal rule permitting recovery here, from a tort law perspective, and despite benefits in some individual cases, would on balance cause more harm than good, and if we find that judgment reasonable, we cannot find that conclusion inconsistent with the FELA’s humanitarian purpose.

l — l 1 — 1

Buckley also sought recovery for a different kind of injury,” namely, the economic cost of the extra medical checkups that he expects to incur as a result of his exposure to asbestos-laden insulation dust. The District Court, when it dismissed the action, did not discuss this aspect of Buckley’s case. But the Second Circuit, when reversing the District Court, held that “a reasonable jury could award” Buckley the “costs” of “medical monitoring” in this case. 79 F. 3d, at 1347. We agreed to decide whether the court correctly found that the FELA permitted a plaintiff without symptoms or disease to recover this economic loss.

The parties do not dispute — and we assume — that an exposed plaintiff can recover related reasonable medical monitoring costs if and when he develops symptoms. As the Second Circuit pointed out, a plaintiff injured through negligence can recover related reasonable medical expenses as an element of damages. Ibid. (citing C. McCormick, Law of *439Damages § 90 (1935)); see also Restatement (Second) of Torts § 924(c) (1977); J. Stein, Stein on Personal Injury Damages § 5.18 (2d ed. 1991). No one has argued that any different principle would apply in the case of a plaintiff whose “injury” consists of a disease, a symptom, or those sorts of emotional distress that fall within the FELA’s definition of “injury.” See Part II, supra. Much of the Second Circuit’s opinion suggests it intended only to apply this basic principle of the law of damages. See, e.g., 79 F. 3d, at 1342 (“[T]his case turns upon whether . . . emotional harm ... is an injury compensable under FELA”); id., at 1347 (monitoring costs are a “traditional element of tort damages”). Insofar as that is so, Part II of our opinion, holding that the emotional distress at issue here is not a compensable “injury,” requires reversal on this point as well.

Other portions of the Second Circuit’s opinion, however, indicate that it may have rested this portion of its decision upon a broader ground, namely, that medical monitoring costs themselves represent a separate negligently caused economic “injury,” 45 U. S. C. § 51, for which a negligently exposed FELA plaintiff (including a plaintiff without disease or symptoms) may recover to the extent that the medical monitoring costs that a reasonable physician would prescribe for the plaintiff exceed the medical monitoring costs that “would have been prescribed in the absence of [the] exposure.” 79 F. 3d, at 1347 (citation omitted). This portion of the opinion, when viewed in light of Buckley’s straightforward claim for an “amount of money” sufficient to “compensate” him for “future medical monitoring expenses,” Plaintiff’s Proposed Charges to the Jury 25, Record, Doc. 33, suggests the existence of an ordinary, but separate, tort law cause of action permitting (as tort law ordinarily permits) the recovery of medical cost damages in the form of a lump sum, see Stein, supra, at §§ 5.1 and 5.18, and irrespective of insurance, Restatement (Second) of Torts, supra, § 920A(2). As so characterized, the Second Circuit’s holding, in our *440view, went beyond the bounds of currently “evolving common law.” Gottshall, supra, at 558 (Souter, J., concurring).

Guided by the parties’ briefs, we have canvassed the state-law cases that have considered whether the negligent causation of this kind of harm (i. e., causing a plaintiff, through negligent exposure to a toxic substance, to incur medical monitoring costs) by itself constitutes a sufficient basis for a tort recovery. We have found no other FELA decisions. We have put to the side several cases that involve special recovery-permitting circumstances, such as the presence of a traumatic physical impact, or the presence of a physical symptom, which for reasons explained in Part II are important but beside the point here. See, e. g., Friends for All Children, Inc. v. Lockheed Aircraft Corp., 746 F. 2d 816, 824-825 (CADC 1984) (traumatic impact); Hagerty v. L & L Marine Services, Inc., 788 F. 2d 315, modified, 797 F. 2d 256 (CA5 1986) (same); Simmons v. Pacor, Inc., 543 Pa. 664, 674 A. 2d 232 (1996) (physical symptom). We have noted that federal courts, interpreting state law, have come to different conclusions about the matter. Compare, e. g., In re Paoli R. Yard PCB Litigation, 916 F. 2d 829 (CA3 1990) (Pennsylvania law), with Ball v. Joy Technologies, Inc., 958 F. 2d 36 (CA4 1991) (West Virginia and Virginia law). And we have ended up focusing on several important State Supreme Court cases that have permitted recovery. Ayers v. Jackson, 106 N. J. 557, 525 A. 2d 287 (1987); Hansen v. Mountain Fuel Supply Co., 858 P. 2d 970 (Utah 1993); Potter v. Firestone Tire & Rubber Co., 6 Cal. 4th 965, 863 P. 2d 795 (1993); see also Burns v. Jacquays Mining Corp., 156 Ariz. 375, 752 P. 2d 28 (App. 1987).

We find it sufficient to note, for present purposes, that the cases authorizing recovery for medical monitoring in the absence of physical injury do not endorse a full-blown, traditional tort law cause of action for lump-sum damages — of the sort that the Court of Appeals seems to have endorsed here. Rather, those courts, while recognizing that medical monitoring costs can amount to a harm that justifies a tort *441remedy, have suggested, or imposed, special limitations on that remedy. Compare Ayers, supra, at 608, 525 A. 2d, at 314 (recommending in future cases creation of “a court-supervised fund to administer medical-surveillance payments”); Hansen, supra, at 982 (suggesting insurance mechanism or court-supervised fund as proper remedy); Potter, supra, at 1010, n. 28, 863 P. 2d, at 825, n. 28 (suggesting that a lump-sum damages award would be inappropriate); Burns, supra, at 381, 752 P. 2d, at 34 (holding that lump-sum damages are not appropriate), with, e.g., Honeycutt v. Walden, 294 Ark. 440, 743 S. W. 2d 809 (1988) (damages award for future medical expenses made necessary by physical injury are awarded as lump-sum payment); Rice v. Hill, 315 Pa. 166, 172 A. 289 (1934) (same); and Restatement (Second) of Torts § 920A(2) (1977) (ordinarily fact that plaintiff is insured is irrelevant to amount of tort recovery). Cf. Weinstein, Individual Justice in Mass Tort Litigation, at 154. We believe that the note of caution, the limitations, and the expressed uneasiness with a traditional lump-sum damages remedy are important, for they suggest a judicial recognition of some of the policy concerns that have been pointed out to us here— concerns of a sort that Gottshall identified.

Since, for example, the particular cancer-related costs at issue are the extra monitoring costs, over and above those otherwise recommended, their identification will sometimes pose special “difficultfies] for judges and juries.” Gottshall, 512 U. S., at 557. Those difficulties in part can reflect uncertainty among medical professionals about just which tests are most usefully administered and when. Cf. Report of U. S. Preventive Services Task Force, Guide to Clinical Preventive Services xxvii, xxx-xxxi, xlvii-xcii (2d ed. 1996). And in part those difficulties can reflect the fact that scientists will not always see a medical need to provide systematic scientific answers to the relevant legal question, namely, whether an exposure calls for extra monitoring. Cf. App. 182 (testimony by Buckley’s expert conceding that periodic colon cancer screening “is recommended by the Ahiericari *442Cancer Society anyway”); id., at 164 (testimony by Buckley’s expert declining to rule out that periodic chest X rays would likely benefit smokers such as Buckley, even in the absence of asbestos exposure). Buckley’s sole expert, then, was equivocal about the need for extra monitoring, and the defense had not yet put on its case.

Moreover, tens of millions of individuals may have suffered exposure to substances that might justify some form of substance-exposure-related medical monitoring. See supra, at 434-435. (The dissent limits its class of potential plaintiffs to employees suing their employers, see post, at 454, but other exposed individuals who satisfy the Paoli test, see post, at 449-450, could sue — at common law.) And that fact, along with uncertainty as to the amount of liability, could threaten both a “flood” of less important cases (potentially absorbing resources better left available to those more seriously harmed, see supra, at 435-436) and the systemic harms that can accompany “unlimited and unpredictable liability” (for example, vast testing liability adversely affecting the allocation of scarce medical resources). The dissent assumes that medical monitoring is not a “costly” remedy, see post, at 451 (internal quotation marks omitted). But Buckley here sought damages worth $950 annually for 36 years; by comparison, of all claims settled by the Center for Claims Resolution, a group representing asbestos manufacturers, from 1988 until 1993, the average settlement for plaintiffs injured by asbestos was about $12,500, and the settlement for nonmalignant plaintiffs among this group averaged $8,810. See App. in Amchem Products, Inc. v. Windsor, O. T. 1996, No. 96-270, p. 578.

Finally, a traditional, full-blown ordinary tort liability rule would ignore the presence of existing alternative sources of payment, thereby leaving a court uncertain about how much of the potentially large recoveries would pay for otherwise unavailable medical testing and how much would accrue to plaintiffs for whom employers or other sources (say, insurance now or in the future) might provide monitoring in any *443event. Cf. 29 CFR § 1910.1001(1) (1996) (requiring employers to provide medical monitoring for workers exposed to asbestos). The Occupational Safety and Health Administration regulations (which the dissent cites) help to demonstrate why the Second Circuit erred: where state and federal regulations already provide the relief that a plaintiff seeks, creating a full-blown tort remedy could entail systemic costs without corresponding benefits. Nor could an employer necessarily protect itself by offering monitoring, see post, at 453-454, for that is not part of the rule of law that Justice Ginsburg would endorse — a rule that, if traditional, would, as we have noted, allow recovery irrespective of the presence of a “collateral source” of payment. See post, at 449.

We do not deny important competing considerations — of a kind that may have led some courts to provide a form of liability. Buckley argues, for example, that it is inequitable to place the economic burden of such care on the negligently exposed plaintiff rather than on the negligent defendant. See, e. g., Ayers, 106 N. J., at 603-606, 525 A. 2d, at 311-312; Potter, 6 Cal. 4th, at 1007-1009, 863 P. 2d, at 824. He points out that providing preventive care to individuals who would otherwise go without can help to mitigate potentially serious future health effects of diseases by detecting them in early stages; again, whether or not this is such a situation, we may assume that such situations occur. And he adds that, despite scientific uncertainties, the difficulty of separating justified from unjustified claims may be less serious than where emotional distress is the harm at issue. See also Ayers, supra; Potter, supra.

We do not deny that Justice Ginsburg paints a sympathetic picture of Buckley and his co-workers; this picture has force because Buckley is sympathetic and he has suffered wrong at the hands of a negligent employer. But we are more troubled than is Justice Ginsburg by the potential systemic effects of creating a new, full-blown, tort law cause of action — for example, the effects upon interests of other *444potential plaintiffs who are not before the court and who depend on a tort system that can distinguish between reliable and serious claims on the one hand, and unreliable and relatively trivial claims on the other. See supra, at 438. The reality is that competing interests are at stake — and those interests sometimes can be reconciled in ways other than simply through the creation of a full-blown, traditional, tort law cause of action. Cf. post, at 454.

We have not tried to balance these, or other, competing considerations here. We point them out to help explain why we consider the limitations and cautions to be important— and integral — parts of the state-court decisions that permit asymptomatic plaintiffs a separate tort claim for medical monitoring costs. That being so, we do not find sufficient support in the common law for the unqualified rule of lump-sum damages recovery that is, at least arguably, before us here. And given the mix of competing general policy considerations, plaintiff’s policy-based arguments do not convince us that the FELA contains a tort liability rule of that unqualified kind.

This limited conclusion disposes of the matter before us. We need not, and do not, express any view here about the extent to which the FELA might, or might not, accommodate medical cost recovery rules more finely tailored than the rule we have considered.

IV

For the reasons stated, we reverse the determination of the Second Circuit, and we remand the case for further proceedings consistent with this opinion.

It is so ordered.

Justice Ginsburg,

with whom Justice Stevens joins, concurring in the judgment in part and dissenting in part.

The Federal Employers’ Liability Act (FELA) was enacted to facilitate recovery for railworkers who suffer injuries as a result of their employers’ negligence. “Congress intended *445the creation of no static remedy, but one which would be developed and enlarged to meet changing conditions and changing concepts of industry’s duty toward its workers.” Kernan v. American Dredging Co., 355 U. S. 426, 432 (1958). Until recently, this Court accorded the FELA a notably “liberal construction in order to accomplish [Congress’] objects.” Urie v. Thompson, 337 U. S. 163, 180 (1949). Today’s decision, however, continues the step-back approach taken in Consolidated Rail Corporation v. Gottshall, 512 U. S. 532 (1994). Even if the Gottshall decision supported the Court’s rejection of Michael Buckley’s claim for emotional distress, the Court’s disposition of Buckley’s medical monitoring claim marks a new and enigmatic departure from a once “constant and established course.” Urie, 337 U. S., at 181-182.

Buckley’s extensive contact with asbestos particles in Grand Central’s tunnels, as I comprehend his situation, constituted “physical impact” as that term was used in Gott-shall. Nevertheless, I concur in the Court’s judgment with respect to Buckley’s emotional distress claim. In my view, that claim fails because Buckley did not present objective evidence of severe emotional distress. See Atchison, T & S. F. R. Co. v. Buell, 480 U. S. 557, 566-567, n. 13 (1987) (“severe emotional injury ... has generally been required to establish liability for purely emotional injury”); see also id., at 569, n. 18. Buckley testified at trial that he was angry at Metro-North and fearful of developing an asbestos-related disease. However, he sought no professional help to ease his distress, and presented no medical testimony concerning his mental health. See 79 F. 3d 1337, 1341 (CA2 1996). Under these circumstances, Buckley’s emotional distress claim fails as a matter of law. Cf. Gottshall, 512 U. S., at 563-564, 566-567 (Ginsburg, J., dissenting) (describing as “unquestionably genuine and severe” emotional distress suffered by one respondent who had a nervous breakdown, and another who was hospitalized, lost weight, and had, inter alia, suicidal preoccupations, anxiety, insomnia, cold sweats, and nausea).

*446Concerning medical monitoring, the Court of Appeals ruled that Buckley stated a triable claim for monitoring expenses made “necessary because of his exposure to asbestos,” expenses essential “to ensure early detection and cure of any asbestos-related disease he develops." 79 F. 3d, at 1347. I would not disturb that ruling.

I

As a pipefitter for Metro-North, Michael Buckley repaired and maintained the labyrinth of pipes in the steam tunnels of Grand Central Terminal in New York City. The pipes were surrounded by a white insulation material that Buckley and his co-workers had to remove to perform their jobs. Without any protective gear, the pipefitters would hammer, slice, and pull the insulation material, which broke apart as it was removed, scattering dust particles into the air. Fans used to mitigate the intense heat of the steam tunnels spread further dust from insulation pieces that had accumulated on tunnel floors. The dust coated Buckley’s skin and clothing; he testified that he could taste the gritty insulation material as it entered his mouth and nose. The pipefitters would emerge from their work in the tunnels covered from head to toe with white dust; for this appearance, they were dubbed “the snowmen of Grand Central.”

The insulation material covering Grand Central’s pipes was made of asbestos, widely recognized as a carcinogen since the mid-1970’s. Metro-North did not tell the pipefit-ters of, or provide protection against, the danger to which the workers were exposed until 1987, two years after Buckley started working in the steam tunnels. At an asbestos awareness class on August 31, 1987, Buckley and his coworkers learned of the asbestos in the pipe insulation and of the diseases asbestos exposure could cause. Buckley was then given a respirator and some instruction on the “glove bag” method of removing asbestos. He testified that his efforts to use the respirator and glove bag method proved frus*447trating: the respirator fit poorly and slid down his face as he perspired in the intense heat of the steam tunnels; the plastic bags used to isolate the asbestos melted on the hot pipes, spilling out the material instead of containing it.

Buckley and as many as 140 other asbestos-exposed workers sought legal counsel after their complaints to Metro-North management went unresolved. In the FELA action now before us, Buckley is serving as test plaintiff for the claims of all the exposed employees. Metro-North stipulated in the District Court that it had “negligently exposed the plaintiff Michael Buckley to asbestos while he was working in Grand Central Terminal from June 1985 to the beginning of September 1987.” App. 594 (Admitted and Stipulated Facts). “[N]o later than 1986,” Metro-North also conceded, “[it] obtained actual notice of the presence of asbestos. in Grand Central Terminal and notice of the hazard that working with or around asbestos posed to the health and welfare of its employees.” Ibid. Metro-North further acknowledged that “it exposed the plaintiff to asbestos without warning him that he was being exposed to asbestos and without training him how to safely handle and remove asbestos.” Ibid. Prior to Metro-North’s stipulation conceding negligence, the New York Attorney General’s Office and the Office of the Inspector General of the Metropolitan Transportation Authority conducted a joint investigation, leading to these conclusions: Metro-North had “seriously disregarded the health and safety of its workers”; and the railroad’s failings were “particularly egregious” because Metro-North was on notice of the asbestos problem as a result of complaints by its workers, a report by its own consultant, and inspections by the New York State Department of Labor. Id., at 614.

II

Buckley asserted two claims for relief in his FE LA-based complaint: first, he charged Metro-North with negligent infliction of emotional distress; second, he sought compensation *448for the cost of future medical monitoring. The Court definitively rejects Buckley’s first claim by holding that, under the FELA, a railworker may not recover damages for emotional distress unless, and until, he manifests symptoms of a disease. See ante, at 427, 430. As to Buckley’s second claim, however, the Court speaks tentatively. “[T]he respondent in this case,” we are told, “has not shown that he is legally entitled to recover [medical monitoring] costs.” Ante, at 427. “[A]rguably,” the Court explains, Buckley demands an “unqualified rule of lump-sum damages recovery,” ante, at 444, a rule for which the Court finds “[in]sufficient support in the common law,” ibid. The Court pointedly refrains, however, from “expressing] any view . . . about the extent to which the FELA might, or might not, accommodate medical cost recovery rules more finely tailored than” a “rule of [the] unqualified kind.” Ibid. (emphasis in original).

It is not apparent why (or even whether) the Court reverses the Second Circuit’s determination on Buckley’s second claim. The Court of Appeals held that a medical monitoring claim is solidly grounded, and this Court does not hold otherwise. Hypothesizing that Buckley demands lump-sum damages and nothing else, the Court ruminates on the appropriate remedy without answering the anterior question: Does the plaintiff have a claim for relief? Buckley has shown that Metro-North negligently exposed him to “extremely high levels of asbestos,” 79 F. 3d, at 1341, and that this exposure warrants “medical monitoring in order to detect and treat [asbestos-related] diseases as they may arise.” Id., at 1346. Buckley’s expert medical witness estimated the annual costs of proper monitoring at $950. Ibid. 1 We do not know from the Court’s opinion what more a plaintiff must show to qualify for relief.

*449A

In my view, the Second Circuit rightly held that a rail-worker negligently exposed to asbestos states a claim for relief under the FELA; recovery in such cases, again as the Court of Appeals held, should reflect the difference in cost between the medical tests a reasonable physician would prescribe for unexposed persons and the monitoring regime a reasonable physician would advise for persons exposed in the way Michael Buckley and his co-workers were. See id,., at 1347; see infra, at 450-451 (defining an asbestos-exposed worker’s “injury”); see also In re Paoli R. Yard PCB Litigation, 916 F. 2d 829, 849-852 (CA3 1990) (Paoli I), cert. denied sub nom. General Elec. Co. v. Knight, 499 U. S. 961 (1991); In re Paoli R. Yard PCB Litigation, 35 F. 3d 717, 785-788 (CA3 1994) (Paoli II), cert. denied sub nom. General Elec. Co. v. Ingram, 513 U. S. 1190 (1995).

Recognizing such a claim would align the FELA with the “evolving common law.” Gottshall, 512 U. S., at 558 (Sou-ter, J., concurring). “[A medical monitoring] action has been increasingly recognized by state courts as necessary given the latent nature of many diseases caused by exposure to hazardous materials and the traditional common law tort doctrine requirement that an injury be manifest.” Daigle v. Shell Oil Co., 972 F. 2d 1527, 1533 (CA10 1992); see also Schwartz, Recovery of Damages for Expense of Medical Monitoring to Detect or Prevent Future Disease or Condition, 17 A. L. R. 5th 327 (1994). As the Court understates, several state high courts have upheld medical monitoring cost recovery. See ante, at 440. In a pathmarking opinion, the United States Court of Appeals for the Third Circuit, interpreting Pennsylvania law, recognized a right to compensation for monitoring “necessary in order to diagnose properly the warning signs of disease.” See Paoli 1, 916 F. 2d, at 851; see also Paoli II, 35 F. 3d, at 785-788. Similarly, a number of Federal District Courts interpreting state law, and several state courts of first and second instance, have *450sustained medical monitoring claims.2 This Court, responsible for developing FELA law, finds little value in these decisions.

These courts have answered the question this Court passes by: What are the elements of a compensable medical monitoring claim? The Third Circuit, for example, has enumerated: A plaintiff can recover the costs of medical monitoring if (1) he establishes that he was significantly exposed to a proven hazardous substance through the negligent actions of the defendant; (2) as a proximate result of the exposure, the plaintiff suffers a significantly increased risk of contracting a serious latent disease; (3) by reason of the exposure a reasonable physician would prescribe a monitoring regime different from the one that would have been prescribed in the absence of the exposure; and (4) monitoring and testing procedures exist that make the early detection and treatment of the disease possible and beneficial. See Paoli I, 916 F. 2d, at 852; Paoli II, 35 F. 3d, at 788. Each factor must be shown by competent expert testimony. See Paoli 7, 916 F. 2d, at 852.

A claim so defined comports with the terms of the FELA. Under the FELA, a railroad “shall be liable in damages to any person suffering injury while he is employed by such carrier ... for such injury . . . resulting in whole or in part from the negligence of any of the officers, agents, or employees of such carrier.” 45 U. S. C. §51. The “injury” sustained by an asbestos-exposed worker seeking to recover medical monitoring costs is the invasion of that employee’s interest in being free from the economic burden of extraordi*451nary medical surveillance. See Restatement (Second) of Torts § 7 (1964) (defining injury as “the invasion of any legally protected interest of another”); see Friends for All Children, Inc. v. Lockheed Aircraft Corp., 746 F. 2d 816, 826 (CADC 1984) (“It is difficult to dispute that an individual has an interest in avoiding expensive diagnostic examinations just as he or she has an interest in avoiding physical injury.”); Ayers v. Jackson, 106 N. J. 557, 591, 525 A. 2d 287, 304 (1987).

Traditional tort principles upon which the FELA rests warrant recognition of medical monitoring claims of the kind Buckley has asserted. As the Third Circuit explained, “[t]he policy reasons for recognizing this tort are obvious[:]”

“Medical monitoring claims acknowledge that, in a toxic age, significant harm can be done to an individual by a tortfeasor, notwithstanding latent manifestation of that harm. Moreover,. . . recognizing this tort does not ré-quire courts to speculate about the probability of future injury. It merely requires courts to ascertain the probability that the far less costly remedy of medical supervision is appropriate. Allowing plaintiffs to recover the cost of this care deters irresponsible discharge of toxic chemicals by defendants and encourages plaintiffs to detect and treat their injuries as soon as possible. These are conventional goals of the tort system ....” Paoli I, 916 F. 2d, at 852.

