*292Justice WALLACE

delivered the opinion of the Court.

Plaintiffs,1 Mary Berberian, the head nurse in a long-term care facility, and her husband, Emmanuel Berberian, sued defendant Edmund Gernannt, an institutionalized patient with Alzheimer’s dementia, his estate (defendant)2, Diane Lynn, in her capacity as Gernannt’s guardian, and M.H. Rainey, M.D., to recover damages for personal injuries she sustained when Gernannt pushed her. After closing arguments, the trial court instructed the jury that the applicable standard of negligence was that of “a reasonably prudent person who has Alzheimer’s dementia.” The jury found in favor of defendant. On appeal, plaintiffs argued that the trial court should have applied an objective “reasonable person” standard without taking into account Gernannt’s mental disability. The Appellate Division disagreed with plaintiffs and affirmed the trial court. Berberian v. Lynn, 355 N.J.Super. 210, 809 A.2d 865 (2002) . We granted certification, 175 N.J. 549, 816 A.2d 1050 (2003) , and now affirm the judgment of the Appellate Division on different grounds. We hold that mentally incompetent patients owe no duty of care to protect paid caregivers from injuries suffered while caring for those patients.

I.

On October 3, 1997, Gernannt, now deceased, was involuntarily committed to Bergen Pines County Hospital (Bergen Pines) with a diagnosis of senile dementia, Alzheimer’s type. On October 13, 1997, he was transferred from the long-term care unit to the acute geriatric psychiatric unit because he became increasingly agitated and assaultive towards the staff. On November 5,1997, Gernannt was transferred to the eighth floor, where a number of other Alzheimer’s and dementia patients were housed.

*293Plaintiff first met Gernannt on November 8,1997. At that time, she was a nurse supervisor in the long-term care unit and had over twenty years of experience working with Alzheimer’s patients. She knew that Gernannt had dementia and a history of agitation, including prior acts of violence towards staff. With respect to that behavior, plaintiff reported in her notes that Gernannt “refused to go to bed[,] ... was combative, agitated,” and “[t]ried to hit staff.” Plaintiff was also aware of the Bergen Pines standard patient aggression policy. That policy stated that if a patient with dementia is violent, aggressive, resistant or unredireetable, the nurse should retreat from the patient and call security for assistance.

On November 11,1997, Gernannt attempted to leave the unit by way of the fire exit and set off the alarm. Nurse Christine Schell tried to redirect him, but he began hitting her. Schell backed away and walked down the hall to call security. Plaintiff then approached him and extended her hand to help him to his room. Gernannt grabbed plaintiffs hand, pulled her toward him and then pushed her back, causing her to fall and fracture her right leg.

On January 26, 1998, plaintiffs filed a complaint against Lynn, Gernannt, and a fictitious designee. The complaint was later amended to add Gemannt’s estate after he died, and to substitute Dr. Rainey as a defendant in place of the fictitious designee. While not disputing that Gernannt was an adjudicated incompetent, plaintiffs alleged that he, “without provocation negligently, recklessly and carelessly” struck plaintiff, causing her injuries. Further, the complaint alleged that Lynn was negligent for allowing Gemannt’s transfer from the psychiatric ward to the long-term care unit without restraints. The trial court granted the summary judgment motions of Lynn and Dr. Rainey, and plaintiffs do not appeal those judgments.

The balance of the case proceeded to trial. At the conclusion of plaintiffs’ presentation of evidence, defendant moved for an involuntary dismissal. Defendant stressed that there was no dispute as to Gernannt’s mental incompetence, but only as to whether, in *294this condition, he was capable of negligence. Plaintiffs’ counsel argued that mentally disabled adults, regardless of their capacity to comprehend their actions, should be held to an objective, reasonable person standard. The trial court denied the motion for involuntary dismissal.

After the close of the evidence portion of the trial, plaintiffs requested a “reasonable man” standard instruction. The trial court denied the request and charged as follows:

Now in determining the standard of care that defendant, Edmund Gernannt should have used on November 11th, 1997, you must measure his actions as you would a reasonably prudent person who has Mzheimer’s dementia.

You must take into consideration the defendant as an impaired person’s capacity to understand and avoid the danger to which he was exposing plaintiff Berberian in the actual circumstances of this case.