See also Potter v. Firestone Tire & Rubber Co., 6 Cal. 4th 965, 1008, 863 p. 2d 795, 824 (1993); Hansen v. Mountain Fuel Supply Co., 858 P. 2d 970, 976-978 (Utah 1993); Ayers, 106 N. J., at 603-605, 525 A. 2d, at 311-312; Burns v. Jaquays Mining Corp., 156 Ariz. 375, 380-381, 752 P. 2d 28, 33-34 (App. 1987).

On all counts — exposure, increased risk of devastating disease, and the necessity of monitoring — Michael Buckley’s complaint presents a textbook case. Through its stipula*452tions, Metro-North has acknowledged that it failed “to use [the] reasonable care [the FELA requires] in furnishing its employees with a safe place to work.” Buell, 480 U. S., at 558. At trial, “[competent expert testimony ... established both that Buckley suffered a substantial impact from asbestos that . , . significantly increased his risk of contracting an asbestos-related disease and that Buckley should receive medical monitoring in order to ensure early detection and cure of any asbestos-related disease he develops.” 79 F. 3d, at 1347. Thus, Metro-North, “through [its] negligence, caused the plaintiff, in the opinion of medical experts, to need specific medical services — a cost that is neither inconsequential nor of a kind the community generally accepts as part of the wear and tear of daily life. Under [the] principles of tort law, the [tortfeasor] should pay.” Friends for All Children. 746 F. 2d, at 825.

B

The Court, as I read its opinion, leaves open the question whether Buckley may state a claim for relief under the FELA. The Court does not question the medical need for monitoring. It recognizes that cancer, one of the diseases Buckley faces an increased risk of suffering, is “unusually threatening and unusually frightening,” ante, at 435, and that detection of disease in early stages “can help to mitigate potentially serious future health effects,” ante, at 443. On the other hand, the Court notes there may be “uncertainty among medical professionals about just which tests are most usefully administered and when.” Ante, at 441.

It is not uncommon, of course, that doctors will agree that medical attention is needed, yet disagree on what monitoring or treatment course is best. But uncertainty as to which tests are best or when they should be administered is not cause to deny a claim for relief. Fact triers in tort cases routinely face questions lacking indubitably clear answers: Did defendant’s product cause plaintiff’s disease? What will plaintiff’s future disability and medical costs be? It bears repetition, moreover, that recovery on a FELA medical mon*453itoring claim would be limited to the incremental cost of tests a reasonable physician would recommend as a result of the plaintiff’s exposure. See 79 F. 3d, at 1347.

Occupational Safety and Health Administration (OSHA) regulations governing permissible levels of asbestos exposure in the workplace make it plain that medical monitoring is no “trivial” matter, see ante, at 444; the regulations are instructive on appropriate standards for necessary monitoring, see 29 CFR § 1910.1001 (1996); see also 29 U. S. C. § 655(b)(7) (authorizing Secretary of Labor to require employers to provide medical monitoring to employees exposed to hazardous substances). OSHA’s regulations direct employers to provide medical monitoring for employees exposed to certain levels of asbestos, and they describe in detail the monitoring employers must make available. See 29 CFR § 1910.1001(1), App. D, App. E (1996). These regulations apply to all industries covered by the Occupational Safety and Health Act of 1970 (Act). Although the Act does not apply to state public employers such as Metro-North, see 29 U. S. C. § 652(5), New York State has adopted OSHA standards for its public employers, see N. Y. Lab. Law §§ 27-a(3)(c), (4)(a) (McKinney 1986 and Supp. 1997). Had Metro-North assiduously attended to those standards, Buckley might have been spared the costs he now seeks to recover.3

Finally, the Court’s anticipation of a “ ‘flood’ of less important cases” and “‘unlimited and unpredictable liability’” is overblown. See ante, at 442. The employee’s “injury” in the claim at stake is the economic burden additional medical *454surveillance entails, see supra, at 450-451; if an employer provides all that a reasonable physician would recommend for the exposed employee, the employee would incur no costs and hence have no claim for compensation. Nor does the FELA claim Buckley states pave the way for “tens of millions of individuals” with similar claims. See ante, at 442. It is doubtful that many legions in the universe of individuals ever exposed to toxic material could demonstrate that their employers negligently exposed them to a known hazardous substance, and thereby substantially increased the risk that they would suffer debilitating or deadly disease.4 Withholding relief, moreover, is dangerous, for lives will be lost when grave disease is diagnosed too late.

C

The Court emphasizes most heavily that several courts, while authorizing recovery for medical monitoring, have imposed or suggested special limitations on the tort remedy. See ante, at 440-441. In lieu of lump-sum damages, the Court indicates, a court-supervised fund might be the better remedy. See ante, at 441; see also Potter, 6 Cal. 4th, at 1006-1010, and n. 28, 863 P. 2d, at 821-825, and n. 28 (recognizing claim and affirming award for medical monitoring; suggesting in footnote creation of court-supervised fund); Hansen, 858 P. 2d, at 979-982 (reversing grant of summary judgment and recognizing claim for medical monitoring; suggesting creation of court-supervised fund); Ayers, 106 N. J., at 607-611, 525 A. 2d, at 313-315 (affirming damages award for medical monitoring; suggesting creation of court-supervised fund in future cases); Burns, 156 Ariz., at 380-381, 752 P. 2d, at 33-34 (recognizing claim for medical monitoring; holding plaintiffs entitled to award from court-supervised fund).

It is scarcely surprising that the Second Circuit did not consider relief through a court-supervised fund. So far as the record before us shows, no party argued in the District *455Court, the Second Circuit, or even this Court, that medical monitoring expenses may be recoverable, but not through a lump sum, only through a court fund. The question aired below was the prime one the Court obscures: Does Buckley’s medical monitoring claim warrant any relief?

Buckley sought “an ‘amount of money’ sufficient to ‘compensate’ him for ‘future medical monitoring expenses.’” See ante, at 439. He was not more precise about the form relief should take. The Court infers from Buckley’s proposed charges to the jury, however, that he wanted what “tort law ordinarily permits” — damages in a lump sum. See ibid. I believe his claim qualifies for that relief. If the Court deems what “tort law ordinarily permits” inappropriate, however, the Court should at least say, for the guidance of lower courts, “Yes, Buckley has a claim for relief.” Federal Rule of Civil Procedure 54(c) directs a court to grant the relief to which a prevailing party is entitled, even if the party did not demand such relief in its pleadings. Rule 54(c) thus instructs district courts to “compensate the parties or remedy the situation without regard to the constraints of the antiquated and rigid forms of action.” 10 C. Wright, A. Miller, & M. Kane, Federal Practice and Procedure §2662, pp. 133-134 (2d ed. 1983). Under the Federal Rules, “a party should experience little difficulty in securing a remedy other than that demanded in his pleadings when he shows he is entitled to it.” Id., at 135; see also id., §2664, at 163 (Rule 54(c) “has been utilized when the court awards a different type of relief from that demanded in the complaint”); cf. Holt Civic Club v. Tuscaloosa, 439 U. S. 60, 65-66 (1978) (“a federal court should not dismiss a meritorious constitutional claim because the complaint seeks one remedy rather than another plainly appropriate one”) (citing Rule 54(c)).

* * *

The Court today reverses the Second Circuit’s determination that Buckley has stated a claim for relief, but remands the case for further proceedings. If I comprehend the Court’s enigmatic decision correctly, Buckley may replead a *456claim for relief and recover for medical monitoring, but he must receive that relief in a form other than a lump sum. Unaccountably, the Court resists the straightforward statement that would enlighten courts in this and similar cases: A claim for medical monitoring is cognizable under the FELA; it .is a claim entirely in step with “‘evolving common law.’ ” See ante, at 440 (citing Gottshall, 512 U. S., at 558 (Souter, J., concurring)). I therefore dissent from the Court’s judgment to the extent it relates to medical monitoring.

ROBERTS, Justice.

Defendant Eugene R. Pepin appeals a judgment entered in favor of the plaintiffs in the Superior Court (Androscoggin County, Alexander, J.) after a jury-waived trial. Pepin argues that the court erred in finding him liable for the plaintiffs’ claim of negligent infliction of emotional distress (NIED).1 We agree and vacate the judgment.

In June 1988 Pepin was involved in an automobile accident in Auburn with the plaintiffs’ 26-year-old son, Scott W. Cameron. The plaintiffs were notified of the accident shortly after it occurred and arrived at the Central Maine Medical Center emergency room, to see Scott cut, bloody, and battered. The treating physician told the Camerons that Scott had two broken legs, two broken arms, broken ribs, and a severe brain injury, and that he would probably not survive. After six hours of surgery Scott went to the intensive care unit. From that time on, with only brief breaks, the Camerons stayed with their son until he died, six days later.

The plaintiffs instituted this suit in December 1988, seeking damages for severe emotional distress. At the conclusion of the trial on May 28, 1991, the court ordered judgment in the amount of $125,000 to each of the plaintiffs for the emotional distress they suffered and an additional $5,000 to the plaintiffs for their economic loss. This appeal followed.

The essential issue in this case is whether a person, not at the scene when an accident occurs but who subsequently witnesses the accident victim’s pain and suffering, can recover for severe emotional distress against the defendant who negligently caused the accident. We have previously recognized that the victim of negligent conduct has a legally protected interest in his psychic health, with different rules governing recovery depending on whether the plaintiff is characterized as a *281“direct” victim rather than an “indirect” victim. See, e.g., Gammon v. Osteopathic Hosp. of Maine, Inc., 534 A.2d 1282 (Me.1987); Culbert v. Sampson’s Supermarkets, Inc., 444 A.2d 433 (Me.1982). Resolution of this appeal requires that we analyze, for the first time since Culbert, the distinction between direct and indirect victims and determine the scope of the legal duty a defendant owes to an indirect victim.

In jurisdictions recognizing NIED claims, the courts have limited the scope of liability through the application of three basic themes: the impact rule, the zone-of-danger rule, and the foreseeability test. See id. at 434. We previously have applied the foreseeability test to the situation involving both a direct victim, Gammon, and an indirect victim, Culbert. Although analysis in both cases centered on the analytical concept of foreseeability, each decision rested on a distinct and fundamentally different rationale.

In Culbert we vacated the dismissal of a complaint setting forth an NIED claim arising from a mother’s observation of her baby choking on a foreign object in baby food manufactured by the defendant. Rejecting both the impact rule and the zone-of-danger rule, we adopted the foreseeability test enunciated in Dillon v. Legg, 68 Cal.2d 728, 69 Cal.Rptr. 72, 441 P.2d 912 (1968), and held that a plaintiffs psychic injury would be deemed foreseeable, and thus compensable, when the plaintiff i) was present at the scene of the accident, ii) suffered serious mental distress as a result of observing the accident, and iii) was closely related to the victim. Culbert, 444 A.2d at 438. We recognized at that time the different and problematic issues raised in negligence analysis involving indirect victims, but nonetheless expressed confidence that the traditional foreseeability concept, as expressed in Dillon’s three-factor test, would rationally circumscribe the parameters of liability. Id. at 436-47.

Five years after Culbert, we addressed in Gammon the NIED claim of a direct victim. There, in vacating a directed verdict for the defendant, we rejected as “arbitrary” the requirement that a NIED claim must be based on an independent underlying tort and held that proof of negligently inflicted emotional distress itself was sufficient. Gammon, 534 A.2d at 1285. Rather than precluding such claims through employment of any artificial devices,2 we held that the particular claim could be premised on, and limited by, the “traditional tort principle of foreseeability” as expressed in Culbert. Id.

Although broadly stated, Gammon’s adherence to a foreseeability principle necessarily differed from the principle applied in Culbert, because Gammon involved no examination of the three Dillon factors that Culbert explicitly analyzed. Nonetheless, despite the necessarily distinct analyses in these cases, the Camerons argue that Gammon substantially changed Culbert’s rationale, removing the need to take a plaintiffs status into account when determining the scope of the duty a defendant owes to potential indirect victims. They contend that, under Gammon, whether a defendant owes a duty to a plaintiff is strictly a question of fact, dependent solely on the factfinder’s determination whether the injury was a reasonably foreseeable consequence of the defendant’s negligence. They argue that any court-imposed limitation on the scope of a defendant’s duty would be an arbitrary and artificial device contrary to Gammon’s principle. We disagree.

The designation of harm as “foreseeable” gives rise to some confusion in negligence analyses because the question of foreseeability informs both the issue of duty and the issue of proximate cause. Compare Brewer v. Roosevelt Motor Lodge, 295 A.2d 647, 651 (Me.1972) (foreseeability of injury is the test of duty) with Brewer, 295 A.2d at 652 (foreseeability of injury is the foundational basis of proxi*282mate cause). The California Supreme Court recently noted the ambiguous nature of the term, observing that:

Because a general duty exists to avoid causing foreseeable injury to another, the concept of “foreseeability” enters into both the willingness of the court to recognize the existence of a duty ... and into the determination by a trier of fact whether the specific injury in issue was foreseeable.

[A] court’s task — in determining “duty” — is not to decide whether a particular plaintiffs injury was reasonably foreseeable in light of a particular defendant’s conduct, but rather to evaluate more generally whether the category of negligent conduct at issue is sufficiently likely to result in the kind of harm experienced that liability may appropriately be imposed on the negligent party.

The jury, by contrast, considers “foreseeability” in two more focused, fact-specific settings. First, the jury may consider the likelihood or foreseeability of injury in determining whether, in fact, the particular defendant’s conduct was negligent in the first place. Second, foreseeability may be relevant to the jury’s determination of whether the defendant’s negligence was a proximate or legal cause of the plaintiff’s injury.

Thing v. La Chusa, 771 P.2d 814, 819 n. 3 (1989) (quoting Ballard v. Uribe, 715 P.2d 624, 628 n. 6 (1986)) (emphasis in original). Thus, notwithstanding Gammon’s broad language, whether one party owes a duty of care to another necessarily involves considerations beyond the factual determination that a particular injury was a foreseeable consequence of some particular conduct. See, e.g., Howe v. Stubbs, 570 A.2d 1203 (Me.1990) (prior occurrence of three accidents substantially similar to the instant accident did not give rise to a duty to warn).

We have repeatedly recognized the above proposition when asserting that the scope of a defendant’s duty is, initially, a matter of law. Fish v. Paul, 574 A.2d 1365, 1366 (Me.1990); Howe, 570 A.2d at 1203; Joy v. Eastern Maine Medical Center, 529 A.2d 1364, 1365 (Me.1987). While the scope of duty owed does raise the question “whether the defendant is under any obligation for the benefit of the particular plaintiff,” Prosser, Law of Torts, § 53 (4th ed. 1971), quoted in Joy, 529 A.2d at 1365, it is not entirely a question of the foreseeable risk of harm but is in turn dependent on recognizing and weighing relevant policy implications. Indeed, in Trusiani v. Cumberland & York Distributors, Inc., 538 A.2d 258 (Me.1988), decided less than three months after Gammon, we stated that duty, while premised on foreseeability, rested also on other policy considerations:

In the decision of whether or not there is a duty, many factors interplay: the hand of history, our ideals of morals and justice, the convenience of administration of the rule, and our social ideas as to where the loss should fall. In the end the court will decide whether there is a duty on the basis of the mores of the community “always keeping in mind the fact that we endeavor to make a rule in each case that will be practical and in keeping with the general understanding of mankind.”

Id. at 261 (quoting Prosser, Palsgraf Revisited, 52 Mich.L.Rev. 1, 15 (1953)). Foreseeability, then, is one consideration among many that must be taken into account when courts engage in a duty analysis. Cf. Thing, 771 P.2d at 819 n. 3; Elden v. Sheldon, 758 P.2d 582, 586 (1988) (though foreseeability of risk is chief element in determining whether a duty is owed, “policy considerations may dictate a cause of action should not be sanctioned no matter how foreseeable the risk”).

In Gammon itself we acknowledged that future cases might compel further evaluation of policy considerations other than those we emphasized in that case. Gammon, 534 A.2d at 1286. In general, as was the case in Gammon, policy considerations favoring the imposition of liability for an injury resulting from the creation of an unreasonable risk of harm (i.e., factual foreseeability) dominate the analysis. In these circumstances, the issue of liability is properly characterized as a question of fact *283to be submitted to the factfinder. The Camerons’ argument is troubling, especially in the context of an indirect victim’s claim for emotional distress. Commentators have observed that courts have had difficulty applying Dillon and “delineating the boundaries of foreseeability” in the context of an NIED claim by an indirect victim. See generally Comment, Elden v. Sheldon-Should Policy Outweigh Foreseeability?, 1989 B.Y.U.L.Rev. 977, 979 n. 10; Note, Thing v. La Chusa—Public Policy Demands a Limitation on the Bystander Recovery for Infliction of Emotional Distress, 17 W.State U.L.Rev. 499, 504-506 (1990). As the California Supreme Court itself came to recognize in retreating from any expansive interpretation of Dillon:

it is clear that foreseeability of the injury alone is not a useful “guidelines” or a meaningful restriction on the scope of the NIED action. The Dillon experience confirms ... that “[fjoreseeability proves too much ... [;] although it may set tolerable limits for most types of physical harm, it provides virtually no limit on liability for nonphysical harm.”

Thing, 771 P.2d at 826 (quoting Rabin, Tort Recovery For Negligently Inflicting Economic Loss: A Reassessment, 37 Stan. L.Rev. 1513, 1526 (1985)) (emphasis added).

One policy consideration especially implicated in this case and recognized by the courts in some jurisdictions considering the parameters of an NIED claim is the necessity of avoiding both unlimited liability and liability out of all proportion to culpability. See, e.g., Wilder v. City of Keene, 557 A.2d 636, 639 (N.H.1989) (NIED claim of parent who saw injured child in hospital one hour after the accident denied as contrary to policy objective of preventing unlimited liability); Portee v. Jaffee, 417 A.2d 521, 527 (N.J.1980) (adhering to the contemporaneous observation requirement in Dillon so as to avoid “imposing liability in excess of culpability”). This very concern has resulted in at least one court rejecting altogether the notion of recovery by an indirect victim for an NIED claim. See Tobin v. Grossman, 24 N.Y.2d 609, 301 N.Y.S.2d 554, 249 N.E.2d 419 (1969) (rejecting Dillon because of the problems of foreseeability, the risk of unlimited liability, the factor of an unduly burdensome liability, and the difficulty of obtaining any reasonable circumscription, within tolerable limits required by public policy, of a rule creating liability). We recognize both the serious nature of this concern and the need for some principled limitations on the extent of liability in this area.

Recognition of the competing policy considerations that inform the conclusion whether a duty is owed to a particular plaintiff sufficiently answers the Camer-ons’ contention that Gammon decided that any limitation on the scope of liability in an NIED claim would be artificial or arbitrary. Characterizing a rule limiting liability as “unprincipled” or “arbitrary” is often the result of overemphasizing the policy considerations favoring imposition of liability, while at the same time failing to acknowledge any countervailing policies and the necessary compromise between competing and inconsistent policies informing the rule. See Pearson, Liability to Bystanders for Negligently Inflicting Emotional Harm— A Comment on the Nature of Arbitrary Rules, 34 U.Fla.L.Rev. 477, 481-82 (1982). Although foreseeability is a prerequisite to recovery from a negligent defendant,

it has never been sufficient in and of itself. Other policy considerations often have been important enough to justify non-liability for foreseeable consequences in some circumstances. Therefore, an exception to liability based upon foreseeability should not be characterized as arbitrary solely because it is an exception. Rather, there must be an assessment of the policies underlying the exception and of how closely the exception fits the policy offered to support it.

Id. at 515; see also Elden, 758 P.2d at 586. This reasoning supports the conclusion that a decision where to draw a line circumscribing liability need not necessarily be arbi*284trary. Recognizing real differences between classes of potential plaintiffs does not automatically give rise to the arbitrary distinctions that Culbert and Gammon rejected. See Portee, 417 A.2d at 527 (avoiding arbitrary distinctions does not mean that a cause of action exists for all emotional injuries to all close relatives of the victim). Rather, it is precisely these real differences that prevent legal demarcation from being purely arbitrary.

In balancing the competing policy considerations that inform a duty analysis, the Thing court observed that:

It is apparent that reliance on foreseeability of injury alone in finding a duty, and thus a right to recover, is not adequate when the damages sought are for an intangible injury. In order to avoid limitless liability out of all proportion to the degree of a defendant’s negligence, and against which it is impossible to insure without imposing unacceptable costs on those among whom the risk is spread, the right to recover for negligently caused emotional distress must be limited.

Thing, 771 P.2d at 826-27. Indeed, authorities cited by the Camerons purportedly in support of their “pure foreseeability” argument recognize the mandate of policy considerations requiring some limitation on the scope of liability for psychic injury to indirect victims. In Dziokonski v. Babineau, 375 Mass. 555, 380 N.E.2d 1295, 1302 (1978), the court allowed recovery on facts similar to the instant case, but recognized the need for some mechanism, albeit unidentified, to establish the limits of liability for emotional injury: “In some instances it will be clear that the question is properly one for the trier of fact, while in others the claim will fall outside the range of circumstances within which there may be liability.” Massachusetts courts have come to focus on the time when the plaintiff became aware of the injury as the limiting factor. See Gore v. Daniel O’Connell’s Sons, Inc., 17 Mass.App. 645, 461 N.E.2d 256, 260 (1984) (first learning of injury three years after occurrence precludes recovery). See also Tommy’s Elbow Room, Inc. v. Kavorkian, 727 P.2d 1038 (Alaska 1986) (replacing requirement of contemporaneous observation of the accident with requirement of seeing victim at the scene). Compare Masaki v. General Motors Corp., 71 Haw. 1, 780 P.2d 566 (1989) (recovery allowed to parent on same island as accident victim at time of accident) with Kelley v. Kokua Sales & Supply, Inc., 56 Haw. 204, 532 P.2d 673 (1975) (recovery precluded to parent in California at time of injury); compare also Corso v. Merrill, 119 N.H. 647, 406 A.2d 300 (1979) (recovery allowed to parent who did not see accident but saw victim at accident scene) with Wilder v. Keene, 131 N.H. 599, 557 A.2d 636 (1989) (no recovery allowed to parent who saw victim at hospital one hour after the accident).

The foregoing analysis supports our rejection of the pure foreseeability standard urged by the Camerons and supported by a broad reading of Gammon. Adopting the plaintiffs’ expansive view

would extend judicial redress far beyond the bounds of the emotional interest entitled to protection. To avoid imposing liability in excess of culpability, the scope of recovery must be circumscribed to negligent conduct which strikes at the plaintiff’s basic emotional security.

Portee, 417 A.2d at 527 (emphasis added). That is, the scope of the defendant’s duty should be limited to the emotional vulnerability that arises in parents upon actually witnessing their child receiving an injury. The impact of such an experience is surely qualitatively and quantitatively different from the distress occasioned by a subsequent visit to the hospital. We are persuaded by the reasoning of the Thing court to resist any expansive application of the standard adopted in Culbert and thus reaffirm that a plaintiff must demonstrate that he i) was present at the scene of the accident, ii) suffered serious mental distress as a result of contemporaneously perceiving *285the accident, and iii) was closely related to the victim. See Culbert, 444 A.2d at 438; cf. Purty v. Kennebec Valley Medical Center, 551 A.2d 858, 860 (Me.1988) (contemporaneous involvement in incident sufficient to support NIED complaint).

The entry is:

Judgment vacated.

Remanded to the Superior Court for entry of a judgment in favor of the defendant.

All concurring.

Opinion

MOSK, J.

To what extent should the law permit recovery of damages for the negligent infliction of emotional or mental distress unaccompanied by physical injury? We consider this question in two contexts, both presented by an action charging defendants with erroneously diagnosing plaintiff’s wife as suffering from an infectious social disease.

Appealing from a judgment entered after a demurrer was sustained, plaintiff asks us to decide whether he may recover for negligently in*919flicted emotional distress and for loss of consortium, occasioned by emotional injury to his wife. As will appear, in the light of contemporary knowledge we conclude that emotional injury may be fully as severe and debilitating as physical harm, and is no less deserving of redress; the refusal to recognize a cause of action for negligently inflicted injury in the absence of some physical consequence is therefore an anachronism. We further conclude that it is no less regressive to deny recovery for loss of consortium simply because the plaintiffs spouse has suffered a disabling but nonphysical injury. Accordingly, the judgment must be reversed and plaintiff permitted to go to trial.

Plaintiff Stephen H. Molien filed this action against Kaiser Foundation Hospitals (Kaiser) and Thomas Kilbridge, M.D. (Kaiser and Dr. Kilbridge are hereafter sometimes referred to collectively as defendants.) The amended complaint sets forth two causes of action. In determining its sufficiency against a demurrer we are guided by long-settled precepts: “that a general demurrer admits the truth of all material factual allegations in the complaint [citation]; that the question of plaintiffs ability to prove these allegations, or the possible difficulty in making such proof does not concern the reviewing court [citations]; and that plaintiff need only plead facts showing that he may be entitled to some relief [citation].” (Alcorn v. Anbro Engineering, Inc. (1970) 2 Cal.3d 493, 496 [86 Cal.Rptr. 88, 468 P.2d 216].)

The principal allegations of the first cause of action are as follows: Plaintiff and his wife, Valerie G. Molien, are members of the Kaiser Health Plan. Mrs. Molien went to Kaiser for a routine multiphasic physical examination. There, Dr. Kilbridge, a Kaiser staff physician, negligently examined and tested her, and subsequently advised her she had contracted an infectious type of syphilis. The diagnosis was erroneous, as she did not in fact have the disease. Nevertheless she was required to undergo treatment for syphilis, including the administration of massive and unnecessary doses of penicillin. As a result of defendants’ conduct she suffered “injury to her body and shock and injury to her nervous system.”

Defendants knew plaintiff husband would learn of the diagnosis, as they instructed Mrs. Molien to so advise him. Thereafter plaintiff was required to undergo blood tests himself in order to ascertain whether he had contracted syphilis and was the source of his wife’s purported infection. The tests revealed that he did not have the disease.

*920As a result of the negligently erroneous diagnosis, plaintiff’s wife became upset and suspicious that he had engaged in extramarital sexual activities; tension and hostility arose between the two, “causing a break-up of their marriage and the initiation of dissolution proceedings.”

Defendants knew or should have known their diagnosis that plaintiff’s wife had syphilis and that he might also have the disease would cause him emotional distress. He has in fact suffered “extreme emotional distress” as a result of the negligent misdiagnosis. Additionally, he has incurred medical expenses for counseling in an effort to save the marriage.

The second cause of action, after incorporating by reference all the allegations of the first, alleges that as a consequence of defendants’ acts plaintiff has been deprived of the “love, companionship, affection, society, sexual relations, solace, support, and services” of his wife.

The prayer is for damages for mental suffering and loss of consortium, together with medical expenses. The trial court sustained general demurrers to both causes of action, and plaintiff appealed from the ensuing judgment of dismissal.

I

At the outset we consider a procedural issue arising from the fact that on its face the judgment purports to dismiss only the first cause of action, i.e., for mental suffering. In its ruling the court sustained the demurrers to both causes of action, with leave to amend the first cause and without leave to amend the second. When plaintiff failed to amend, the court ordered the first cause of action dismissed; the judgment is silent, however, as to the second.

Defendants contend we are without jurisdiction to review plaintiff’s purported appeal from the order sustaining the demurrer to the second cause of action, i.e., for loss of consortium. They correctly assert that such an order is neither appealable per se nor as a final judgment. (Beazell v. Schrader (1962) 205 Cal.App.2d 673, 674 [23 Cal.Rptr. 189].) Plaintiff responds, however, that “in the interest of justice and to prevent further delay” an appellate court may deem an order sustaining a demurrer to incorporate a judgment of dismissal. (Bellah v. *921 Greenson (1978) 81 Cal.App.3d 614, 618, fn. 1 [146 Cal.Rptr. 535].) He requests that we amend the judgment of dismissal herein to apply to both causes of action, as the trial court intended.

Plaintiffs request is reasonable and finds authority in our recent decision in Tenhet v. Boswell (1976) 18 Cal.3d 150 [133 Cal.Rptr. 10, 554 P.2d 330]. In Tenhet, as here, the trial court failed to dispose of all causes of action set forth in the amended complaint. Ordinarily in that event appeal would be barred by the “one final judgment” rule, i.e., “an appeal may be taken only from the final judgment in an entire action.” (Id. at p. 153.) But we noted with approval the disposition adopted in Gombos v.Ashe (1958) 158 Cal.App.2d 517 [322 P.2d 933]: there the court amended the judgment to include a dismissal of a cause of action as to which a demurrer had been sustained. We found such procedure appropriate when “the trial court’s failure to dispose of all causes of action results from inadvertence or mistake rather than an intention to retain the remaining causes of action for trial.” (18 Cal.3d at p. 154.)

In the present case it is evident that the failure of the court to dismiss the cause of action for loss of consortium was an oversight. We may therefore treat the dismissal as applying to both causes of action, and we amend the judgment accordingly.

II

We turn now to the merits of the appeal and first address plaintiffs contention that he has stated a cause of action for the negligent infliction of emotional distress. Defendants maintain this issue is gov^ erned by Dillon v. Legg (1968) 68 Cal.2d 728 [60 Cal.Rptr. 72, 441 P.2d 912, 29 A.L.R.3d 1316]; they emphasize that plaintiff was not present when the doctor announced the erroneous diagnosis, but learned of it later from his wife. As we shall explain, however, defendants rely too heavily on Dillon: the case is apposite, but not controlling.

A

In Dillon a mother sought damages for emotional trauma and physical injury that resulted when she witnessed the negligently inflicted death of her infant daughter. The defendant contended he owed no duty to the mother because she was outside the zone of physical danger at the time of the accident. But the traditional duty approach, we ex*922plained, begged the question whether the plaintiffs interests were entitled to legal protection; the finding of a duty was simply “‘a shorthand statement of a conclusion, rather than an aid to analysis in itself.’” (68 Cal.2d at p. 734.) We therefore identified forseeability of the risk as the critical inquiry: “In order to limit the otherwise potentially infinite liability which would follow every negligent act, the law of torts holds defendant amenable only for injuries to others which to defendant at the time were reasonably foreseeable.” (Id. at p. 739.) And the fore-? seeable risk may entail not only actual physical impact, but emotional! injury as well. (Id. at pp. 739-740 & fn. 5.)

Confining our analysis to the situation in which a plaintiffs emotional shock caused by harm to a third person ripened into a physical injury, we listed three factors bearing on the determination whether the defendant should reasonably have foreseen injury to the plaintiff: “(1) Whether plaintiff was located near the scene of the accident as contrasted with one who was a distance away from it. (2) Whether the shock resulted from a direct emotional impact upon plaintiff from the sensory and contemporaneous observance of the accident, as contrasted with learning of the accident from others after its occurrence. (3) Whether plaintiff and the victim were closely related, as contrasted with an absence of any relationship or the presence of only a distant relationship.” (Id. at pp. 740-741.)

Consideration of these factors, we said, would enable the court to decide “whether the accident and harm [were] reasonably foreseeable. Such reasonable foreseeability does not turn on whether the particular [defendant] as an individual would have in actuality foreseen the exact accident and loss; it contemplates that courts, on a case-to-case basis, analyzing all the circumstances, will decide what the ordinary man under such circumstances should reasonably have foreseen. The courts thus mark out the areas of liability, excluding the remote and unexpected.” (Id. at p. 741.) Applying these principles and noting the presence of all three of the above factors, we concluded: “Surely the negligent driver who causes the death of a young child may reasonably expect that the mother will not be far distant and will upon witnessing the accident suffer emotional trauma.” (Ibid.)

It must be remembered, however, that in Dillon the plaintiff sought recovery of damages she suffered as a percipient witness to the injury of a third person, and the three guidelines there noted served as a limita*923tion on that particular cause of action. (See^ e.g., Justus v. Atchison (1977) 19 Cal.3d 564, 582-585 [139 Cal.Rptr. 97, 565 P.2d 122].) Here, by contrast, plaintiff was himself a direct victim of the assertedly negligent act. By insisting that the present facts fail to satisfy the first and second of the Dillon criteria, defendants urge a rote application of the guidelines to a case factually dissimilar to the bystander scenario. In so doing, they overlook our explicit statement in Dillon that an obligation hinging on foreseeability “must necessarily be adjudicated only on a case-by-case basis. . . . [N]o immutable rule can establish the extent of that obligation for every circumstance in the future.” (68 Cal.2d at p. 740.)

Hence the significance of Dillon for the present action lies not in its delineation of guidelines fashioned for resolution of the precise issue then before us; rather, we apply its general principle of foreseeability to the facts at hand, much as we have done in other cases presenting complex questions of tort liability. (See, e.g., Tarasoff v. Regents of University of California (1976) 17 Cal.3d 425, 434-435 [131 Cal. Rptr. 14, 551 P.2d 334, 83 A.L.R.3d 1166]; Rodriguez v. Bethlehem Steel Corp. (1974) 12 Cal.3d 382, 399-400 [115 Cal.Rptr. 765, 525 P.2d 669].)

In the case at bar the risk of harm to plaintiff was reasonably foreseeable to defendants. It is easily predictable that an erroneous diagnosis of syphilis and its probable source would produce marital discord and resultant emotional distress to a married patient’s spouse; Dr. Kilbridge’s advice to Mrs. Molien to have her husband examined for the disease confirms that plaintiff was a foreseeable victim of the negligent diagnosis. Because the disease is normally transmitted only by sexual relations, it is rational to anticipate that both husband and wife would experience anxiety, suspicion, and hostility when confronted with what they had every reason to believe was reliable medical evidence of a particularly noxious infidelity.

We thus agree with plaintiff that the alleged tortious conduct of defendant was directed to him as well as to his wife. Because the risk of harm to him was reasonably foreseeable we hold, in negligence parlance, that under these circumstances defendants owed plaintiff a duty to exercise due care in diagnosing the physical condition of his wife. There remains the question whether plaintiff is barred from recovery by the fact that he suffered no physical injury.

*924B

As observed in Jarchow v. Transamerica Title Ins. Co. (1975) 48 Cal.App.3d 917, 935 [122 Cal.Rptr. 470], “California courts have attempted to resolve the public policy problems inherent in mental distress cases in a variety of ways.” Whether legal protection should extend to the interest in emotional tranquility has been a subject of controversy not only in California, but elsewhere: “No general agreement has yet been reached as to the liability for negligence resulting in fright, shock, or other ‘mental suffering,’ or its physical consequences.” (Prosser, Torts (4th ed. 1971) § 54, p. 327.) The issue, not novel, has inspired numerous and substantial scholarly expositions since the turn of the century. (See, e.g., materials collected in Prosser, op. cit. supra, at p. 50, fn. 27 & p. 327, fn. 31; 1 Dooley, Modern Tort Law (1977) § 15.07, p. 323, fn. 36; 2 Harper & James, The Law of Torts (1956) § 18.4, pp. 1031-1032, fn. 1.)

As early as 1896, this court recognized that mental suffering “constitutes an aggravation of damages when it naturally ensues from the act complained of.” (Sloane v. Southern Cal. Ry. Co. (1896) 111 Cal. 668, 680 [44 P. 320].) But such suffering alone, we said, would not afford a right of action. (Ibid.) We pondered the question whether a nervous disorder suffered by the plaintiff after she was wrongfully put off a train was a physical or a mental injury: “The interdependence of the mind and body is in many respects so close that it is impossible to distinguish their respective influence upon each other. It must be conceded that a nervous shock or paroxysm, or a disturbance of the nervous system, is distinct from mental anguish, and falls within the physiological, rather than the psychological, branch of the human organism. It is a matter of general knowledge that an attack of sudden fright or an exposure to imminent peril has produced in individuals a complete change in their nervous system, and rendered one who was physically strong and vigorous weak and timid. Such a result must be regarded as an injury to the body rather than to the mind, even though the mind be at the same time injuriously affected.” (Ibid.)

The foundation was thus laid, nearly a century ago, for two beliefs that have since been frequently reiterated: first, recovery for emotional distress must be relegated to the status of parasitic damages; and second, mental disturbances can be distinctly classified as either psychological or physical injury. That medical science and particularly the field of mental health have made much progress in the 20th century is *925manifest; yet, despite some noteworthy exceptions, the principles underlying the decision in Sloane still pervade the law of negligence.

The present state of the law is articulated in BAJI No. 12.80 (6th ed. 1977): “There can be no recovery of damages for emotional distress unaccompanied by physical injury where such emotional distress arises only from negligent conduct. [¶] However, if a plaintiff has suffered a shock to the nervous system or other physical harm which was proximately caused by negligent conduct of a defendant, then such plaintiff is entitled to recover damages from such a defendant for any resulting physical harm and emotional distress.”

The BAJI language appears to be derived mainly from the opinions in Vanoni v. Western Airlines (1967) 247 Cal.App.2d 793, 795-797 [56 Cal.Rptr. 115], and Espinosa v. Beverly Hospital (1952) 114 Cal.App. 2d 232, 234 [249 P.2d 843], both of which relied on Sloane. The principle has been reiterated elsewhere, but in each instance is traceable either directly or indirectly to Sloane. (See, e.g., Fuentes v. Perez (1977) 66 Cal.App.3d 163, 168 [136 Cal.Rptr. 275]; Leasman v. Beech Aircraft Corp. (1975) 48 Cal.App.3d 376, 381 [121 Cal.Rptr. 768]; Gautier v. General Telephone Co. (1965) 234 Cal.App.2d 302, 307 [44 Cal.Rptr. 404].) It therefore appears the rule has been immutable since its early origin, with virtually no regard for the factual contexts in which claims arose, or the alleged causes of emotional distress, or the prevailing state of medical knowledge.

Plaintiff urges that we recognize the concept of negligent infliction of emotional distress as an independent tort. In this inquiry we first seek to identify the rationale for the Sloane rulé. None appears in the opinion, possibly because the court classified the plaintiffs condition, “nervous paroxysm,” as a physical injury, and hence had no need to justify a denial of recovery for psychological injury alone. Neither did the Espinosa court provide any justification for its rejection of the plaintiff’s attempt to “subvert the ancient rule that mental suffering alone will not support an action for damages based upon negligence.” (114 Cal.App.2d at p. 234.) Therefore, we must look elsewhere.

The primary justification for the requirement of physical injury appears to be that it serves as a screening device to minimize a presumed risk of feigned injuries and false claims. (See, e.g., Prosser, op. cit. supra, at p. 328; 1 Dooley, op. cit. supra, at p. 319; Comment, Negligently Inflicted Mental Distress: The Case for an Independent Tort *926(1971) 59 Geo.L.J. 1237, 1244; Rest.2d Torts, § 436A, com. b.) Such harm is believed to be susceptible of objective ascertainment and hence to corroborate the authenticity of the claim.

Although most courts still adhere to the early view, the scholars assert that such artificial barriers to recovery are unnecessary. Thus Dean Prosser explains that “the difficulty is not insuperable. Not only fright and shock, but other kinds of mental injury are marked by definite physical symptoms, which are capable of clear medical proof. It is entirely possible to allow recovery only upon satisfactory evidence and deny it when there is nothing to corroborate the claim, or to look for some guarantee of genuineness in the circumstances of the case. The problem is one of proof, and it will not be necessary to deny a remedy in all cases because some claims may be false.” (Prosser, op. cit. supra, at p. 328; see also 1 Dooley, op. cit. supra, at p. 319.)

The foregoing analysis was expressly adopted by the New York Court of Appeals when it held that “Freedom from mental disturbance is now a protected interest in this State.” (Ferrara v. Galluchio (1958) 5 N.Y.2d 16 [176 N.Y.S.2d 996, 999, 152 N.E.2d 249, 71 A.L.R.2d 331].) The case involved a medical malpractice action brought by a patient who, after receiving negligently administered X-ray treatments from the defendants, consulted a dermatologist who advised her to exercise certain precautions because the area of the X-ray burn might become cancerous. The plaintiff alleged she developed a severe “cancer-phobia” and sought damages for mental anguish. In affirming a jury verdict for the plaintiff, the New York high court deemed it “entirely plausible, under such circumstances, that plaintiff would undergo exceptional mental suffering over the possibility of developing cancer.” (Id. at p. 1000; see also Johnson v. State (1975) 37 N.Y.2d 378 [372 N.Y.S.2d 638, 643, 334 N.E.2d 590], in which the court held that “recovery for emotional harm to one subjected directly to the tortious act may not be disallowed so long as the evidence is sufficient to show causation and substantiality of the harm suffered, together with a ‘guarantee of genuineness’ to which the court referred in the Ferrara case [citations].”)

Ferrara represents a view not generally followed in California. Our courts have instead devised various means of compensating for the infliction of emotional distress, provided there is some assurance of the validity of the claim. As we have seen, physical injury, whether it occurs contemporaneously with or is a consequence of emotional distress, *927provides one such guarantee. (Capelouto v. Kaiser Foundation Hospital (1972) 7 Cal.3d 889, 892-893 [103 Cal.Rptr. 856, 500 P.2d 880]; Vanoni v. Western Airlines, supra, 247 Cal.App.2d at pp. 795-797.) Another arises when the plaintiff asserts an independent cause of action apart from personal injury. Thus in a suit against an insurer for damages resulting from its wrongful refusal to settle a claim against the insured within the policy limits, the plaintiff was permitted to recover for mental distress as well as for pecuniary loss. We concluded: “Obviously, where, as here, the claim is actionable and has resulted in substantial damages apart from those due to mental distress, the danger of fictitious claims is reduced, and we are not here concerned with mere bad manners or trivialities but tortious conduct resulting in substantial invasions of clearly protected interests.” (Cristi v. Security Ins. Co. (1967) 66 Cal.2d 425, 434 [58 Cal.Rptr. 13, 426 P.2d 173]; accord, Gruenberg v. Aetna Ins. Co. (1973) 9 Cal.3d 566, 579 [108 Cal.Rptr. 480, 510 P.2d 1032]; Jarchow v. Transamerica Title Ins. Co., supra, 48 Cal.App.3d at p. 937; Windeler v. Scheers Jewelers (1970) 8 Cal.App. 3d 844 [88 Cal.Rptr. 39].)

Finally, intentional torts will support an award of damages for emotional distress alone, but only in cases involving “extreme and outrageous intentional invasions of one’s mental and emotional tranquility.” (Alcorn v. Anbro Engineering, Inc., supra, 2 Cal.3d at p. 498.) As we explained in State Rubbish etc. Assn. v. Siliznoff (1952) 38 Cal.2d 330, 338 [240 P.2d 282], it is the outrageous conduct that serves to insure that the plaintiff experienced serious mental suffering and convinces the courts of the validity of the claim.

We thus reach the crucial question whether continued adherence to the venerable rule that would bar recovery in this case is warranted. Although we recognize a need to guard against fraudulent claims, we are not persuaded that the presently existing artificial lines of demarcation are the only appropriate means of attaining this goal. As observed by Presiding Justice Gardner in his concurring opinion in Allen v. Jones (1980) 104 Cal.App.3d 207, 216 [163 Cal.Rptr. 445], “In no other area are the vagaries of our law more apparent than in the distinction between mental and emotional distress accompanied by physical manifestation and such discomfort unaccompanied by physical manifestation.”

The Hawaii Supreme Court confronted the issue forthrightly and discarded the traditional rule that there can be no recovery for the negligent infliction of emotional distress alone. (Rodrigues v. State *928(1970) 52 Hawaii 156, 283 [472 P.2d 509].) It explained that “Courts which have administered claims of mental distress incident to an independent cause of action are just as competent to administer such claims when they are raised as an independent ground for damages.” (Id. at p. 519.) Moreover, defendants will not be exposed to potentially unlimited liability for invasions of emotional tranquility that are trivial and transient if recovery is limited to claims of serious mental distress. The court therefore adopted as its standard: “serious mental distress may be found where a reasonable man, normally constituted, would be unable to adequately cope with the mental stress engendered by the circumstances of the case.” (Id. at p. 520.)

The Rodrigues court further noted the “multiplication of psychic stimuli” that society presently faces, and the “increasing widespread knowledge of the debilitating effect mental distress may have on an individual’s capacity to carry on the functions of life.” {Ibid.) Accordingly, the court recognized that “the interest in freedom from negligent infliction of serious mental distress is entitled to independent legal protection. We hold, therefore, that there is a duty to refrain from the negligent infliction of serious mental distress.” (Ibid.) 1

We agree that the unqualified requirement of physical injury is no longer justifiable. It supposedly serves to satisfy the cynic that the claim of emotional distress is genuine. Yet we perceive two significant difficulties with the scheme. First, the classification is both overinclusive and underinclusive when viewed in the light of its purported purpose of screening false claims. It is overinclusive in permitting recovery for emotional distress when the suffering accompanies or results in any physical injury whatever, no matter how trivial. If physical injury, however slight, provides the ticket for admission to the courthouse, it is difficult for advocates of the “floodgates” premonition to deny that the doors are already wide open: as we observed in Capelouto v. Kaiser Foundation Hospitals, supra, 1 Cal.3d at page 893, “mental suffering frequently constitutes the principal element of tort damages. .. . ” More *929significantly, the classification is underinclusive because it mechanically denies court access to claims that may well be valid and could be proved if the plaintiffs were permitted to go to trial.