Defendant has the burden to prove by a preponderance of evidence that defendant, Edmund Gernannt had such deficient mental capacity at the time of the accident that he had no capacity to avoid the danger of pushing the Plaintiff, Mary Berberian.

[Emphasis added.]

During deliberations, the jury questioned whether plaintiffs needed to show that Gernannt was aware of the consequences of his actions in order for him to be found negligent. In response to the jury’s inquiry, the trial court replied:

[T]he defendant has to prove to you that he had either no capacity to appreciate that danger or he had such diminished capacity to appreciate it that he didn’t have any appreciation of the danger to which he placed Mrs. Berberian on November 11th of 1996. But it’s defendant’s burden to prove that to you.

The jury returned a verdict in favor of defendant.

Plaintiffs appealed. The Appellate Division affirmed, holding that “the appropriate capacity-based standard of care for mentally incompetent defendants, such as Gernannt, is that of a reasonable prudent person who has Alzheimer’s disease in light of the defendant’s capacity.” Berberian, supra, 355 N.J.Super. at 223, 809 A.2d at 873. In a concurring opinion, Judge Lintner concluded that Gernannt had no duty of care because his “dementia and corresponding inability to act reasonably ... is the very reason for his being institutionalized and under the care of plaintiff.” Id. *295at 225, 809 A.2d at 874 (citations omitted). Based on that reasoning, Judge Lintner concluded that the trial court should have granted defendant’s motion for involuntary dismissal. Ibid.

II.

Plaintiffs contend that it was error to use a capacity-based standard of care for the mentally incompetent Gernannt. Plaintiffs urge that this Court’s ruling in Cowan v. Doering, 111 N.J. 451, 545 A.2d 159 (1988), which held that capacity-based standards should be used in comparative negligence eases against mentally disturbed persons, does not apply here. They assert that the major concern underlying the capacity-based doctrine announced in Cowan was the general protection of plaintiffs, not defendants. Further, plaintiffs argue that the decision below will undermine the tort law system, and that the decision is unwarranted and unfair. Finally, plaintiffs contend that the “fireman’s rule” should not apply to healthcare workers because it may lead to less responsive health care in the future.

Defendant responds that the Appellate Division properly applied a capacity-based standard and that Cowan provides legal support for that standard. In addition, defendant agrees with Judge Lintner’s concurring opinion that the trial court should have granted an involuntary dismissal of the negligence claim based on the “fireman’s rule” rationale.

A.

Generally, the reasonable person standard applies to a mentally deficient person. Restatement (Second) of Torts § 283B (1965) provides that:

Unless the actor is a child, his insanity or other mental deficiency does not relieve the actor from liability for conduct which does not conform to the standard of a reasonable man under like circumstances.

“The rule that a mentally deficient adult is liable for his torts is an old one, dating back at least to 1616, at a time when the action for *296trespass rested upon the older basis of strict liability, without regard to any fault of the individual.” Id. at § 283B comment b.

The rule’s persistence in modern law has been justified on the following grounds:

1. The difficulty of drawing any satisfactory line between mental deficiency and those variations of temperament, intellect, and emotional balance which cannot, as a practical matter, be taken into account in imposing liability for damage done.

2. The unsatisfactory character of the evidence of mental deficiency in many cases, together with the ease with which it can be feigned, the difficulties which the triers of fact must encounter in determining its existence, nature, degree, and effect; and some fear of introducing into the law of torts the confusion which has surrounded such a defense in the criminal law. Although this factor may be of decreasing importance with the continued development of medical and psychiatric science, it remains at the present time a major obstacle to any allowance for mental deficiency.

3. The feeling that if mental defectives are to live in the world they should pay for the damage they do, and that it is better that their wealth, if any, should be used to compensate innocent victims than that it should remain in their hands.

4. The belief that their liability will mean that those who have charge of them or their estates will be stimulated to look after them, keep them in order, and see that they do not do harm.

[Ibid.]

The Restatement identifies a “reasonable person” as “a person exercising those qualities of attention, knowledge, intelligence, and judgment which society requires of its members for the protection of their own interests and the interests of others.” Id. at § 283 comment b. Further, it recognizes that “allowances must be made for some of the differences between individuals, the risk apparent to the actor, his capacity to meet it, and the circumstances under which he must act.” Id. at § 283 comment c. However, the Restatement limits the distinction with respect to the standards of care governing the tort liability of children and physically disabled persons, but not mentally disabled persons. See id. at § 283A (providing that a child must conform his or her conduct to that of “a reasonable person of like age, intelligence, and experience under like circumstances”); see also id. at § 283C (providing that a physically disabled individual must conform his or her conduct to “that of a reasonable man under like disability”).