The second defect in the requirement of physical injury is that it encourages extravagant pleading and distorted testimony. Thus it has been urged that the law should provide a remedy for serious invasions of emotional tranquility, “otherwise the tendency would be for the victim to exaggerate symptoms of sick headaches, nausea, insomnia, etc., to make out a technical basis of bodily injury, upon which to predicate a parasitic recovery for the more grievous disturbance, the mental and emotional distress she endured.” (Magruder, Mental and Emotional Disturbance in the Law of Torts (1936) 49 Harv.L.Rev. 1033, 1059; see also Annot. (1959) 64 A.L.R.2d 100, 117, fn. 18, 128 & fn. 8 [suggesting that “in most instances of severe mental disturbance some deleterious physical consequence can, with a little ingenuity, be found...,” and that characterization of an injury as physical or mental may depend on the ingenuity of counsel in framing the pleadings].)

Furthermore, as we observed in Sloane v. Southern Cal. Ry. Co., supra, 111 Cal. at page 680, the border between physical and emotional injury is not clearly delineated. In 1896 we deemed a “nervous shock or paroxysm” to be distinguishable from mere mental anguish. Today, the notion that physical harm includes “shock to the nervous system” is an accepted aspect of our law of negligence. (See BAJI No. 12.71 (6th ed. 1977).) The Restatement, too, attempts to draw the distinction: “The rule [precluding recovery for negligently caused emotional distress alone] applies to all forms of emotional disturbance, including temporary fright, nervous shock, nausea, grief, rage, and humiliation. The fact that these are accompanied by transitory, non-recurring physical phenomena, harmless in themselves, such as dizziness, vomiting, and the like, does not make the actor liable where such phenomena are in themselves inconsequential and do not amount to any substantial bodily harm. On the other hand, long continued nausea or headaches may amount to physical illness, which is bodily harm; and even long continued mental disturbance.. . may be classified by the courts as illness, notwithstanding [its] mental character. This becomes a medical or psychiatric problem, rather than one of law.” (Rest.2d Torts, § 436A, com. c.)

In our view the attempted distinction between physical and psychological injury merely clouds the issue. The essential question is one of *930proof; whether the plaintiff has suffered a serious and compensable injury should not turn on this artificial and often arbitrary classification scheme. We thus agree with the view of the Rodrigues court: “In cases other than where proof of mental distress is of a medically significant nature, [citations] the general standard of proof required to support a claim of mental distress is some guarantee of genuineness in the circumstances of the case. [Citation.]” (472 P.2d at p. 520.) This standard is not as difficult to apply as it may seem in the abstract. As Justice Traynor explained in this court’s unanimous opinion in State Rubbish etc. Assn. v. Siliznoff, supra, 38 Cal.2d at page 338, the jurors are best situated to determine whether and to what extent the defendant’s conduct caused emotional distress, by referring to their own experience. In addition, there will doubtless be circumstances in which the alleged emotional injury is susceptible of objective ascertainment by expert medical testimony. (See Comment, Negligently Inflicted Mental Distress: The Case for an Independent Tort (1971) 59 Geo.L.J. 1237, 1248 et seq.) To repeat: this is a matter of proof to be presented to the trier of fact. The screening of claims on this basis at the pleading stage is a usurpation of the jury’s function.

More than half a century ago Roscoe Pound recognized that claims of emotional distress were capable of verification by means more precise than the then-prevailing requirement of physical impact; we think his logic applies equally to the present requirement of physical injury: “In reality [the impact requirement] was a practical rule, growing out of the limitations of trial by jury, the difficulty of proof in cases of injuries manifest subjectively only and the backwardness of our knowledge with respect to the relations of mind and body. In view of the danger of imposition, the courts, on a balance of the interests involved, refused to go beyond cases where there was a voucher for the truth of the plaintiff’s claim.... With the rise of modern psychology the basis of this caution in securing an important element of the interest of personality was removed.” (Pound, Interpretations of Legal History (1923) pp. 120-121.)

For all these reasons we hold that a cause of action may be stated for the negligent infliction of serious emotional distress. Applying these principles to the case before us, we conclude that the complaint states such a cause of action. The negligent examination of Mrs. Molien and the conduct flowing therefrom are objectively verifiable actions by the defendants that foreseeably elicited serious emotional responses in the plaintiff and hence serve as a measure of the validity of plaintiff’s claim *931for emotional distress. As yet another corroborating factor, we note the universally accepted gravity of a false imputation of syphilis: by statute it constitutes slander per se. (Civ. Code, § 46, subd. 2; Schessler v. Keck (1954) 125 Cal.App.2d 827 [271 P.2d 588].)

It follows that the trial court erred in sustaining the demurrer to the cause of action for emotional distress.

Ill

The court also erred in sustaining the demurrer to the cause of action for loss of consortium. Both parties focus, appropriately, on our decision in Rodriguez v. Bethlehem Steel Corp., supra, 12 Cal.3d 382, in which this cause of action had its genesis in California. After rejecting a number of arguments against such recovery, we held that “each spouse has a cause of action for loss of consortium, as defined herein, caused by a negligent or intentional injury to the other spouse by a third party.” (Id. at p. 408.)

The negligently inflicted injury in Rodriguez consisted of an extensive and permanent paralysis of the plaintiffs husband caused when he was struck on the head by a falling pipe weighing over 600 pounds. Defendants now urge that we limit the general principle there announced to the factual context in which it arose, and hold that the cause of action for loss of consortium requires severe physical injury to the nonplaintiff spouse. But nowhere in our opinion did we restrict its rule to the particular facts then before us. Defendants think it significant that we referred to Mr. Rodriguez’s condition as a “severely disabling injury” and understood the personal loss suffered by the spouse of a “severely disabled person.” (Id. at p. 400.) These simple descriptive phrases, however, will not support the inference defendants seek to draw: obviously a person may become “severely disabled” mentally no less than physically, and the resulting detriment to that individual’s spouse is no less serious than if the disability were an impairment of mobility or other bodily function.2

*932The issue in Rodriguez was whether to recognize the cause of action for loss of consortium at all {id. at p. 385), and our holding spoke only of recovery for “a negligent or intentional injury” to the plaintiff’s spouse {id. at p. 408). We had no reason to delimit the kinds of “injury” that would support the cause of action, nor did we endeavor to do so. Certainly the facts presented a compelling justification for permitting Mrs. Rodriguez to recover: her loss was “palpable and extreme.” (Note, Right to Recover for Loss of Consortium (1975) 63 Cal.L.Rev. 323.) But the fact that it was caused by a devastating physical injury to her husband was not vital to our decision. Indeed, we not only defined “consortium” to embrace such intangibles as “conjugal society, comfort, affection, and companionship,” we acknowledged that “An important aspect of consortium is.. .the moral support each spouse gives the other.... ” (12 Cal.3d at p. 405.) Thus the impairment of one spouse’s mental health could well deprive the other of the “companionship and moral support that marriage provides no less than its sexual side.” {Id. at pp. 405-406.)

Two years after Rodriguez the Massachusetts Supreme Court addressed this issue directly and recognized a cause of action for loss of consortium arising out of severe emotional distress intentionally inflicted on the plaintiff’s spouse: “the underlying purpose of such an action is to compensate for the loss of the companionship, affection and sexual enjoyment of one’s spouse, and it is clear that these can be lost as a result of psychological or emotional injury as well as from actual physical harm.” {Agis v. Howard Johnson Company (1976) 371 Mass. 140 [355 N.E.2d 315, 320].) The same reasoning applies when, as here, the alleged injury is negligently inflicted.3

Finally, defendants present no persuasive reasons to justify their proposal to limit recovery for loss of consortium to cases in which the plaintiff’s spouse suffers severe physical injury. Indeed, we perceive compelling grounds for not drawing this line. It is true our opinion in Rodriguez contemplates injury to the nonplaintiff spouse that is suifi*933ciently serious and disabling to raise the inference that the conjugal relationship is more than superficially or temporarily impaired. As we earlier explained, however, it is irrefutable that certain psychological injuries can be no less severe and debilitating than physical injuries. We could accept defendants’ position only by rejecting the manifest truth that a marital relationship can be grievously injured when one spouse suffers a traumatically induced neurosis, psychosis, chronic depression, or phobia.

Whether the degree of harm suffered by the plaintiff’s spouse is sufficiently severe to give rise to a cause of action for loss of consortium is a matter of proof. When the injury is emotional rather than physical, the plaintiff may have a more difficult task in proving negligence, causation, and the requisite degree of harm; but these are questions for the jury, as in all litigation for loss of consortium. In Rodriguez we acknowledged that the loss is “principally a form of mental suffering” (12 Cal. 3d at p. 401), but nevertheless declared our faith in the ability of the jury to exercise sound judgment in fixing compensation. {Ibid.) We reaffirm that faith today.

The judgment is modified to order a dismissal of the second cause of action and, as so modified, the judgment is reversed in its entirety.

Bird, C. J., Tobriner, J., and Newman, J., concurred.

Manuel, J., concurred in the judgment.

CLARK, J.

I dissent.

Our court today allows—for the first time—a money award against one who unintentionally disturbs the mental tranquillity of another.

Because such disturbances are commonplace in our complex society, because they cannot be objectively observed or measured, but mainly because it is for the Legislature to create new causes of action and to fix the limits of recovery, this court has until today refused the invitation to open wide the door to damage claims fraught with potential abuse.

As acknowledged by the majority, this court’s first significant extension of tort liability occurred in Dillon v. Legg (1968) 68 Cal.2d 728 [69 Cal.Rptr. 72, 441 P.2d 912, 29 A.L.R.3d 1316], 12 short years ago. *934In a four-to-three decision Amaya v. Home Ice, Fuel & Supply Co. (1963) 59 Cal.2d 295 [29 Cal.Rptr. 33, 379 P.2d 513] was overruled, to hold that a mother witnessing a negligent act causing the death of her minor child could maintain an action against the tortfeasor for “‘great emotional disturbance and shock and injury to her nervous system’ which caused her great physical and mental pain and suffering.” (Dillon v. Legg, supra, 68 Cal.2d 728, 731.) In Amaya, five years earlier, we held that a mother observing her seventeen-month-old son “‘struck and run over by the defendants’ truck’” is not entitled to recover for her “‘emotional shock and great mental disturbance... sustaining injury to her body and shock and injury to her nervous system and person....’” (Amaya v. Home Ice, Fuel & Supply Co., supra, 59 Cal.2d 295, 298.)

In overruling Amaya, this court created a new cause of action. (See Dillon v. Legg, supra, 68 Cal.2d 728, dis. opn. of Burke, J., at pp. 748-749.) But today’s majority overstretch “the new elasticity proclaimed by the [Dillon\ majority” (id., at p. 749) which purported to limit recovery to damages for “shock which resulted in physical injury.” (Id., at p. 740; italics added.) Now the majority will permit recovery for negligently caused emotional distress unaccompanied by physical injury. The dissenters in Dillon were prescient in their concern our courts were entering a “‘fantastic realm of infinite liability’” (id., at p. 751).1

Good reason exists for denying recovery for plaintiffs’ claim although the majority appear to acknowledge none. (Ante, at pp. 924-925.)2 The requirement of a concurrence of physical injury with claimed emotional distress is a safeguard eliminating spurious claims for negligently inflicted mental distress. That safeguard is now abandoned in favor of newly declared standards designed by the majority opinion to limit recoveries under their new, independent tort. A plaintiff claiming his or *935her mental tranquility has been disturbed can now recover “‘where proof of mental distress is of a medically significant nature,’” or the claim of mental distress is supported by “‘some guarantee of genuineness in the circumstances of the case.’” (Ante, p. 930.) In applying these standards, jurors are said to be “best situated to determine whether and to what extent the defendant’s conduct caused emotional distress, by referring to their own experience.” (Id.) Such standards are nonstandards, opening wide the door to abuse.

The majority incorrectly rely on State Rubbish etc. Assn. v. Siliznoff (1952) 38 Cal.2d 330 [240 P.2d 282] for their contention that jurors are best situated to determine if a defendant’s conduct causes emotional distress warranting recovery of damages pursuant to standards fixed by today’s majority. However, Siliznoff deals with intentional infliction of fright, the court stating that jurors are “ordinarily in a better position .. .to determine whether outrageous conduct results in mental distress than whether that distress in turn results in physical injury.” (Id., at p. 311; italics added.) A different and difficult medical question is presented when the resulting traumatic effect of mental distress must be determined. It is this question which the majority would depend on jurors to answer. Relying on a medical study (Smith, Relations of Emotions to Injury and Disease (1944) 30 Va.L.Rev. 193), this court concluded in Amaya that questions of the effects of emotional distress would not be easy ones for jurors. “Here that ‘difficult medical question’ cannot be so easily avoided. In the cited article... Dr. Smith... concludes (1) that ‘a majority of persons claiming injury from psychic causes possessed sub-normal resistance to psychic stimuli’; (2) that ‘In only 55 of the 301 cases surveyed could we say actual causation was proved by a preponderance of substantial and credible evidence’; and (3) that hence ‘The skeptical courts were...correct in doubting whether adequate criteria of proof existed in this field to make administration of a remedy feasible. Law, in a commendable desire to be forward looking, outran scientific standards. Taking all cases decided between 1850 and 1944.. .the net balance of justice would have been greater had all courts denied damages for injury imputed to psychic stimuli alone.’” (Amaya v. Home Ice, Fuel & Supply Co., supra, 59 Cal.2d 295, 311.) No empirical evidence exists and the record fails to establish that psychiatrists and jurors have since become better equipped to evaluate the traumatic effects of psychic stimuli.

The resolution of conflicts the majority would leave to jurors, “as doctors well know. ..often borders on fancy when the causation of al*936leged psychoneural disorders is at issue.... Much timeliness remains in Dr. Smith’s warning (id., at p. 212 of 30 Va.L.Rev.) that ‘eagerness to be progressive may cause extravagent credulity and injury to scientific standards of proof.’ Extravagant credulity, of course, means ultimate injustice.” (Id., at p. 312.)

The fundamental problem is not foreseeing (by unguided hindsight) the consequences of unintentional conduct, but rather realistically limiting liability for those consequences. “It is unthinkable that any one shall be liable to the end of time for all the results that follow in endless sequence from his single act. Causation cannot be the answer; in a very real sense the consequences of an act go forward to eternity, and back to the beginning of the world.” (Prosser, Palsgraf Revisited (1953) 52 Mich.L.Rev. 1, 24.) In a system compensating injury based on fault, consideration must be given to the “moral blame attached to the defendant’s conduct” (Biakanja v. Irving (1958) 49 Cal.2d 647, 650 [320 P.2d 16, 65 A.L.R.2d 1358]) in fixing liability. When the defendant’s act is merely negligent rather than intentional, lesser moral blame attaches, cautioning against extending liability. (See Bauer, The Degree of Moral Fault as Affecting Defendant’s Liability (1933) 81 U.Pa.L.Rev. 586, 588-592.) Liability should be proportionate to the actor’s culpability, having in mind the utility ánd necessity of the conduct negligently performed. Where, as here, imposition of liability is far disproportionate to the degree of culpability, we do a disservice to the public—who must ultimately bear the cost—by sanctioning claims for hurt feelings.3

The signatories to the majority opinion have—in cases where the balance has weighed more heavily in favor of liability than in the instant case—refused for policy reasons to extend liability. In Borer v. American Airlines, Inc. (1977) 19 Cal.3d 441 [138 Cal.Rptr. 302, 563 P.2d 858], this court noted that “foreseeable injury to a legally recognized relationship” does not necessarily postulate a cause of action, and that “social policy must at some point intervene to delimit liability.... ‘Every injury has ramifying consequences, like the ripplings of the wa*937ters, without end. The problem for the law is to limit the legal consequences of wrongs to a controllable degree.’” (Id., at p. 446.) The author of today’s majority opinion has also properly cautioned against imposition of new burdens on the courts: “As Chief Justice Burger lamented in United States v. Richardson (1974) 418 U.S. 166, 179 [41 L.Ed.2d 678, 689-690, 94 S.Ct. 2940]: ‘As our society has become more complex, our numbers more vast, our lives more varied, and our resources more strained, citizens increasingly request the intervention of the courts on a greater variety of issues than at any period of our national development.’” (Carsten v. Psychology Examining Com. (1980) ante, pp. 793, 801, fn. 2 [166 Cal.Rptr. 844, 614 P.2d 276].)

The majority’s creation of new consequences for old acts is wrong. The judgment should be affirmed.

Richardson, J., concurred.

Opinion

BAXTER, J.

We granted review in this case to consider:

(1) whether emotional distress engendered by a fear of cancer or other serious physical illness or injury following exposure to a carcinogen or other toxic substance is an injury for which damages may be recovered in a negligence action in the absence of physical injury;

(2) whether Firestone Tire and Rubber Company is liable for intentional infliction of emotional distress under Christensen v. Superior Court (1991) 54 Cal.3d 868 [2 Cal.Rptr.2d 79, 820 P.2d 181];

*974(3) whether the cost of future medical monitoring to detect the onset of cancer is a recoverable item of damage when, as a result of a defendant’s negligence, a plaintiff has an increased risk of future illness but suffers no present physical injury or illness; and

(4) whether any effect should be given to evidence that a plaintiff has negligently ingested other toxic substances or carcinogens.

Our analysis of existing case law and policy considerations relevant to the availability of damages for emotional distress leads us to conclude that, generally, in the absence of a present physical injury or illness, recovery of damages for fear of cancer in a negligence action should be allowed only if the plaintiff pleads and proves that the fear stems from a knowledge, corroborated by reliable medical and scientific opinion, that it is more likely than not that the feared cancer will develop in the future due to the toxic exposure.

We also conclude, however, that an exception to this general rule is warranted if the toxic exposure that has resulted in the fear of cancer is caused by conduct amounting to “oppression, fraud, or malice,” as defined in Civil Code section 3294. In such cases, a plaintiff should be allowed to recover without having to show knowledge that it is more likely than not that the feared cancer will occur, so long as the plaintiff’s fear is otherwise serious, genuine and reasonable.

We find further that Christensen v. Superior Court, supra, 54 Cal.3d 868, precludes any liability for intentional infliction of emotional distress in the absence of a determination that Firestone’s extreme and outrageous conduct was directed at plaintiffs or undertaken with knowledge of their presence and consumption of the groundwater, and with knowledge of a substantial certainty that they would suffer severe emotional injury upon discovery of the facts.

On the issue of medical monitoring costs, we hold that such costs are a compensable item of damages in a negligence action where the proofs demonstrate, through reliable medical expert testimony, that the need for future monitoring is a reasonably certain consequence of the plaintiff’s toxic exposure and that the recommended monitoring is reasonable.

Finally, we conclude that when a defendant in a negligence action demonstrates that a plaintiff’s smoking is negligent and that a portion of the plaintiff’s fear of cancer is attributable to the smoking, comparative fault principles may be applied to reduce the amount of recovery for emotional distress damages based on such fear.

*975I.

Factual and Procedural Background

This is a toxic exposure case brought by four landowners living adjacent to a landfill. As a result of defendant Firestone’s practice of disposing of its toxic wastes at the landfill, the landowners were subjected to prolonged exposure to certain carcinogens. While none of the landowners currently suffers from any cancerous or precancerous condition, each faces an enhanced but unquantified risk of developing cancer in the future due to the exposure.

The following background facts are contained in the trial court’s statement of decision following trial.

From 1963 until 1980, Firestone operated a tire manufacturing plant near Salinas. In 1967, Firestone contracted with Salinas Disposal Service and Rural Disposal (hereafter SDS), two refuse collection companies operating the Crazy Horse landfill (hereafter Crazy Horse), for disposal of its industrial waste. Firestone agreed to deposit its waste in dumpsters provided by SDS located at the plant site. SDS agreed to haul the waste to Crazy Horse and deposit it there.

Crazy Horse, a class II sanitary landfill owned by the City of Salinas, covers approximately 125 acres suitable for the disposal of household and commercial solid waste. Unlike dump sites that are classified class I, class II landfills such as Crazy Horse prohibit toxic substances and liquids because of the danger that they will leach into the groundwater and cause contamination.

At the outset of their contractual relationship, SDS informed Firestone that no solvents, cleaning fluids, oils or liquids were permitted at Crazy Horse. Firestone provided assurances that these types of waste would not be sent to the landfill.

Notwithstanding its assurances, Firestone sent large quantities of liquid waste to Crazy Horse, including banbury drippings (a by-product of the tire manufacturing process) containing a combination of semiliquid toxic chemicals. Firestone also sent liquid waste oils, liquid tread end cements, and solvents to the landfill.

In May 1977, Firestone’s plant engineer, who was in charge of all environmental matters, sent a memorandum to Firestone’s plant managers *976and department heads. The memorandum, reflecting official plant policy, explained liquid waste disposal procedures and described the particular waste materials involved and the proper method of handling them.

In order to comply with this policy, Firestone initially made efforts to take the waste materials to a class I dump site. However, Firestone accumulated more waste than had been anticipated and disposing of the waste proved costly. When noncompliance with the policy became widespread, the plant engineer sent another memorandum to plant management complaining about the lack of compliance and pointing out that the policy was required by California law.

During this time, the Salinas plant operated under a production manager who had been sent from Firestone’s company headquarters in Akron, Ohio, for the purpose of “turning the plant around” and making it more profitable. This manager became angered over the costs of the waste disposal program and decided to discontinue it. As a consequence, Firestone’s hazardous waste materials were once again deposited at Crazy Horse.

Frank and Shirley Potter owned property and lived adjacent to Crazy Horse. Joe and Linda Plescia were their neighbors.

In 1984, the Potters and the Plescias (hereafter plaintiffs) discovered that toxic chemicals had contaminated their domestic water wells. The chemicals included: benzene; toluene; chloroform; 1,1 -dichloroethene; methylene chloride; tetrachloroethene; 1,1,1 -trichloroethane; trichloroethene; and vinyl chloride. Of these, both benzene and vinyl chloride are known to be human carcinogens. Many of the others are strongly suspected to be carcinogens.

In 1985, plaintiffs filed separate suits against Firestone for damages and declaratory relief. Their complaints against Firestone stated causes of action for, inter alia, negligence, negligent and intentional infliction of emotional distress, and strict liability/ultrahazardous activity. The two cases were tried together in a court trial. After considering all the evidence, the court found that Firestone was negligent; that negligent and intentional infliction of emotional distress were established; and that Firestone’s conduct was an ultrahazardous activity that would subject Firestone to strict liability for resulting damages. Judgment was entered in favor of plaintiffs.

In its statement of decision, the trial court concluded that Firestone’s waste disposal practices from 1967 until 1974 constituted actionable negligence. In particular, it determined that Firestone’s dumping of liquid and semiliquid wastes at Crazy Horse, despite having been told that such dumping was prohibited, fell below the appropriate standard of care. In rejecting *977Firestone’s argument that it was not negligent because the dangers posed by toxins were not widely known until the mid-1970’s, the trial court concluded that: (1) Firestone had been informed by SDS that no solvents, cleaning fluids, oils or liquids were permitted at Crazy Horse; (2) it fell below the standard of care for a large, international corporation with scientific and legal experts in its employ, having been alerted to the impropriety of disposing of these wastes at the landfill, to violate these regulations without at least making reasonable inquiry into the reasons for the restrictions; and (3) if Firestone had made a minimal inquiry, it would have discovered, among other things, the dangers to groundwater from landfill leachates and the potential for contaminating domestic wells.

The trial court also concluded that Firestone was liable for intentional infliction of emotional distress. The court found that the 1977 memorandum detailing how liquid wastes should be disposed reflected Firestone’s increased knowledge at that time about the dangers of toxic waste. Given the evidence regarding this memorandum and the fact that the memorandum represented Firestone’s official waste disposal policy, the court concluded that Firestone’s decision to dump its waste at Crazy Horse in violation of that policy in order to reduce costs was extreme and outrageous conduct.

Finally, the trial court determined that the dumping of large amounts of toxic wastes in a class II landfill constituted an ultrahazardous activity.

In finding liability, the trial court determined that the toxic chemicals in plaintiffs’ drinking water were the same chemicals or “daughter” chemicals as those used at the Firestone plant. Firestone was the heaviest single contributor of waste at Crazy Horse, and the only contributor with the identical “suite” of chemicals to those found in the water. The court also noted the expert testimony established that the chemicals that migrated off the Firestone plant site so closely resembled those in the water that the comparison constituted a virtual “fingerprint” identifying Firestone as the source of the contaminants.

The court did not attribute any item of damage to any one specific theory of recovery. After noting that plaintiffs’ likelihood of harm due to their toxic exposure was the subject of conflicting medical opinions at trial, the court concluded there was convincing evidence that the prolonged nature of the exposure had “enhanced” plaintiffs’ risk of developing cancer and other maladies, and that this enhanced susceptibility was a “presently existing physical condition.” The court observed that although there was no way to quantify this risk, the risk was nevertheless very real. In its view, reliable scientific opinion and common sense both supported the conclusion that a *978prolonged period of exposure substantially increased the susceptibility to disease.

The court also stated that although plaintiffs testified to a constellation of physical symptoms which they attributed to the toxic chemicals, it was “not possible to demonstrate with sufficient certainty a causal connection between these symptoms and the well water contamination. Nevertheless, plaintiffs will always fear, and reasonably so, that physical impairments they experience are the result of the well water and are the precursers [sz'c] of life threatening disease. Their fears are not merely subjective but are corroborated by substantial medical and scientific opinion.” Based on these findings, plaintiffs were awarded damages totalling $800,000 for their lifelong fear of cancer and resultant emotional distress.

The court further concluded that since plaintiffs now live with an increased vulnerability to serious disease, it was axiomatic that they should receive periodic medical monitoring to detect the onset of disease at the earliest possible time and that early diagnosis was unquestionably important to increase the chances of effective treatment. Accordingly, the court awarded damages totalling $142,975 as the present value of the costs of such monitoring, based on plaintiffs’ life expectancies.

The court also awarded plaintiffs damages totalling $269,500 for psychiatric illness and the cost of treating such illness,1 as well as damages totalling $108,100 for the general disruption of their lives and the invasion of their privacy.2 Finally, the court awarded punitive damages totalling $2.6 million based on Firestone’s conscious disregard for the rights and safety of others in dumping its toxic wastes at the landfill after 1977.

Firestone appealed, arguing that the damage awards were not supported by any of the legal theories relied on by the trial court and that the evidence was insufficient to support the trial court’s findings. It claimed that the award for “fear of cancer” in the absence of physical injury was an unwarranted extension of liability for negligent infliction of emotional distress, that if such fear is compensable it should not be so where the plaintiff cannot establish that he or she has a “probability” of developing cancer, and that the amount of damages awarded each plaintiff was not based on proof of individualized injury. The award for “psychiatric injury” was challenged on the ground that the injury was indistinguishable from fear of cancer and was not supported by the evidence.

*979Firestone asserted a number of other errors in its appeal. It argued that intentional infliction of emotional distress had not been established because its conduct was not shown to be “extreme and outrageous,” and the evidence did not support the finding that it was undertaken with the intent to cause, or reckless disregard of the probability of causing, such injury. Firestone further contended that the elements of a cause of action for strict liability for ultrahazardous activity had not been established, and that, in any event, if damages for fear of cancer could not be awarded on a negligence theory, it followed that they should not be awarded on a strict liability for ultrahazardous activity theory. Additionally, it challenged the damages awarded for medical monitoring on the ground that the amounts were not supported by the evidence and that the cost of medical examinations was not an item of damage that should be imposed on it.

Finally, Firestone argued that the trial court had erred in admitting and considering irrelevant evidence, that plaintiffs’ comparative negligence had not been considered, that compensation for “disruption” of plaintiffs’ lives was improper in an action in which property damages are not recoverable,3 and that the court erred in assessing punitive damages.

The Court of Appeal reversed the awards for medical monitoring costs, as well as a postjudgment order directing Firestone to pay costs and interest, but otherwise affirmed the judgment. The court held that, given the circumstances in which plaintiffs ingested the carcinogens, it was unnecessary for them to establish a present physical injury in order to recover for their fear of cancer. It further held it was unnecessary for plaintiffs to prove they were likely to develop cancer, noting their fear was certain, definite and real, and not contingent on whether they in fact develop the disease. Plaintiffs had proven the elements of a negligence cause of action and had demonstrated, under an objective standard, that their emotional distress was serious. The court also held Firestone was properly found liable for intentional infliction of emotional distress. However, the court reversed the awards for medical monitoring costs because plaintiffs failed to establish that cancer was reasonably certain to occur, and did not address the challenge to the amount of those awards. The court affirmed the amount of the compensatory damages award and found the punitive damage award proper.

Because that court concluded that the negligence and intentional infliction of emotional distress causes of action supported the damage awards, it did not reach Firestone’s claim that the trial court erred in finding that its conduct constituted an ultrahazardous activity for which it was strictly liable.

*980II.

Discussion

Before addressing the parties’ claims, it would be useful to identify what is not at issue in this case and to reiterate what is. Firestone does not currently challenge, nor do we undertake to address, the correctness of the award for the general disruption to plaintiffs’ lives. We also do not consider Firestone’s perfunctory claim that the psychiatric illness component of the emotional distress award is erroneous.4 (See People v. Ashmus (1991) 54 Cal.3d 932, 985, fn. 15 [2 Cal.Rptr.2d 112, 820 P.2d 214].) Consequently, the only damages at issue here are the fear of cancer component of the emotional distress award, the award for medical monitoring costs and the award for punitive damages. We also consider whether Firestone may be held liable for intentional infliction of emotional distress under Christensen v. Superior Court, supra, 54 Cal.3d 868, and whether comparative fault principles regarding plaintiffs’ smoking are properly invoked in this case.

A. Negligence: Fear of Cancer

“Fear of cancer” is a term generally used to describe a present anxiety over developing cancer in the future.5 Claims for fear of cancer have been increasingly asserted in toxic tort cases as more and more substances have been linked with cancer. Typically, a person’s likelihood of developing cancer as a result of a toxic exposure is difficult to predict because many forms of cancer are characterized by long latency periods (anywhere from 20 to 30 years), and presentation is dependent upon the interrelation of myriad factors.

The availability of damages for fear of cancer as a result of exposure to carcinogens or other toxins in negligence actions is a relatively novel issue *981for California courts. Other jurisdictions, however, have considered such claims and the appropriate limits on recovery. Factors deemed important to the compensability of such fear have included proof of a discernible physical injury (e.g., Wisniewski v. Johns-Manville Corp. (3d Cir. 1985) 759 F.2d 271, 274; Eagle-Picher Industries, Inc. v. Cox (Fla.Dist.Ct.App. 1985) 481 So.2d 517, 528-529; Payton v. Abbott Labs (1982) 386 Mass. 450 [437 N.E.2d 171, 180-181] [hereafter Payton]), proof of a physical impact or physical invasion (e.g., Herber v. Johns-Manville Corp. (3d Cir. 1986) 785 F.2d 79, 85; Wilson v. Key Tronic Corp. (1985) 40 Wn.App. 802 [701 P.2d 518, 524] [hereafter Wilson]; Wetherill v. University of Chicago (N.D.Ill. 1983) 565 F.Supp. 1553, 1560 [hereafter Wetherill]), and objective proof of mental distress (e.g., Stites v. Sundstrand Heat Transfer, Inc. (W.D.Mich 1987) 660 F.Supp. 1516, 1526, 1527; Daley v. LaCroix (1970) 384 Mich. 4 [179 N.W.2d 390, 395]).

We must now consider whether, pursuant to California precedent, emotional distress engendered by the fear of developing cancer in the future as a result of a toxic exposure is a recoverable item of damages in a negligence action.

1. Parasitic Recovery: Immune System Impairment and/or Cellular Damage as Physical Injury

Because it initially appeared plaintiffs might have suffered damage to their immune systems, we solicited the views of the parties on whether such damage constitutes physical injury. We did so because it is settled in California that in ordinary negligence actions for physical injury, recovery for emotional distress caused by that injury is available as an item of parasitic damages. (Crisci v. Security Insurance Co. (1967) 66 Cal.2d 425, 433 [58 Cal.Rptr. 13, 426 P.2d 173]; Merenda v. Superior Court (1992) 3 Cal.App.4th 1, 8-9 [4 Cal.Rptr.2d 87].) Where a plaintiff can demonstrate a physical injury caused by the defendant’s negligence, anxiety specifically due to a reasonable fear of a future harm attributable to the injury may also constitute a proper element of damages. (E.g., Jones v. United Railroads of San Francisco (1921) 54 Cal.App. 744 [202 P. 919] [affirming damages for emotional distress endured up to time of trial where plaintiff reasonably feared permanent disability in the future as direct and proximate result from physical injury received in accident].)

Although the availability of parasitic damages for emotional distress engendered by a fear of developing cancer in the future appears to be an *982issue of first impression in California,6 other jurisdictions have concluded that such damages are recoverable when they are derivative of a claim for serious physical injuries. For example, the court in Ferrara v. Galluchio (1958) 5 N.Y.2d 16, 21-22 [176 N.Y.S.2d 996, 1000, 152 N.E.2d 249, 71 A.L.R.2d 331] upheld an award of emotional distress damages based on the plaintiff’s fear of cancer where she had been negligently burned in X-ray treatments and later advised by a dermatologist to have her tissue examined every six months as cancer might develop. (Accord, Dempsey v. Hartley (E.D.Pa. 1951) 94 F.Supp. 918, 920-921 [fear of breast cancer due to traumatic breast injury]; Alley v. Charlotte Pipe & Foundry Co. (1912) 159 N.C. 327 [74 S.E. 885, 886] [fear stemming from sarcoma liable to ensue from bum wound].) In these cases, the existence of a present physical injury, rather than the degree of probability that the disease may actually develop, is determinative.

No California cases address whether impairment of the immune system response and cellular damage constitute “physical injury” sufficient to allow recovery for parasitic emotional distress damages. Courts in other jurisdictions that have considered this issue recently have come to differing conclusions.

Plaintiffs, citing several such cases, contend that immune system impairment and cellular damage is a physical injury for which parasitic damages for emotional distress are available. (E.g., Werlein v. United States (D.Minn. 1990) 746 F.Supp. 887, 901, 906 [chromosomal breakage and damage to cardiovascular and immunal systems sufficient to satisfy present physical injury requirement for recovery of emotional distress damages where medical experts were prepared to testify as to such injury and authenticity of plaintiffs’ symptoms]; Anderson v. W.R. Grace & Co. (D.Mass. 1986) 628 F.Supp. 1219, 1226-1227 [subcellular harm or harm affecting body’s ability to fight disease and causing harm to body’s organ systems sufficient to support claim for emotional distress]; cf. Barth v. Firestone Tire and Rubber Co. (N.D.Cal. 1987) 661 F.Supp. 193, 196 [hereafter Barth] [determining that, under California law, injury to immune system is form of *983actionable physical injury];7 Brafford v. Susquehanna Corp. (D.Colo. 1984) 586 F.Supp. 14 [although availability of emotional distress damages not specifically discussed, claim for physical injury allowed to proceed where evidence showed that chromosomal damage caused by radiation operated to deprive plaintiffs of a certain degree of immunity].)

Conversely, Firestone contends that mere subcellular changes that are unaccompanied by clinically verifiable symptoms of illness or disease do not constitute a physical injury sufficient to support a claim for parasitic emotional distress damages. To support this contention, Firestone relies on a case in which workers’ claims for fear of cancer from asbestos exposure were denied because they had failed to show that their fear was based on knowledge that their lungs were functionally impaired. (In re Hawaii Federal Asbestos Cases (D.Hawaii 1990) 734 F.Supp. 1563, 1569-1570.) There it was held that a physical injury was not established by the mere presence of asbestos fibers in the lungs or by evidence of physiological changes in the lungs such as pleural thickening and pleural plaques. (Id., at p. 1567.) Firestone also relies on cases holding that in the absence of some verifiable impairment, asbestos-related subcellular changes do not give rise to valid claims for physical injury. (E.g., Schweitzer v. Consolidated Rail Corp. (3d Cir. 1985) 758 F.2d 936, 942 [although availability of emotional distress damages not discussed, subclinical injury resulting from exposure to asbestos held insufficient to constitute requisite actual loss or damage under Federal Employers’ Liability Act]; Owens-Illinois v. Armstrong (1991) 87 Md.App. 699 [591 A.2d 544, 560-561] [pleural plaques and pleural scarring do not cause functional impairment or harm and therefore are not compensable].)

It is not clear from the record in this case, however, that these plaintiffs’ emotional distress is parasitic to this type of supposed injury. The statement of decision by the trial court does not include an express finding that plaintiffs’ exposure to the contaminated well water resulted in physical injury, cellular damage or immune system impairment. The court made no *984mention of plaintiffs’ immune system response, cellular systems or cells, and made no specific determination of damage or impairment thereto. While the trial court concluded that plaintiffs do have an enhanced “susceptibility” or “risk” for developing cancer and other maladies, it characterized this as a “presently existing physical condition,” not as a physical injury. We conclude, therefore, that we lack an appropriate factual record for resolving whether impairment to the immune response system or cellular damage constitutes a physical injury for which parasitic damages for emotional distress ought to be available.8

2. Nonparasitic Fear of Cancer Recovery

We next determine whether the absence of a present physical injury precludes recovery for emotional distress engendered by fear of cancer. Firestone argues that California should not recognize a duty to avoid negligently causing emotional distress to another, but, if such a duty is recognized, recovery should be permitted in the absence of physical injury only on proof that the plaintiff’s emotional distress or fear is caused by knowledge that future physical injury or illness is more likely than not to occur as a direct result of the defendant’s conduct. Amici curiae, many of whom represent organizations of manufacturers and their insurers, would preclude all recovery for emotional distress in the absence of physical injury.

a. Independent Duty

Firestone first asks the court to expressly adopt the rule recently applied by the Supreme Court of Texas in Boyles v. Kerr (Tex. 1993) 855 S.W.2d 593. There the court held that there is no duty to avoid negligently causing emotional distress to another, and that damages for emotional distress are recoverable only if the defendant has breached some other duty to the plaintiff. (Id., at p. 594.)

That is already the law in California. Indeed, the Texas court relied on recent decisions of this court in which we recognized that there is no independent tort of negligent infliction of emotional distress. (Boyles v. Kerr, supra, 855 S.W.2d at p. 599.) The tort is negligence, a cause of action in which a duty to the plaintiff is an essential element. (See Burgess v. Superior Court (1992) 2 Cal.4th 1064, 1073 [9 Cal.Rptr.2d 615, 831 P.2d 1197] [hereafter Burgess]; Christensen v. Superior Court, supra, 54 Cal.3d 868, *985890-891; Marlene F. v. Affiliated Psychiatric Medical Clinic, Inc. (1989) 48 Cal.3d 583, 590 [257 Cal.Rptr. 98, 770 P.2d 278] [hereafter Marlene F.]; see also Anderson v. Northrop Corp. (1988) 203 Cal.App.3d 772, 776 [250 Cal.Rptr. 189].) That duty may be imposed by law, be assumed by the defendant, or exist by virtue of a special relationship. (Marlene F., supra, 48 Cal.3d at p. 590.)

The lesson of these decisions is: unless the defendant has assumed a duty to plaintiff in which the emotional condition of the plaintiff is an object, recovery is available only if the emotional distress arises out of the defendant’s breach of some other legal duty and the emotional distress is proximately caused by that breach of duty. Even then, with rare exceptions, a breach of the duty must threaten physical injury, not simply damage to property or financial interests. (See Cooper v. Superior Court (1984) 153 Cal.App.3d 1008, 1012-1013 [200 Cal.Rptr. 746]; Quezada v. Hart (1977) 67 Cal.App.3d 754, 761-763 [136 Cal.Rptr. 815]; cf. Holliday v. Jones (1989) 215 Cal.App.3d 102, 117, 119 [264 Cal.Rptr. 448].)

Those limits on recovery for emotional distress caused by the negligent conduct of another do not aid Firestone here, however. Firestone did violate a duty imposed on it by law and regulation to dispose of toxic waste only in a class I landfill and to avoid contamination of underground water.9 The violation led directly to plaintiffs’ ingestion of various known and suspected carcinogens, and thus to their fear of suffering the very harm which the Legislature sought by statute to avoid. Their fear of cancer was proximately caused by Firestone’s unlawful conduct which threatened serious physical injury.

This is not a case in which a negligence cause of action is predicated only on a claim that the defendant breached a duty to avoid causing emotional distress.

b. Absence of Physical Injury

Amici curiae argue that no recovery for emotional distress arising from fear of cancer should be allowed in any case unless the plaintiff can establish a present physical injury such as a clinically verifiable cancerous or precancerous condition. Amici curiae advance several legal and policy arguments to support this position. None is persuasive.

*986Amici curiae first assert that, under California case law, the existence of a physical injury is a predicate to recovering damages for emotional distress in a negligence action unless the action involves “bystander” recovery (e.g., Thing v. La Chusa (1989) 48 Cal.3d 644 [257 Cal.Rptr. 865, 771 P.2d 814] [hereafter Thing]), or there is a “preexisting relationship” between the plaintiff and defendant (e.g., Marlene F., supra, 48 Cal.3d 583) which creates a duty to the plaintiff, neither of which is implicated here. This assertion is plainly without merit.

Significantly, we recently reaffirmed the principle that, in California, “damages for negligently inflicted emotional distress may be recovered in the absence of physical injury or impact. . . .” (Burgess, supra, 2 Cal.4th at p. 1074.) We held that “physical injury is not a prerequisite for recovering damages for serious emotional distress,” especially where “there exists a ‘guarantee of genuineness in the circumstances of the case.’ [Citation.]” (Id., at p. 1079.)

Contrary to amici curiae’s assertions, this principle has never been restricted to cases involving bystanders or preexisting relationships. Notably, amici curiae cite no authority even suggesting such a limitation.10 Nor is there any question but that Firestone had a duty to any person who might foreseeably come in contact with its hazardous waste to use care in the disposal of that material, care which includes compliance with all government regulations governing the location and manner of disposal. In this court Firestone has abandoned any claim that it was not negligent or that plaintiffs were not foreseeable victims of its negligence.11

Amici curiae next contend that substantial policy reasons nevertheless support a physical injury requirement for recovery of fear of cancer damages *987where no preexisting relationship exists. They suggest that allowing recovery in the absence of a physical injury would create limitless liability and would result in a flood of litigation which thereby would impose onerous burdens on courts, corporations, insurers and society in general. Allowing such recovery would promote fraud and artful pleading, and would also encourage plaintiffs to seek damages based on a subjective fear of cancer. In amici curiae’s view, a physical injury requirement is thus essential to provide meaningful limits on the class of potential plaintiffs and clear guidelines for resolving disputes over liability without the necessity for trial.

This argument overlooks the reasons for our decision to discard the requirement of physical injury. As we observed more than a decade ago, “[t]he primary justification for the requirement of physical injury appears to be that it serves as a screening device to minimize a presumed risk of feigned injuries and false claims. [Citations.]” (Molien v. Kaiser Foundation Hospitals (1980) 27 Cal.3d 916, 925-926 [167 Cal.Rptr. 831, 616 P.2d 813, 16 A.L.R.4th 518] [hereafter Molien], disapproved on other grounds, Burgess, supra, 2 Cal.4th at p. 1074.) Such harm was “believed to be susceptible of objective ascertainment and hence to corroborate the authenticity of the claim.” (Molien, supra, 27 Cal.3d at p. 926.)

In Molien, supra, 27 Cal.3d 916, we perceived two significant difficulties with the physical injury requirement. First, “the classification is both over-inclusive and underinclusive when viewed in the light of its purported purpose of screening false claims.” (27 Cal.3d at p. 928.) It is overinclusive in that it permits recovery whenever the suffering accompanies or results in physical injury, no matter how trivial (ibid.), yet underinclusive in that it mechanically denies court access to potentially valid claims that could be proved if the plaintiffs were permitted to go to trial (id., at p. 929).

Second, we observed that the physical injury requirement “encourages extravagant pleading and distorted testimony.” (Molien, supra, 27 Cal.3d at p. 929.) We concluded that the retention of the requirement ought to be reconsidered because of the tendency of victims to exaggerate sick headaches, nausea, insomnia and other symptoms in order to make out a technical basis of bodily injury upon which to predicate a parasitic recovery for the more grievous disturbance, consisting of the mental and emotional distress endured. (Ibid.)

Therefore, rather than adhere to what we perceived as an artificial and often arbitrary means of guarding against fraudulent claims, we acknowledged that “[t]he essential question is one of proof[.]” (Molien, supra, 27 Cal.3d at pp. 929-930.) Thus, “ ‘[i]n cases other than where proof of *988mental distress is of a medically significant nature, [citations] the general standard of proof required to support a claim of mental distress is some guarantee of genuineness in the circumstances of the case. [Citation.]’ ” (Id., at p. 930, citing Rodrigues v. State (1970) 52 Hawaii 156, 173 [472 P.2d 509, 520] [hereafter Rodrigues].)

Our reasons for discarding the physical injury requirement in Mo-lien, supra, 27 Cal.3d 916, remain valid today and are equally applicable in a toxic exposure case. That is, the physical injury requirement is a hopelessly imprecise screening device—it would allow recovery for fear of cancer whenever such distress accompanies or results in any physical injury, no matter how trivial, yet would disallow recovery in all cases where the fear is both serious and genuine but no physical injury has yet manifested itself. While we agree with amici curiae that meaningful limits on the class of potential plaintiffs and clear guidelines for resolving disputes in advance of trial are necessary, imposing a physical injury requirement represents an inherently flawed and inferior means of attempting to achieve these goals.

c. Likelihood of Cancer in the Future

We next consider whether recovery of damages for emotional distress caused by fear of cancer should depend upon a showing that the plaintiff’s fears stem from a knowledge that there is a probable likelihood of developing cancer in the future due to the toxic exposure. This is a matter of hot debate among the parties and amici curiae. Firestone and numerous amici curiae argue that because fear of cancer claims are linked to a future harm which may or may not materialize, such claims raise concerns about speculation and uncertainty and therefore warrant a requirement that the plaintiff show the feared cancer is more likely than not to occur. Plaintiffs and other amici curiae respond that such a requirement is inappropriate in the context of a mental distress claim, and that there are viable methods, apart from requiring quantification of the cancer risk, to screen claims and determine the reasonableness and genuineness of a plaintiff’s fears.

Plaintiffs favor the approach adopted by the Court of Appeal, which requires the following showing. The toxic exposure plaintiff must first prove the elements of a negligence cause of action. The plaintiff must then establish that his or her fear of cancer is serious, and that the seriousness meets an objective standard (i.e., the distress must be reasonable under the circumstances). Although a plaintiff is not required to establish that the cancer is likely to occur, the finder of fact should consider evidence regarding the likelihood that cancer will occur (i.e., evidence that the disease is only a remote possibility could lead a trier of fact to conclude that a *989plaintiff’s fears were unreasonable). Finally, the finder of fact should test the genuineness of the plaintiff’s fear under the factors discussed in Molien, supra, 27 Cal.3d 916, including expert testimony, a juror’s own experience, and the particular circumstances of the case.

In affirming the fear of cancer award, the Court of Appeal remarked that “the fact that [plaintiffs’] water supply was contaminated by carcinogens is, by itself, surely a circumstance which is likely to cause emotional distress in most reasonable persons.” (Italics added.) In addition, although the Court of Appeal purported to call for a showing of the actual likelihood that the feared cancer will occur, the court indicated that the absence of such evidence is immaterial where, as here, the trier of fact finds a significantly increased risk of cancer.

We decline to adopt the Court of Appeal’s approach. Although the court properly recognized that a toxic exposure plaintiff is required to establish the reasonableness of his or her fear of cancer,12 it erred in concluding that reasonableness is established by the mere fact of an exposure to, or a significant increase in, the risk of cancer.

A carcinogenic or other toxic ingestion or exposure, without more, does not provide a basis for fearing future physical injury or illness which the law is prepared to recognize as reasonable. The fact that one is aware that he or she has ingested or been otherwise exposed to a carcinogen or other toxin, without any regard to the nature, magnitude and proportion of the exposure or its likely consequences, provides no meaningful basis upon which to evaluate the reasonableness of one’s fear. For example, nearly everybody is exposed to carcinogens which appear naturally in all types of foods. Yet ordinary consumption of such foods is not substantially likely to result in cancer. (See Ames & Gold, Too Many Rodent Carcinogens: Mitogenesis Increases Mutagenesis (1990) 249 Science 970, 971, fn. 10 [observing that apples, celery, coffee, carrots, cauliflower, grapes, honey, orange juice, potatoes and many other common foods naturally produce carcinogenic pesticides that have been found to induce tumors when administered to rodents in large doses].) Nor is the knowledge of such consumption likely to result in a reasonable fear of cancer.

Moreover, permitting recovery for fear of cancer damages based solely upon a plaintiff’s knowledge that his or her risk of cancer has been significantly increased by a toxic exposure, without requiring any further showing *990of the actual likelihood of the feared cancer due to the exposure, provides no protection against unreasonable claims based upon wholly speculative fears. For example, a plaintiff’s risk of contracting cancer might be significantly increased by 100 or more percent due to a particular toxic exposure, yet the actual risk of the feared cancer might itself be insignificant and no more than a mere possibility. As even plaintiffs appear to concede, evidence of knowledge that cancer is only a remote possibility could lead a trier of fact to conclude that a claimed fear is objectively unreasonable. This concession only proves the point—the way to avoid damage awards for unreasonable fear, i.e., in those cases where the feared cancer is at best only remotely possible, is to require a showing of the actual likelihood of the feared cancer to establish its significance.

Accordingly, we reject the Court of Appeal’s approach because it attaches undue significance to the mere ingestion of a carcinogen, and because it focuses on the increased risk of cancer in isolation.

We turn now to Firestone’s argument that fear of cancer should be compensable only where the fear is based upon knowledge that cancer is probable, i.e., that it is more likely than not that cancer will develop. In evaluating this argument, we first consider whether it is reasonable for a person to genuinely and seriously fear a disease that is not probable, and if so, whether the emotional distress engendered by such fear warrants recognition as a compensable harm.

We cannot say that it would never be reasonable for a person who has ingested toxic substances to harbor a genuine and serious fear of cancer where reliable medical or scientific opinion indicates that such ingestion has significantly increased his or her risk of cancer, but not to a probable likelihood. Indeed, we would be very hard pressed to find that, as a matter of law, a plaintiff faced with a 20 percent or 30 percent chance of developing cancer cannot genuinely, seriously and reasonably fear the prospect of cancer. Nonetheless, we conclude, for the public policy reasons identified below, that emotional distress caused by the fear of a cancer that is not probable should generally not be compensable in a negligence action.

As a starting point in our analysis, we recognize the indisputable fact that all of us are exposed to carcinogens every day. As one commentator has observed, “[i]t is difficult to go a week without news of toxic exposure. Virtually everyone in society is conscious of the fact that the air they breathe, water, food and drugs they ingest, land on which they live, or products to which they are exposed are potential health hazards. Although few are exposed to all, few also can escape exposure to any.” (Dworkin, *991 Fear Of Disease And Delayed Manifestation Injuries: A Solution Or A Pandora’s Box? (1984) 53 Fordham L. Rev. 527, 576, fns. omitted.)

Thus, all of us are potential fear of cancer plaintiffs, provided we are sufficiently aware of and worried about the possibility of developing cancer from exposure to or ingestion of a carcinogenic substance. The enormity of the class of potential plaintiffs cannot be overstated; indeed, a single class action may easily involve hundreds, if not thousands, of fear of cancer claims. (See Willmore, In Fear of Cancerphobia (Sept. 28, 1988) 3 Toxics L. Rptr. (Bur.Nat. Affairs) 559, 563 [hereafter Willmore].)

With this consideration in mind, we believe the tremendous societal cost of otherwise allowing emotional distress compensation to a potentially unrestricted plaintiff class demonstrates the necessity of imposing some limit on the class. (See Borer v. American Airlines, Inc. (1977) 19 Cal.3d 441, 447 [138 Cal.Rptr. 302, 563 P.2d 858] [hereafter Borer] [refusing to recognize a child’s right to recover for the loss of a parent’s consortium]; see also Thing, supra, 48 Cal.3d at pp. 664-665 [limiting bystander recovery of damages for negligent infliction of emotional distress].) Proliferation of fear of cancer claims in California in the absence of meaningful restrictions might compromise the availability and affordability of liability insurance for toxic liability risks. (See Willmore, supra, 3 Toxics L. Rptr. at p. 563.) “Should [fear of cancer] liability continue to grow, and thereby lead to a substantial increase in toxic tort litigation, such liability insurance will become even more scarce and prohibitively expensive.” (Ibid.) In the end, the burden of payment of awards for fear of cancer in the absence of a more likely than not restriction will inevitably be borne by the public generally in substantially increased insurance premiums or, alternatively, in the enhanced danger that accrues from the greater number of residents and businesses that may choose to go without any insurance. (See Borer, supra, 19 Cal.3d at p. 447.)

A second policy concern that weighs in favor of a more likely than not threshold is the unduly detrimental impact that unrestricted fear liability would have in the health care field. As amicus curiae California Medical Association points out, access to prescription drugs is likely to be impeded by allowing recovery of fear of cancer damages in negligence cases without the imposition of a heightened threshold. To wit, thousands of drugs having no known harmful effects are currently being prescribed and utilized. New data about potentially harmful effects may not develop for years. If and when negative data are discovered and made public, however, one can expect numerous lawsuits to be filed by patients who currently have no physical injury or illness but who nonetheless fear the risk of adverse effects *992from the drugs they used.13 Unless meaningful restrictions are placed on this potential plaintiff class, the threat of numerous large, adverse monetary awards, coupled with the added cost of insuring against such liability (assuming insurance would be available), could diminish the availability of new, beneficial prescription drugs or increase their price beyond the reach of those who need them most. (Cf. Brown, supra, 44 Cal.3d at p. 1063 [emphasizing public policy favoring development and marketing of beneficial new drugs and relying on the same reasons in sharply limiting strict liability recovery against prescription drug manufacturers].)

Moreover, in Burgess, supra, 2 Cal.4th at pages 1082-1084, we acknowledged the importance of considering the impact of emotional distress liability on the “crisis” in the availability and cost of medical malpractice insurance. Although we were not persuaded in that case that the impact of such liability was sufficient to deny recovery for a mother’s emotional distress arising from the negligent delivery of her baby, we observed, inter alia, that the class of potential plaintiffs in that type of situation was clearly limited. (2 Cal.4th at p. 1084.)

In stark contrast to the limited impact of emotional distress liability in the negligent delivery type of situation, fear of cancer liability in the context of physicians prescribing drugs will surely exacerbate the medical malpractice crisis. Specifically, for every patient who might actually develop cancer because of a particular drug, there could be hundreds or thousands of patients who might allege they were negligently prescribed the drug.14 Not only will the additional expense of insuring against fear lawsuits and fear *993liability under these circumstances add to the cost of physician services, but physicians who would otherwise prescribe and administer new or innovative drugs might be discouraged from doing so for fear of potential liability. This would inhibit physicians in their ability to provide quality care to patients, as well as increase the practice of defensive medicine.

A third policy concern to consider is that allowing recovery to all victims who have a fear of cancer may work to the detriment of those who sustain actual physical injury and those who ultimately develop cancer as a result of toxic exposure. That is, to allow compensation to all plaintiffs with objectively reasonable cancer fears, even where the threatened cancer is not probable, raises the very significant concern that defendants and their insurers will be unable to ensure adequate compensation for those victims who actually develop cancer or other physical injuries. Consider, for instance, that in this case damages totalling $800,000 for fear of cancer were awarded to four plaintiffs. If the same recovery were to be allowed in large class actions, liability for this one type of injury alone would be staggering. As one commentator astutely noted: “It would be a regrettable irony if in the rush to compensate the psychically injured we make it impossible to compensate those suffering of permanent and serious physical injuries.” (Will-more, supra, 3 Toxics L. Rptr. at p. 563.)

A fourth reason supporting the imposition of a more likely than not limitation is to establish a sufficiently definite and predictable threshold for recovery to permit consistent application from case to case. (See Thing, supra, 48 Cal.3d at p. 664; Elden v. Sheldon (1988) 46 Cal.3d 267, 276 [250 Cal.Rptr. 254, 758 P.2d 582].) Indeed, without such a threshold, the likelihood of inconsistent results increases since juries may differ over the point at which a plaintiff’s fear is a genuine and reasonable fear, i.e., one jury might deem knowledge of a 2 or 5 percent likelihood of future illness or injury to be sufficient (cf. Heider v. Employers Mutual Liability Ins. Co. (La.Ct.App. 1970) 231 So.2d 438, 442 [affirming award for plaintiff’s fear of becoming epileptic where experts estimated likelihood at 2 to 5 percent]), while another jury might not. A more definite threshold will avoid inconsistent results and may contribute to early resolution or settlement of claims.

Finally, while a more likely than not limitation may foreclose compensation to many persons with genuine and objectively reasonable fears, it is sometimes necessary to “limit the class of potential plaintiffs if emotional injury absent physical harm is to continue to be a recoverable item of damages in a negligence action.” (Thing, supra, 48 Cal.3d at p. 666.) We *994have recognized, in analogous contexts, that restricting the liability of a negligent tortfeasor for emotional loss may be warranted in consideration of the following factors: the intangible nature of the loss, the inadequacy of monetary damages to make whole the loss, the difficulty of measuring the damage, and the societal cost of attempting to compensate the plaintiff. (Borer, supra, 19 Cal.3d at pp. 447-449; Baxter v. Superior Court (1977) 19 Cal.3d 461, 464 [138 Cal.Rptr. 315, 563 P.2d 871] [refusing to recognize a parent’s cause of action for loss of a child’s consortium].) These considerations are equally relevant to fear of cancer claims in toxic exposure cases.

Plaintiffs and amici curiae advance several reasons why a more likely than not threshold for fear of cancer claims should be rejected. None is convincing.

First, plaintiffs argue that a more likely than not restriction is unworkable because the risk of contracting cancer from any one source is unquantifiable. In their view; adoption of such a rule would effectively preclude any emotional distress recovery.

We are unpersuaded by this argument because its factual premise appears highly suspect. Although the experts in this case asserted it was impossible to quantify the risk of cancer from any particular toxic exposure, experts in other cases do not share that view. For instance, in Clark v. Taylor (1st Cir. 1983) 710 F.2d 4, 14, an expert testified that the plaintiff’s risk of developing bladder cancer had increased from one in ten thousand to one in ten as a result of his exposure to benzidine. In Sterling, supra, 855 F.2d 1188, 1205, the court found an increased risk for susceptibility to cancer of 25-30 percent. In Pollock v. Johns-Manville Sales Corp. (D.N.J. 1988) 686 F.Supp. 489, 490 (hereafter Pollock), an expert was prepared to testify that the plaintiff’s exposure to asbestos resulted in a 43 percent chance of cancer. In Dartez v. Fibreboard Corp. (5th Cir. 1985) 765 F.2d 456, 466. (hereafter Dartez), an expert testified that a person employed as insulator, who smoked moderately and was exposed to asbestos, would have a risk of lung cancer approaching 50 percent. Finally, in both Gideon v. Johns-Manville Sales Corp. (5th Cir. 1985) 761 F.2d 1129, 1138 (hereafter Gideon), and Jackson v. Johns-Manville Sales Corp. (5th Cir.) 781 F.2d 394, 413, certiorari denied (1986) 478 U.S. 1022 [92 L.Ed.2d 743, 106 S.Ct. 3339], there was expert testimony in each case that the plaintiff had a greater than 50 percent risk of contracting cancer as a result of toxic exposure.

Second, plaintiffs and amici curiae point out that while decisions from other jurisdictions have employed a more likely than not limitation for the *995so-called “increased risk” claim,15 they have thus far declined to do so in the context of a fear of cancer claim. (E.g., Sterling, supra, 855 F.2d at pp. 1205-1206; Lavelle v. Owens-Coming Fiberglas Corp. (1987) 30 Ohio Misc.2d 11 [507 N.E.2d 476, 480-481] [hereafter Lavelle]-, In re Moorenovich (D.Me. 1986) 634 F.Supp. 634, 636-637 [hereafter Moorenovich].) Those decisions, it is asserted, allowed recovery for a plaintiff’s fear of cancer in situations similar to those present here without proof that cancer was more likely than not to occur. (Sterling, supra, 855 F.2d at p. 1206; Moorenovich, supra, 634 F.Supp. at p. 637; see also Lavelle, supra, 507 N.E.2d at p. 481; Dartez, supra, 765 F.2d at pp. 467-468.)

We remain unconvinced. Although it is true that the cited cases permitted fear of cancer recovery so long as the plaintiffs’ fears were genuine and reasonable, many of them involved plaintiffs who, in addition to their emotional distress, sustained serious or permanent physical injury as a result of a particular toxic exposure. (Sterling, supra, 855 F.2d 1188 [kidney and liver damage, and numerous central nervous injuries]; Lavelle, supra, 507 N.E.2d 476, 478 [asbestosis]; Dartez, supra, 765 F.2d 456, 468 [plaintiff “injured” by accumulation of asbestos fibers in lungs].)16 It is clear from passages in these cases that the respective courts were acutely aware of the *996plaintiffs’ existing physical injuries and were deciding the appropriate basis for fear of cancer recovery in that context. (Sterling, supra, 855 F.2d at pp. 1205-1206;17 Lavelle, supra, 507 N.E.2d at pp. 480-481 [although court recognized that Ohio law generally allows recovery of emotional distress damages without accompanying physical injury, court repeatedly referred to plaintiff as “asbestosis-afflicted”]; Dartez, supra, 765 F.2d at p. 468 [observing that Texas law recognized the right to compensation for mental distress where such distress is the natural result of a physical injury, and finding that plaintiff had been “injured” by the accumulation of asbestos fibers in his lungs].) Because these cases were decided within the context of a much narrower class of potential plaintiffs, they did not implicate or address the important public policy considerations at issue here.

Moreover, many of plaintiffs’ cases do not warrant much weight because they were rendered by federal courts and have not been cited by the states whose laws they attempted to apply. For instance, in Moorenovich, supra, 634 F.Supp. 634, a federal district court applied a pure reasonableness standard for fear of cancer recovery in attempting to predict how the Maine Supreme Judicial Court would decide the issue. The court, apparently finding no Maine authorities involving fear of cancer claims, simply relied on a case that had allowed bystander recovery for foreseeable emotional distress suffered by a mother who saw her baby choke on a foreign substance in baby food. (634 F.Supp. at p. 637.) The Maine courts have not cited Moorenovich, supra, 634 F.Supp. 634, at all. (See also Dartez, supra, 765 F.2d 456 [fear analysis not discussed or adopted by Texas courts]; Sterling, supra, 855 F.2d 1188 [not cited by Tennessee courts].)

*997Similarly, in Lavelle, supra, 507 N.E.2d 476, a lower court in Ohio simply followed state decisional law that recognized a separate cause of action for serious emotional distress without a contemporaneous physical injury. The lower court relied on state appellate authorities that were not decided in a fear of cancer context, and did not address the policy concerns identified in this case. Lavelle, supra, 507 N.E.2d 476, has not been cited by the Ohio appellate courts.

Accordingly, we decline to follow the rationale of the above cases, for to do so would be to ignore substantial public policy concerns.18 We are satisfied that the more likely than not threshold for fear of cancer claims in negligence actions strikes the appropriate balance between the interests of toxic exposure litigants and the burdens on society and judicial administration.

To summarize, we hold with respect to negligent infliction of emotional distress claims arising out of exposure to carcinogens and/or other toxic substances: Unless an express exception to this general rule is recognized, in the absence of a present physical injury or illness, damages for fear of cancer may be recovered only if the plaintiff pleads and proves that (1) as a result of the defendant’s negligent breach of a duty owed to the plaintiff, the plaintiff is exposed to a toxic substance which threatens cancer; and (2) the plaintiff’s fear stems from a knowledge, corroborated by reliable medical or scientific opinion, that it is more likely than not that the plaintiff will develop the cancer in the future due to the toxic exposure. Under this rule, a plaintiff must do more than simply establish knowledge of a toxic ingestion or exposure and a significant increased risk of cancer. The plaintiff must further show that based upon reliable medical or scientific opinion, the plaintiff harbors a serious fear that the toxic ingestion or exposure was of such magnitude and proportion as to likely result in the feared cancer.

3. Oppressive, Fraudulent or Malicious Conduct

Plaintiffs argue that if damages for fear of cancer in the absence of physical injury are limited to cases in which the cancer will more likely than *998not occur, the court should distinguish intentional conduct. We agree that certain aggravated conduct may warrant different treatment. In this part, we recognize an exception to the general rule set out above.

Plaintiffs suggest that the more likely than not threshold should not be applied where a defendant intentionally violates a statute or regulation prohibiting the disposal of toxins. Plaintiffs are quick to point out that the policy concerns for limiting liability in ordinary negligence cases are not triggered in cases involving such defendants.

Although an exception to the general rule appears appropriate, we do not believe it should focus on intentional violators of the law. For one thing, while a defendant may be aware that its conduct is wrong and potentially dangerous, it may not have knowledge of a particular statute or regulation proscribing it. There may be times where a defendant does not specifically intend to violate the law, yet the defendant proceeds to act egregiously in conscious disregard of others.

With these considerations in mind, we conclude it preferable to recognize an exception that focuses on the totality of circumstances in evaluating a defendant’s conduct. Accordingly, we hold that a toxic exposure plaintiff need not meet the more likely than not threshold for fear of cancer recovery in a negligence action if the plaintiff pleads and proves that the defendant’s conduct in causing the exposure amounts to “oppression, fraud, or malice” as defined in Civil Code section 3294, which authorizes the imposition of punitive damages. Thus, for instance, fear of cancer damages may be recovered without demonstrating that cancer is probable where it is shown that the defendant is guilty of “despicable conduct which is. carried on by the defendant with a willful and conscious disregard of the rights or safety of others.” (Civ. Code, § 3294, subd. (c)(1) [defining one type of malice].) “A person acts with conscious disregard of the rights or safety of others when [he] [she] is aware of the probable dangerous consequences of [his] [her] conduct and willfully and deliberately fails to avoid those consequences.” (BAJI No. 14.71 (1992 rev.) (7th ed. pocket pt.) [defining “malice”].)

When a defendant acts with oppression, fraud or malice, no reason, policy or otherwise, justifies application of the more likely than not threshold. Any burden or consequence to society from imposing liability is offset by the deterrent impact of holding morally blameworthy defendants fully responsible for the damages they cause, including damage in the form of emotional distress suffered by victims of the misconduct who reasonably fear future cancer.

*999Under such circumstances, the potential liability of a defendant is not disproportionate to culpability. While the imposition of liability for emotional distress resulting from negligent handling of toxic substances may result in costs out of proportion to the culpability of the negligent actor, this concern is diminished or nonexistent when the conduct is despicable and undertaken in conscious disregard of the danger to the health or interests of others. The significance of the size of the potential class of plaintiffs is similarly diminished and the moral blame heightened since the defendant is aware of the danger posed by its conduct and acts in conscious disregard of the known risk. (Cf. Amaya v. Home Ice, Fuel & Supply Co. (1963) 59 Cal.2d 295, 315 [29 Cal.Rptr. 33, 379 P.2d 513], overruled on other grounds, Dillon v. Legg (1968) 68 Cal.2d 728, 748 [69 Cal.Rptr. 72, 441 P.2d 912, 29 A.L.RJd 1316] [“[T]he increased liability imposed on an intentional wrongdoer . . . reflects] the psychological fact that solicitude for the interests of the actor weighs less in the balance as his moral guilt increases and the social utility of his conduct diminishes.”].) For these reasons, the more likely than not threshold should not be available as a shield when the defendant acts with a sufficient degree of moral blameworthiness.

Once the plaintiff establishes that the defendant has acted with oppression, fraud or malice, the plaintiff must still demonstrate that his or her fear of cancer is reasonable, genuine and serious in order to recover damages. In determining what constitutes reasonable fear, we refer to our previous discussion at part H.A.2.C., ante, in which we observed that it is not enough for a plaintiff to show simply an ingestion of a carcinogen or a significant increase in the risk of cancer. In addition, the plaintiff must show that his or her actual risk of cancer is significant before recovery will be allowed.19 Under this reasoning, a plaintiff’s fear is not compensable when the risk of cancer is significantly increased, but remains a remote possibility.

To reiterate, in the absence of a physical injury or illness, a plaintiff may recover damages for negligently inflicted emotional distress engendered by a fear of cancer without meeting the more likely than not threshold if the plaintiff pleads and proves that: (1) as a result of the defendant’s negligent breach of a duty owed to the plaintiff, he or she is exposed to a toxic substance which threatens cancer; (2) the defendant, in breaching its duty to the plaintiff, acted with oppression, fraud or malice as defined in Civil Code *1000section 3294;20 and (3) the plaintiff’s fear of cancer stems from a knowledge, corroborated by reliable medical or scientific opinion, that the toxic exposure caused by the defendant’s breach of duty has significantly increased the plaintiff’s risk of cancer and has resulted in an actual risk of cancer that is significant.

In our view, Firestone’s conduct brings this case within the “oppression, fraud or malice” exception for recovery of fear of cancer damages. The trial court determined that in May of 1977, officials in key management positions at Firestone’s Salinas plant had increased knowledge regarding the dangers involved with the careless disposal of hazardous wastes, and had a specific, written policy for hazardous waste disposal. However, these officials, while professing support for the policy in written distributions, in actuality largely ignored the policy. The court found especially reprehensible the fact that Firestone, through its plant production manager, actively discouraged compliance with its internal policies and California law solely for the sake of reducing corporate costs. Under these circumstances, we believe there are sufficient facts supporting the trial court’s conclusion that such conduct displayed a conscious disregard of the rights and safety of others.21

B. Intentional Infliction of Emotional Distress

The trial court ruled that after May 1977, Firestone’s continued dumping of its hazardous wastes at Crazy Horse amounted to outrageous conduct: “The materials were known to be and specifically designated as hazardous. It was clear that there was a great probability of these materials infiltrating and contaminating neighboring wells. Defendant had to realize that the eventual discovery of such a condition by those drinking the contaminated water would almost certainly result in their suffering severe emotional distress. In fact, with the knowledge that the defendant had at this time there also would have come an understanding of the dangerous condition that had been *1001created by the dumping that had taken place over previous years. Nevertheless, defendant went ahead with its illegal dumping. This not only displayed a reckless disregard of the probability of causing emotional distress but also amounted to a ratification of its past acts in this regard.” The court then determined that plaintiffs suffered severe emotional distress as a direct result of Firestone’s intentional acts.

The Court of Appeal, relying on Nally v. Grace Community Church of the Valley (1988) 47 Cal.3d 278, 300 [253 Cal.Rptr. 97, 763 P.2d 948] and Cole v. Fair Oaks Fire Protection Dist. (1987) 43 Cal.3d 148, 155, footnote 7 [233 Cal.Rptr. 308, 729 P.2d 743], agreed that Firestone’s conduct after 1977 was sufficiently extreme and outrageous to support liability for intentional infliction of emotional distress. The court noted in particular Firestone’s knowledge of the health hazards posed by its dumping and its deliberate disregard of these hazards in an effort to cut costs.

We next consider whether Firestone was properly found liable for intentional infliction of emotional distress, and if not, whether the award for punitive damages is otherwise appropriate.

1. The Christensen Requirements for Intentional Infliction of Emotional Distress

After the Court of Appeal rendered its decision, we issued our opinion in Christensen v. Superior Court, supra, 54 Cal.3d 868 (hereafter Christensen), and asked the parties to address the impact of that opinion on the award of compensatory and punitive damages for intentional infliction of emotional distress in this case. As we will explain, it is questionable whether the record here supports a finding of intentional infliction of emotional distress by Firestone.

“The elements of the tort of intentional infliction of emotional distress are: ‘ “(1) extreme and outrageous conduct by the defendant with the intention of causing, or reckless disregard of the probability of causing, emotional distress; (2) the plaintiff’s suffering severe or extreme emotional distress; and (3) actual and proximate causation of the emotional distress by the defendant’s outrageous conduct. . . .” Conduct to be outrageous must be so extreme as to exceed all bounds of that usually tolerated in a civilized community.’ [Citation.] The defendant must have engaged in ‘conduct intended to inflict injury or engaged in with the realization that injury will result.’ [Citation.]” (Christensen, supra, 54 Cal.3d at p. 903.)

In Christensen, supra, we held that “ ‘[t]he law limits claims of intentional infliction of emotional distress to egregious conduct toward plaintiff proximately caused by defendant. ’ [Citation.] The only exception to this rule is *1002that recognized when the defendant is aware, but acts with reckless disregard, of the plaintiff and the probability that his or her conduct will cause severe emotional distress to that plaintiff. [Citations.] Where reckless disregard of the plaintiff’s interests is the theory of recovery, the presence of the plaintiff at the time the outrageous conduct occurs is recognized as the element establishing a higher degree of culpability which, in turn, justifies recovery of greater damages by a broader group of plaintiffs than allowed on a negligent infliction of emotional distress theory. [Citation.]” (Christensen, supra, 54 Cal.3d at pp. 905-906, italics in original, fn. omitted.)

Thus, “[i]t is not enough that the conduct be intentional and outrageous. It must be conduct directed at the plaintiff, or occur in the presence of a plaintiff of whom the defendant is aware.” (Christensen, supra, 54 Cal.3d at p. 903, italics added.) “The requirement that the defendant’s conduct be directed primarily at the plaintiff is a factor which distinguishes intentional infliction of emotional distress from the negligent infliction of such injury.” (Id., at p. 904; see Ochoa v. Superior Court (1985) 39 Cal.3d 159, 165, fn. 5 [216 Cal.Rptr. 661, 703 P.2d 1].)

In this case, it is ambiguous whether the lower courts determined that Firestone’s conduct was directed at these particular plaintiffs in the sense intended by Christensen, supra, 54 Cal.3d at pages 903-906. Although the Court of Appeal correctly rejected Firestone’s contention that Firestone was not liable because it did not know the particular names of any individual whose groundwater was contaminated by the hazardous waste, it is unclear whether it believed that Firestone was actually aware of the presence of these particular plaintiffs and their consumption and use of the water.

Furthermore, it is questionable whether the trial court made a finding that Firestone possessed the requisite knowledge, and if so, whether such a finding would be supported by substantial evidence.22 Although the trial court concluded that Firestone “had to realize” that the eventual discovery of the toxic contamination “by those drinking the contaminated water would almost certainly result in their suffering severe emotional distress,” this may be interpreted in one of two ways. First, this may have been a finding that Firestone actually knew of these particular plaintiffs and their consumption *1003of the water, and nevertheless sent prohibited wastes to Crazy Horse despite a realization that plaintiffs would almost certainly suffer severe emotional distress upon their discovery of the facts. Alternatively, this may have been a finding that Firestone had to have realized that its misconduct was almost certain to cause severe emotional distress to any person who might foresee-ably consume the water and subsequently discover the facts. Although the knowledge requirement is met under the first interpretation of the court’s ruling, it is not satisfied under the second because knowledge of these particular plaintiffs is lacking.

This conclusion is consistent with the result reached in Christensen, supra, 54 Cal.3d 868, itself. There we held that, even though it was alleged that defendants’ conduct in mishandling the remains of deceased persons was intentional and outrageous and was substantially certain to cause extreme emotional distress to relatives and close friends of the deceased, the plaintiffs’ cause of action for intentional infliction of emotional distress was not sufficiently supported where there was no allegation that the defendants’ misconduct was directed primarily at plaintiffs, or that it was calculated to cause them severe emotional distress, or that it was done with knowledge of their presence and with a substantial certainty that they would suffer severe emotional injury. (Christensen, supra, 54 Cal.3d at pp. 903, 906.)

2. Threshold for Recovery

For guidance of the lower courts should the Court of Appeal determine that a retrial on this claim is appropriate, we hold that recovery of fear of cancer damages in actions for intentional infliction of emotional distress should not depend on a showing of a medically corroborated belief that it is more likely than not that the plaintiff will develop the feared cancer as a result of the toxic exposure.

The reasons for not applying the more likely than not threshold are obvious. First, the intentional infliction cause of action requires a showing of “extreme and outrageous conduct” which is directed at the plaintiff. (Christensen, supra, 54 Cal.3d at p. 903.) Thus, a high degree of culpability is required which justifies recovery of greater damages by a broader group of plaintiffs than allowed in an ordinary negligence action. (See id., at p. 906.) Moreover, where a defendant undertakes extreme and outrageous conduct toward the plaintiff, the concern that liability will be imposed out of proportion to fault is not present. Finally, the requirement of extreme and outrageous conduct directed at the plaintiff places adequate limitations on the class of potential plaintiffs who might sue for fear of cancer under this theory. Therefore, the public policy concerns supporting application of the heightened threshold (see pt. II.A.2.C., ante) are not implicated.

*1004Of course, even though the heightened threshold is not applicable in intentional infliction actions, it must nevertheless be established that the plaintiff’s fear of cancer is reasonable, that is, that the fear is based upon medically or scientifically corroborated knowledge that the defendant’s conduct has significantly increased the plaintiff’s risk of cancer and that the plaintiff’s actual risk of the threatened cancer is significant. Reasonableness of the fear is required because in intentional infliction actions, recovery is allowed only for “severe or extreme emotional distress.” (Christensen, supra, 54 Cal.3d at p. 903.) Severe emotional distress means “ ‘emotional distress of such substantial quality or enduring quality that no reasonable [person] in civilized society should be expected to endure it.’ ” (Girard v. Ball (1981) 125 Cal.App.3d 772, 787-788 [178 Cal.Rptr. 406], citing Fletcher v. Western Life Ins. Co. (1970) 10 Cal.App.3d 376, 397 [89 Cal.Rptr. 78, 47 A.L.R.3d 286]; see Rest.2d Torts, § 46, com. j, p. 78 [“distress must be reasonable and justified under the circumstances”].)

3. Punitive Damages

As indicated in part II.A.3., ante, we believe there is sufficient evidence to support the trial court’s conclusion that Firestone acted reprehensibly in conscious disregard of the rights and safety of others. But because the trial court was of the view that Firestone’s conduct constituted intentional infliction of emotional distress when it assessed punitive damages against Firestone, and might not have made the award or might have awarded a lesser sum had it not made that finding, that aspect of the judgment should also be reversed. It is not necessary therefore to consider Firestone’s several challenges to the propriety of awarding punitive damages in this case. For guidance of the court should there be a retrial we note, however, that punitive damages sometimes may be assessed in unintentional tort actions under Civil Code section 3294 (see SKF Farms v. Superior Court (1984) 153 Cal.App.3d 902, 907 [200 Cal.Rptr. 497]; Grimshaw v. Ford Motor Co. (1981) 119 Cal.App.3d 757, 811 [174 Cal.Rptr. 348] [no constitutional infirmity in applying Civ. Code, § 3294 to unintentional tort]), so long as “actual, substantial damages” have been awarded (see Kizer v. County of San Mateo (1991) 53 Cal.3d 139, 147 [279 Cal.Rptr. 318, 806 P.2d 1353] [“actual damages are an absolute predicate for an award of punitive damages”]; Bezaire v. Fidelity & Deposit Co. (1970) 12 Cal.App.3d 888, 892 [91 Cal.Rptr. 142]).

C. Medical Monitoring Costs

In the context of a toxic exposure action, a claim for medical monitoring seeks to recover the cost of future periodic medical examinations intended to *1005facilitate early detection and treatment of disease caused by a plaintiff’s exposure to toxic substances. (Ayers v. Jackson Tp. (1987) 106 NJ. 557 [525 A.2d 287, 308, 76 A.L.R.4th 571] [hereafter Ayers].) We shall now undertake to decide whether and under what circumstances a toxic exposure plaintiff may recover medical monitoring damages in a negligence action.

The trial court awarded medical monitoring damages to plaintiffs, determining that “[s]ince plaintiffs must now live with an increased vulnerability to serious disease it is axiomatic that they should receive periodic medical monitoring in order to determine at the earliest possible time the onset of disease.” The Court of Appeal reversed. Citing Civil Code section 3283,23 the court concluded that such an award must be based upon either a present physical injury or a threat of a future injury that is more likely than not to occur, and that neither had been demonstrated here.

Firestone and amici curiae urge us to affirm the Court of Appeal judgment in this regard. Essentially, Firestone, amici curiae, and the Court of Appeal assume that the reasonableness of medical intervention, and hence compensability, is dependent upon the sufficiency of proof that the occurrence of the disease is reasonably certain. Firestone points to various cases in other jurisdictions that share similar views. (E.g., Ball v. Joy Manufacturing Co. (S.D.W.Va. 1990) 755 F.Supp. 1344, 1372 [denying medical monitoring damages where plaintiff had not suffered present demonstrable injury]; Villari v Terminix International, Inc. (E.D.Pa. 1987) 663 F.Supp. 727, 735 [observing that, under Pennsylvania law, plaintiff seeking costs of medical surveillance as element of damages must demonstrate some physical injury].)

We are not convinced by these decisions and find the Court of Appeal’s analysis in Miranda v. Shell Oil Co. (1993) 17 Cal.App.4th 1651 [15 Cal.Rptr.2d 569] (hereafter Miranda) persuasive. In Miranda, the court observed that “[t]he cost of anticipated medical care reasonably certain to be required in the future has long been held to be a proper item of recoverable damages under [Civil Code section 3333].[24] (Buswell v. City and County of San Francisco (1948) 89 Cal.App.2d 123, 133 [200 P.2d 115].) In our view, expenditures for prospective medical testing and evaluation, which would be unnecessary if the particular plaintiff had not been wrongfully exposed to pollutants, are a correlative detriment within section 3333. (See [In re Paoli *1006 R.R. Yard PCB Litigation (3d Cir. 1990) 916 F.2d 829, 852]; and Coover v. Painless Parker, Dentist (1930) 105 Cal.App. 110, 115 [286 P. 1048].) Thus, such a plaintiff may collect damages from the tortfeasor measured by the ‘reasonable medical and other expenses’ to be incurred for monitoring. (Rest.2d Torts, § 924; see [citations].)

“We have found no authority which limits the applicability of Civil Code section 3333 to those situations where physical injury is evident. Civil Code section 3282 defines ‘detriment’ as ‘a loss or harm suffered in person or property.’ ‘Harm,’ under the Restatement Second of Torts means ‘the existence of loss or detriment in fact of any kind to a person . . . .’ (Rest.2d Torts, § 7, subd. (2), italics added.) The Restatement distinguishes ‘physical harm’ by classifying it as ‘the physical impairment of the human body, or of land or chattels.’ ([Id.,] § 7, subds. (2) and (3).) According to the Restatement’s analysis, a plaintiff is entitled to recover damages from the tortfeasor for all ‘harm’—as opposed to ‘physical harm’—‘past, present and prospective, legally caused by the tort.’ ([Id.,] § 910; see also [id.,] § 7, com. d.; & [id.,] § 917.” (Miranda, supra, 17 Cal.App.4th at pp. 1656-1657.)

In holding that recovery of medical monitoring damages is not contingent upon a showing of a present physical injury or upon proof that injury is reasonably certain to occur in the future, the Miranda court aligned itself with a number of other courts that have considered the issue. (E.g., Ayers, supra, 525 A.2d 287, 312-313; In re Paoli R.R. Yard PCB Litigation (3d Cir. 1990) 916 F.2d 829, 852 [hereafter In re Paoli]; Burns v. Jaquays Mining Corp. (1987) 156 Ariz. 375 [752 P.2d 28, 33].) Consistent with these other decisions, the court determined that such recovery was not available solely upon proof of an exposure to toxic chemicals; rather, there must be a further showing that the need for monitoring is a reasonably certain consequence of the exposure, based upon a consideration of at least the following five factors: (1) the significance and extent of the plaintiff’s exposure to the chemicals; (2) the relative toxicity of the chemicals; (3) the seriousness of the diseases for which plaintiff is at an increased risk; (4) the relative increase in the plaintiff’s chances of developing a disease as a result of the exposure, when compared to (a) plaintiff’s chances of developing the disease had he or she not been exposed, and (b) the chances of members of the public at large of developing the disease; and (5) the clinical value of early detection and diagnosis. (Miranda, supra, 17 Cal.App.4th at pp. 1657-1658, citing Ayers, supra, 525 A.2d at p. 312.)25

Like the court in Miranda, supra, 17 Cal.App.4th 1651, and Ayers, supra, 525 A.2d 287, we conclude that a reasonably certain need for medical *1007monitoring is an item of damage for which compensation should be allowed. Recognition that a defendant’s conduct has created the need for future medical monitoring does not create a new tort. It is simply a compensable item of damage when liability is established under traditional tort theories of recovery.

That medical monitoring may be called for as a result of a defendant’s tortious conduct, even in the absence of actual physical injury, was compellingly demonstrated in the case of Friends For All Children, Inc. v. Lockheed Aircraft Corp. (D.C. Cir. 1984) 746 F.2d 816 [241 App.D.C. 83, 46 A.L.R.4th 1113] [hereafter Friends For All Children]. There, suit was instituted on behalf of 149 Vietnamese orphaned children who survived a plane crash during the evacuation of Vietnam in 1975. The complaint alleged that because of decompression, as well as the impact of the crash, the children suffered from a neurological disorder genetically classified as minimal brain dysfunction. In that case, the Court of Appeals affirmed the imposition of liability on Lockheed for diagnostic examination expenses because the crash proximately caused the need for a comprehensive diagnostic examination. (746 F.2d at pp. 825-826.) In doing so, the court rejected the argument that the need for diagnostic examination was not a compensable injury, and, as did the court in Miranda, supra, 17 Cal.App.4th at page 1657, cited with approval the Restatement’s definition of injury as “ ‘the invasion of any legally protected interest of another.’ ” (746 F.2d at p. 826, citing Rest.2d Torts, § 7.) Consequently, the court in Friends For All Children, supra, 746 F.2d at page 826, held that a reasonable need for medical examinations was itself compensable, without proof of other injury; “It is difficult to dispute that an individual has an interest in avoiding expensive diagnostic examinations just as he or she has an interest in avoiding physical injury. When a defendant negligently invades this interest, the injury to which is neither speculative nor resistant to proof, it is elementary that the defendant should make the plaintiff whole by paying for the examinations.” (Fn. omitted.)26

It bears emphasizing that allowing compensation for medical monitoring costs “does not require courts to speculate about the probability of future *1008injury. It merely requires courts to ascertain the probability that the far less costly remedy of medical supervision is appropriate.” (In re Paoli, supra, 916 F.2d at p. 852.) Indeed, “[s]cience may well counsel medical intervention with respect to a known health risk long before it reaches the point where the law would regard its occurrence as ‘reasonably certain. ’ [Citation.]” (Miranda, supra, 17 Cal.App.4th at p. 1658.) We are therefore persuaded that recovery of medical monitoring damages should not be dependent upon a showing that a particular cancer or disease is reasonably certain to occur in the future.

Finally, as Miranda, supra, 17 Cal.App.4th 1651, and other cases have stressed, recovery of medical monitoring costs is supported by a number of sound public policy considerations. First, there is an important public health interest in fostering access to medical testing for individuals whose exposure to toxic chemicals creates an enhanced risk of disease, particularly in light of the value of early diagnosis and treatment for many cancer patients. (Ayers, supra, 525 A.2d at p. 311; Miranda, supra, 17 Cal.App.4th at p. 1660.) Second, there is a deterrence value in recognizing medical surveillance claims—“[allowing plaintiffs to recover the cost of this care deters irresponsible discharge of toxic chemicals by defendants . . . .” (In re Paoli, supra, 916 F.2d at p. 852; Miranda, supra, 17 Cal.App.4th at p. 1660; Ayers, supra, 525 A.2d at pp. 311-312; cf. Friends For All Children, supra, 746 F.2d at p. 825].) Third, “[t]he availability of a substantial remedy before the consequences of the plaintiffs’ exposure are manifest may also have the beneficial effect of preventing or mitigating serious future illnesses and thus reduce the overall costs to the responsible parties.” (Ayers, supra, 525 A.2d at p. 312; see Miranda, supra, 17 Cal.App.4th at p. 1660.) In this regard, the early detection of cancer may improve the prospects for cure, treatment, prolongation of life and minimization of pain and disability. Finally, societal notions of fairness and elemental justice are better served by allowing recovery of medical monitoring costs. That is, it would be inequitable for an individual wrongfully exposed to dangerous toxins, but unable to prove that cancer or disease is likely, to have to pay the expense of medical monitoring when such intervention is clearly reasonable and necessary. (Ayers, supra, 525 A.2d at p. 312; see Miranda, supra, 17 Cal.App.4th at p. 1660.)

In light of the foregoing, we believe the Miranda court’s analysis appropriately recognizes that medical science may necessarily and properly intervene in the absence of physical injury where there is a significant but not *1009necessarily likely risk of serious disease. Accordingly, consistent with Miranda, supra, 17 Cal.App.4th 1651, and the cases cited above, we hold that the cost of medical monitoring is a compensable item of damages where the proofs demonstrate, through reliable medical expert testimony, that the need for future monitoring is a reasonably certain consequence of a plaintiff’s toxic exposure and that the recommended monitoring is reasonable. In determining the reasonableness and necessity of monitoring, the following factors are relevant: (1) the significance and extent of the plaintiff’s exposure to chemicals; (2) the toxicity of the chemicals; (3) the relative increase in the chance of onset of disease in the exposed plaintiff as a result of the exposure, when compared to (a) the plaintiff’s chances of developing the disease had he or she not been exposed, and (b) the chances of the members of the public at large of developing the disease; (4) the seriousness of the disease for which the plaintiff is at risk; and (5) the clinical value of early detection and diagnosis. Under this holding, it is for the trier of fact to decide, on the basis of competent medical testimony, whether and to what extent the particular plaintiff’s exposure to toxic chemicals in a given situation justifies future periodic medical monitoring.

We are confident that our holding will not, as Firestone and amici curiae warn, open the floodgates of litigation. The five factors provide substantial evidentiary burdens for toxic exposure plaintiffs and do not, as Firestone insists, allow medical monitoring damages to be based “solely upon a showing of an increased but unquantified risk resulting from exposure to toxic chemicals.” Moreover, toxic exposure plaintiffs may recover “only if the evidence establishes the necessity, as a direct consequence of the exposure in issue, for specific monitoring beyond that which an individual should pursue as a matter of general good sense and foresight.” (Miranda, supra, 17 Cal.App.4th at p. 1660.)27 Thus there can be no recovery for preventative medical care and checkups to which members of the public at large should prudently submit. (17 Cal.App.4th at p. 1660.) Finally, contrary to the protestations of Firestone and amici curiae, medical monitoring costs are not speculative because they are based upon the specific dollar costs of *1010reasonable and necessary periodic examinations. (See Ayers, supra, 525 A.2d at p. 313.)28

D. Smoking and Comparative Fault

In this case, all four plaintiffs were long-time cigarette smokers. Cigarette smoke evidently contains 40,000 to 60,000 parts per billion (ppb) of benzene—more than 2,500 times the concentration detected in plaintiffs’ contaminated water.29 We now consider what effect, if any, should be given to the evidence that plaintiffs, on their own, voluntarily ingested this toxic substance.

In its statement of decision, the trial court commented: “Defendant points out that plaintiffs have made themselves more susceptible to illness from smoking cigarettes. Although this is no doubt true, it does not relieve defendant from accountability for burdening plaintiffs with a significantly greater vulnerability to serious disease through the ingestion of defendant’s toxins.”

On appeal, Firestone argued that under comparative fault principles, plaintiffs’ smoking should reduce or entirely preclude their recovery for fear of cancer. The Court of Appeal rejected this argument, reasoning: “Comparative fault is applicable only if the plaintiff’s negligence is a proximate cause of the injury. ‘Negligence unrelated to the cause or causes of the accident is not a bar.’ [Citations.] In this case, the fact that [plaintiffs] smoked cigarettes is wholly unrelated to the circumstances which caused [plaintiffs’] water supply to be contaminated with toxics. For comparative *1011fault principles to apply, [plaintiffs’] conduct would have had to contribute, in some manner, to this contamination.”

We agree with Firestone that the Court of Appeal erred in its reasoning. Under comparative fault principles, damages are apportioned based upon the various causes contributing to a plaintiff’s harm, as opposed to a particular defendant’s negligence. (Li v. Yellow Cab Co. (1975) 13 Cal.3d 804, 813 [119 Cal.Rptr. 858, 532 P.2d 1226, 78 A.L.R.3d 393] [hereafter Li] [“liability for damage will be borne by those whose negligence caused it in direct proportion to their respective fault”]; see Garcia v. Estate of Norton (1986) 183 Cal.App.3d 413, 421 [228 Cal.Rptr. 108] [recognizing that in actions founded on strict products liability, a plaintiff’s recovery must be reduced to the extent that his own lack of reasonable care contributed to his injury].) Therefore, the fact that plaintiffs’ smoking did not contribute to the contamination of their well water is not determinative.

Nonetheless, we agree with the Court of Appeal’s ultimate conclusion that comparative fault principles were not properly invoked in this case. Firestone failed to establish a causal link between plaintiffs’ smoking and the harm they suffered, i.e., their fear of a significantly increased risk of cancer. As plaintiffs point out, Firestone apparently introduced no evidence at trial suggesting that any portion of plaintiffs’ fear was attributable to their own smoking.30

In other cases, however, when a defendant demonstrates that a plaintiff’s smoking is negligent and that a portion of the plaintiff’s fear of developing cancer is attributable to the smoking, comparative fault principles may be applied in determining the extent to which the plaintiff’s emotional distress damages for such fear should be reduced to reflect the proportion of such damages for which the plaintiff should properly bear the responsibility. (See Li, supra, 13 Cal.3d at p. 813.)

Finally, we also observe that evidence of smoking by a plaintiff is relevant to whether the plaintiff’s fear is reasonable and genuine. Thus, if a plaintiff had smoked heavily for 20 years without fearing cancer, the trier of fact may *1012consider that evidence in assessing the legitimacy of the plaintiff’s fear of cancer claim.31

III.

Disposition

The judgment of the Court of Appeal is reversed insofar as it affirms the award of punitive damages and the award of damages for plaintiffs’ fear of cancer, and reverses the award for future medical monitoring. The cause is remanded to the Court of Appeal for further proceedings consistent with this opinion, that may include, if appropriate, a remand to the trial court for a retrial on the above damages, a remand for a retrial on the issue of Firestone’s liability for intentional infliction of emotional distress, and/or consideration of issues that were not heretofore reached by the Court of Appeal.

Lucas, C. J., Panelli, J., and Arabian, J., concurred.

MOSK, J., Concurring and Dissenting.

I concur in the majority opinion to the extent it recognizes a cause of action in negligence for causing fear of cancer in the absence of a claim of physical injury or disease. I also concur in the majority opinion’s treatment of Firestone’s comparative fault claim, and I concur in the opinion to the extent it reverses the judgment of the Court of Appeal on the cause of action for medical monitoring costs.

I disagree with the majority in two respects. First, I agree with Justice George’s contention that when a defendant negligently exposes a plaintiff to carcinogenic toxins, plaintiff’s recovery for resulting fear of cancer should not depend on proof that it is probable the cancer will actually occur. As Justice George demonstrates, under settled tort principles, proof of the emotional damage flowing from defendant’s negligent act should not depend on proof of the probable occurrence of the disease.

*1013I also agree with Justice Kennard that the majority err in creating an anomalous new cause of action in negligence requiring proof of malicious conduct. When it is shown that the defendant has acted with conscious disregard of the plaintiff’s health and safety in exposing the plaintiff to carcinogenic toxins, the plaintiff may state a claim for an intentional tort. I write separately, however, because I am convinced this case readily fits the rubric of intentional infliction of emotional distress. I would affirm the judgment of the Court of Appeal on this cause of action without remand for retrial.

We recently restated the elements of a cause of action for intentional infliction of emotional distress. They are: “(i) outrageous conduct by defendant, (ii) an intention by defendant to cause, or reckless disregard of the probability of causing, emotional distress, (iii) severe emotional distress, and (iv) an actual and proximate causal link between the tortious conduct and the emotional distress.” (Nally v. Grace Community Church (1988) 47 Cal.3d 278, 300 [253 Cal.Rptr. 97, 763 P.2d 948], italics added; see also Christensen v. Superior Court (1991) 54 Cal.3d 868, 903 [2 Cal.Rptr.2d 79, 820 P.2d 181] [Christensen].) Furthermore, the defendant “must have engaged in ‘conduct intended to inflict injury or engaged in with the realization that injury will result.’ ” (Christensen, supra, 54 Cal.3d at p. 903, quoting Davidson v. City of Westminster (1982) 32 Cal.3d 197, 210 [185 Cal.Rptr. 252, 649 P.2d 894].)

This case falls into the category of “reckless disregard of the probability of causing emotional distress.” As the Court of Appeal observed, the defendants knew that the wastes they deposited at the Crazy Horse dump would pose a health hazard to anyone near the dump. The defendants were aware that it was prohibited to dump toxic waste at the Crazy Horse dump because of the danger such waste would leach into and contaminate the groundwater. They agreed not to dump toxic wastes at the dump, but, knowing of the danger to users of the local water supply, they nevertheless intentionally dumped carcinogenic toxic waste there. Thus defendants created a probability that once their illegal and ultrahazardous conduct was discovered, it would cause emotional distress to those who used the local water supply. It seems clear that this conduct meets the definition of reckless conduct in the context of the tort of intentional infliction of emotional distress.

The majority, however, relying on this court’s misguided discussion in Christensen, supra, 54 Cal.3d 868, 903-904, would require plaintiffs in toxic exposure cases to show that the reckless defendant directed his or her conduct at the plaintiffs in particular, knowing of their individual presence in harm’s way. (Maj. opn., ante, at pp. 1001-1003.)

*1014It is inconsistent with the definition of recklessness to require that the defendant direct his or her conduct at, or be aware of, particular plaintiffs. By definition, a reckless person acts in culpable disregard of the results of his or her conduct. In this state, “[a] defendant’s conduct is in reckless disregard of the probability of causing emotional distress if [he] [she] has knowledge of a high degree of probability that emotional distress will result and acts with deliberate disregard of that probability or with a conscious disregard of the probable results.” (BAJI No. 12.77 (1992 re-rev.) (7th ed. pocket pt.) p. 27; see Spackman v. Good (1966) 245 Cal.App.2d 518, 530 [54 Cal.Rptr. 78]; see also Davidson v. City of Westminster, supra, 32 Cal.3d at p. 210; Ledger v. Tippitt (1985) 164 Cal.App.3d 625, 642 [210 Cal.Rptr. 814].)

The Restatement Second of Torts explains that intentional infliction of emotional distress may be actionable when defendant’s conduct is reckless: “One who by extreme and outrageous conduct intentionally or recklessly causes severe emotional distress to another is subject to liability for such emotional distress . . . .” (Rest.2d Torts, § 46.) A comment to this section explains: “The rule stated in this Section applies where the actor desires to inflict severe emotional distress, and also where he knows that such distress is certain, or substantially certain, to result from his conduct. It applies also where he acts recklessly, as that term is defined in § 500, in deliberate disregard of a high degree of probability that the emotional distress will follow.” (Rest.2d Torts, supra, § 46, com. i, p. 77, italics added.)

Section 500 defines reckless disregard of the safety of others as: “The actor’s conduct is in reckless disregard of the safety of another if he does an act or intentionally fails to do an act which it is his duty to the other to do, knowing or having reason to know of facts which would lead a reasonable man to realize, not only that his conduct creates an unreasonable risk of physical harm to another, but also that such risk is substantially greater than that which is necessary to make his conduct negligent.” (Rest.2d Torts, supra, § 500.) Although the culpable act must be intentional, “the actor does not intend to cause the harm which results from it. It is enough that he realizes or from facts which he knows, should realize that there is a strong probability that harm may result. . . .” (Rest.2d Torts, supra, § 500, com. f, p. 590, italics added.)

Most significantly, the Restatement would not require that the actor be aware that any particular person is in the zone of danger caused by the culpable act: “If the actor’s conduct is such as to involve a high degree of risk that serious harm will result from it to anyone who is within range of its effect, the fact that he knows or has reason to know that others are within such range is conclusive of the recklessness of his conduct toward them. It is *1015 not, however, necessary that the actor know that there is anyone within the area made dangerous by his conduct. It is enough that he knows that there is strong probability that others may rightfully come within such zone.” (Rest.2d Torts, supra, § 500, com. d, p. 589, italics added.)

Under these standards, there should be no requirement that plaintiffs show that defendants were aware of their individual existence or that defendants directed their hazardous conduct against identifiable persons in particular. Defendants should have realized the probability that their hazardous conduct would cause emotional distress, and they must be charged with knowledge that there was a strong probability that others would come within the zone of danger of their conduct. They knew the reason that their conduct was prohibited was to protect all persons who lived near the dump.

Accordingly, I would affirm the judgment of the Court of Appeal with respect to the cause of action for intentional infliction of emotional distress.

KENNARD, J., Concurring and Dissenting.

I concur in the judgment and in much of the reasoning of the majority opinion. In particular, I agree with the majority that recovery of fear-of-cancer damages in toxic exposure cases not involving immediate physical injury should be subject to the following conditions: When a defendant has caused the plaintiff to unknowingly ingest toxic chemicals by an act or omission that is merely negligent, the plaintiff may recover damages for emotional distress caused by fear of future cancer only upon proof of a more-than-even chance that cancer will actually develop. But when the defendant has acted with conscious disregard of the plaintiff’s health and safety—and thereby demonstrated a level of moral culpability significantly beyond mere negligence—then the plaintiff may recover fear-of-cancer damages whenever the plaintiff’s resulting emotional distress is genuine, serious, and reasonable.

My disagreement with the majority is only about the legal pigeonhole in which to situate the liability imposed in the latter situation. The majority places this liability within the tort of negligence, even though proof of malice will be indispensable to recovery for emotional distress, which may be the plaintiff’s only compensable injury. This seems to me a poor fit at best, and one that cannot long endure. Surely the law of negligence, and especially its rules for recovery of emotional distress damages, are complicated enough without establishing a subspecies of negligence liability requiring proof of malicious conduct. The goal of simplicity and clarity in the law would be better served, in my view, by placing the liability for maliciously caused fear of cancer somewhere within the family of intentional or quasi-intentional torts.

*1016Among the existing tort categories, liability for maliciously induced fear of cancer fits most comfortably within the tort of willful misconduct.1 This is “a tort separate and distinct from negligence and involves different principles of liability and different defenses.” (Palazzi v. Air Cargo Terminals, Inc. (1966) 244 Cal.App.2d 190, 195 [52 Cal.Rptr. 817]; see Shepardson v. McLellan (1963) 59 Cal.2d 83, 89 [27 Cal.Rptr. 884, 378 P.2d 108]; Savage v. Van Marie (1974) 39 Cal.App.3d 241, 245 [114 Cal.Rptr. 51].) “[W]illful misconduct implies the intentional doing of something either with knowledge, express or implied, that serious injury is a probable, as distinguished from a possible, result, or the intentional doing of an act with a wanton and reckless disregard of its consequences.” (Williams v. Carr (1968) 68 Cal.2d 579, 584 [68 Cal.Rptr. 305, 440 P.2d 505]; see also Goncalves v. Los Banos Mining Co. (1962) 58 Cal.2d 916, 918 [26 Cal.Rptr. 769, 376 P.2d 833]; Bastían v. County of San Luis Obispo (1988) 199 Cal.App.3d 520, 533 [245 Cal.Rptr. 78]; Prosser & Keeton on Torts (5th ed. 1984) § 34, pp. 212-214.) Willful misconduct, like negligence, is subject to the rule of comparative fault. (Southern Pac. Transportation Co. v. State of California (1981) 115 Cal.App.3d 116, 121 [171 Cal.Rptr. 187]; Sorensen v. Allred (1980) 112 Cal.App.3d 717, 725 [169 Cal.Rptr. 441, 10 A.L.RAth 937].)

Justice Traynor, writing for a majority of this court, has explained that “[n]egligence is an unintentional tort, a failure to exercise the degree of care in a given situation that a reasonable [person] under similar circumstances would exercise to protect others from harm.” (Donnelly v. Southern Pacific Co. (1941) 18 Cal.2d 863, 869 [118 P.2d 465].) “A negligent person,” in other words, “has no desire to cause the harm that results from his [or her] carelessness . . . .” (Ibid.) By contrast, an act performed with an intent to cause harm is termed “willful.” “Willfulness and negligence are contradictory terms. ... If conduct is negligent, it is not willful; if it is willful, it is not negligent.” (Ibid., citations omitted; accord, Lambreton v. Industrial Acc. Com. (1956) 46 Cal.2d 498, 503 [297 P.2d 9]; Tognazzini v. Freeman (1912) 18 Cal.App. 468, 473-474 [123 P. 540]; see also Arvin- Kern Co. v. B. J. Service, Inc. (1960) 178 Cal.App.2d 783, 792 [3 Cal.Rptr. 238].)

*1017Between these two clearly distinguishable forms of behavior—negligence and willfulness—we find what is now generally known as willful misconduct. Justice Traynor described the tort this way: “A tort having some of the characteristics of both negligence and willfulness occurs when a person with no intent to cause harm intentionally performs an act so unreasonable and dangerous that he [or she] knows, or should know, it is highly probable that-harm will result. . . . Such a tort has been labeled ‘willful negligence,’ ‘wanton and willful negligence,’ ‘wanton and willful misconduct,’ and even ‘gross negligence.’ It is most accurately designated as wanton and reckless misconduct. It involves no intention ... to do harm, and it differs from negligence in that it does involve an intention to perform an act that the actor knows, or should know, will very probably cause harm.” (Donnelly v. Southern Pacific Co., supra, 18 Cal.2d 863, 869, citations omitted.)2

This description of willful misconduct corresponds closely to the majority’s description of behavior for which fear-of-cancer damages are recoverable absent both physical injury and a probability that cancer will result. The majority explains that “fear of cancer damages may be recovered without demonstrating that cancer is probable where it is shown that the defendant is guilty of ‘despicable conduct which is carried on by the defendant with a willful and conscious disregard of the rights or safety of others.’ (Civ. Code, - § 3294, subd. (c)(1) [defining one type of ‘malice’].) ‘A person acts with conscious disregard of the rights or safety of others when [he] [she] is aware of the probable dangerous consequences of [his] [her] conduct and willfully and deliberately fails to avoid those consequences.’ (BAJI No. 14.71 (1992 rev.) (7th ed. pocket pt.) [defining ‘malice’].)” (Maj. opn., ante, p. 998; see also, Taylor v. Superior Court (1979) 24 Cal.3d 890, 895-896 [157 Cal.Rptr. 693, 598 P.2d 854].)3

Thus, the tort of willful misconduct seems to me an appropriate home for the liability that the court today recognizes for malicious contamination of a substance or substances likely to be consumed by others. Certainly, the tort *1018of willful misconduct would be a more appropriate home than the tort of negligence. But there is another possibility worthy of mention.

The existence of a substantial body of legislation designed to protect the public from exposure to toxic substances could provide a basis for liability. As section 874A of the Restatement Second of Torts explains: “When a legislative provision protects a class of persons by proscribing or requiring certain conduct but does not provide a civil remedy for the violation, the court may, if it determines that the remedy is appropriate in furtherance of the purpose of the legislation and needed to assure the effectiveness of the provision, accord to an injured member of the class a right of action, using a suitable existing tort action or a new cause of action analogous to an existing tort action.” Applying this principle, courts may use a legislative prohibition as the basis for recognizing a new intentional tort, or for expanding the scope of an existing intentional tort to cover the prohibited conduct. (See Smith v. Superior Court (1984) 151 Cal.App.3d 491, 497-500 [262 Cal.Rptr. 754] [intentional spoliation of evidence]; Middlesex Ins. Co. v. Mann (1981) 124 Cal.App.3d 558, 570 [177 Cal.Rptr. 495] [violation of fiduciary duty]; Czap v. Credit Bureau of Santa Clara Valley (1970) 7 Cal.App.3d 1, 6 [86 Cal.Rptr. 417] [unfair collection practice]; Laczko v. Jules Meyers, Inc. (1969) 276 Cal.App.2d 293, 295 [80 Cal.Rptr. 798] [tampering with vehicle odometer].) Here, defendant’s flagrant and willful violation of environmental laws and regulations designed to protect public health could provide the impetus for recognition of a new tort of malicious toxic contamination. The increasing incidence of such behavior, an unfortunate byproduct of our society’s dependence on toxic chemicals, warrants the specific public and legal attention that a new tort category would provide.

Recognition of a new tort would be consistent also with section 870 of the Restatement Second of Torts, which provides: “One who intentionally causes injury to another is subject to liability to the other for that injury, if his [or her] conduct is generally culpable and not justifiable under the circumstances. This liability may be imposed although the actor’s conduct does not come within a traditional category of tort liability.” The liability contemplated by this section is not confined to defendants who have acted for the very purpose of inflicting harm. Rather, a defendant is understood to “intend” a harm if the defendant knows or believes that the harm is certain, or substantially certain, to result from the defendant’s act. (Rest.2d Torts, § 870, com. b, p. 280.) Thus, it would be consistent with this section to recognize a new category of intentional tort liability for cases such as this one in which the defendant must have known that its improper and unlawful handling of toxic wastes would result in contamination of groundwater and eventually pose a significant threat to the health of those who, like plaintiffs, relied upon the groundwater for their domestic water needs.

*1019Either of these alternative approaches would be preferable to creating, as the majority has done, a new subcategory within the tort of negligence for malicious toxic contamination that results in genuine, serious, and reasonable fear of cancer. The majority properly recognizes and applies the principle that greater moral fault justifies increased liability for resulting harm (see generally, Bauer, The Degree of Moral Fault as Affecting Defendant’s Liability (1933) 81 U.Pa.L.Rev. 586), but it unaccountably fails to recognize that liability premised on proof of malice is not liability for negligence.

GEORGE, J., Concurring and Dissenting.

I concur in the majority’s conclusion that plaintiffs may recover from Firestone for the emotional distress they have suffered as a result of their fear of developing cancer because of Firestone’s egregious misconduct in the disposal of its toxic waste. I dissent, however, from the majority opinion insofar as it holds that plaintiffs would not be entitled to recover for their emotional distress had defendant simply been negligent in contaminating plaintiffs’ water supply.

As I shall explain, I believe the majority opinion has departed from well-established tort principles—long recognized in California—in holding that, when a defendant negligently contaminates another person’s water supply, subjecting that person to the risk of personal injury or illness, the victim of this contamination may recover for the emotional distress reasonably suffered by the fear of incurring such injury or illness only if the victim can establish that he or she is "more likely than not” to develop the injury or illness.

As the majority opinion recognizes, a reasonable person who has consumed, cooked with, and bathed in water that has been contaminated by toxic waste is likely to sustain serious emotional distress relating to the fear of developing a serious illness in the future, not only when the person’s chance of developing an illness is more than 50 percent, but also when his or her chance of developing the illness is considerably lower, for example, “only” 25 or 30 percent. In denying recovery to such a victim, despite the circumstance that—because of the risk of personal harm engendered by the defendant’s negligent conduct—a person of ordinary sensibilities in the victim’s position reasonably would suffer serious emotional distress, the majority opinion eliminates an important legal protection to which all persons, including victims of toxic waste exposure, long have been entitled.

In explaining its rationale for establishing a novel, high threshold—“more likely than not”—for recovery for emotional distress in this setting, the majority opinion suggests that, in the case of “toxic torts,” a variety of “public policy” reasons support its departure from generally governing legal *1020principles. Distilled to its essence, however, the majority’s position amounts to a determination that, when a defendant’s wrongful conduct has the potential to cause serious physical and emotional harm to a large number of persons, such conduct should be afforded a greater shield from liability than conduct possessing the potential to harm only a more limited number of persons. In my view, the controlling public policy formulated in this area— for example, the stringent legislative controls governing the discarding of toxic waste—does not support the majority’s approach. Indeed, it appears distressingly ironic and inconsistent with legislatively prescribed public policy to accord the individual victim of a so-called “toxic tort” less protection than would be accorded the victim of a more traditional course of negligent conduct.

In past decisions, this court has taken into account the danger that potentially disproportionate liability might be imposed when the issue presented was whether, and under what circumstances, a defendant who negligently injured one person should be held liable for the emotional distress suffered by other persons by reason of their concern over the condition of the injured person. The majority opinion in the present case, however, is the first to invoke such a rationale to limit recovery by persons who, as result of a defendant’s negligence, have been made to suffer the risk of personal physical injury or illness and who, as a consequence, reasonably have incurred emotional distress arising out of concern for their own health and safety. I believe there is no justification for limiting the recovery to which this class of persons is entitled, simply because the defendant’s wrongful conduct has endangered the personal safety of a large number of invididuals.

Finally, the majority’s determination to embrace this novel, restrictive approach is all the more difficult to understand in that the majority’s formulation is at odds with most of the decisions from other jurisdictions that have addressed this very issue in the arena of toxic torts and fear of cancer. As discussed below, numerous federal and sister-state decisions demonstrate that the policy reasons offered by the majority in support of its “more likely than not” threshold standard appropriately may be invoked when a plaintiff seeks compensation for what, in contrast, are essentially future damages (e.g., future medical expenses, loss of earnings, diminished life expectancy), for an illness or disease that may (or may not) develop in the future. As these out-of-state decisions explain, however, considerations such as those invoked by the majority do not justify the adoption of a stringent standard when a plaintiff simply seeks to recover present damages for the serious emotional distress that he or she already has suffered, reasonably and foreseeably, because of the substantial risk to the plaintiff’s health posed by the defendant’s negligence.

*1021In sum, in my view no sound basis exists for the majority’s adoption of a completely novel approach narrowly limiting the circumstances under which a person—whose water supply has been contaminated as a result of a defendant’s negligent disposal of toxic waste—may recover for the serious emotional distress that he or she reasonably has suffered.