*297B.

The issue on appeal is one of first impression in New Jersey. Both parties cite Cowan to support their respective positions. In Cowan, supra, the mentally disturbed plaintiff was treated in a hospital for an overdose of sleeping pills. 111 N.J. at 453, 545 A.2d at 160. During her stay, she jumped from her hospital room window and was seriously injured. Ibid. The plaintiff sued her treating physician and nurses for negligently failing to protect her from self-injury. Ibid. The trial court refused to instruct the jury on comparative negligence and the plaintiff recovered a judgment against the defendants. Ibid. On appeal, the Appellate Division affirmed, finding that the “plaintiff committed the very act that [the] defendants were under a duty to prevent.” Cowan v. Doering, 215 N.J.Super. 484, 495, 522 A.2d 444, 450 (1987).

This Court also affirmed, holding that a plaintiff is excused “from exercising reasonable self-care only when that duty is itself encompassed by the duty of care owed by the defendant to the plaintiff.” Cowan, supra, 111 N.J. at 460, 545 A.2d at 163. The Court noted that the “defendants were aware of the plaintiffs propensity for self-damaging acts,” her “history of such conduct,” her “attempted suicide that same morning,” and they “understood [her] personality disorder.” Id. at 464, 545 A.2d at 165. In light of the above facts, the Court found that the defendant professional health care workers breached their duty to “treat [the plaintiff] for this disorder and to treat her for the manifestations or symptoms of the disorder, namely, suicidal or other self-harmful acts.” Id. at 464, 545 A.2d at 166.

In addition, the Court explained that “[t]his standard recognizes that a mentally disturbed plaintiff is not capable of adhering to a reasonable person’s standard of self-care, but at the same time holds that plaintiff responsible for the consequences of conduct that is unreasonable in light of the plaintiff’s capacity.” Id. at 460, 545 A.2d at 163. The Court noted that a capacity-based standard was congruent with its previous holding that recognized a rebutta*298ble presumption of incapacity for children under seven years old, but also found that a child’s conduct should be measured in light of his or her capacity to exercise care under all attendant circumstances. Id. at 459, 545 A.2d at 163 (citing Bush v. New Jersey & New York Transit Co., 30 N.J. 345-55, 153 A.2d 28-34 (1959)).

A similar result was reached in Tobia v. Cooper Hosp. Univ. Med. Ctr., 136 N.J. 335, 643 A.2d 1 (1994). There, an elderly patient was injured when she fell from an emergency room stretcher. Id. at 339, 643 A.2d at 2-3. According to the plaintiff, the attendant had lowered the side rails, failed to lock the wheels, and left the area. Ibid. The plaintiff fell while attempting to get off of the unlocked stretcher. Ibid. The Court held that a health care professional may not assert comparative negligence as a defense when a professional’s duty includes the exercise of reasonable care to prevent the patient from engaging in self-damaging conduct. Id. at 338, 643 A.2d at 2.

C.

While Cowan and Tobia tangentially inform this case, decisions from other jurisdictions with fact patterns closer to the present case are also instructive.

An early case creating an exception to the Restatement’s rule governing tort liability for the mentally incompetent was Anicet v. Gant, 580 So.2d 273 (Fla.Dist.Ct.App.), review denied, 591 So.2d 181 (Fla.1991). In Anicet, the defendant, a violently insane patient, injured the plaintiff, a hospital attendant responsible for treating and restraining the defendant. Id. at 274. The plaintiff was aware of the defendant’s propensity for violence. Ibid. The court held that “no duty to refrain from violent conduct arises on the part of a person who has no capacity to control it to one who is specifically employed to do just that.” Id. at 277 (citations omitted).

The court’s decision was based largely on an analysis of the parties’ relationship. First, the court indicated that the plaintiff was not wholly innocent because “he was employed to encounter, *299and knowingly did encounter, just the dangers which injured him.” Id. at 276. The court found the “fireman’s rule” analogous, and quoted one of this Court’s rulings:

Stated affirmatively, what is meant is that it is the fireman’s business to deal with that very hazard and hence, ... he cannot complain of negligence in the creation of the very occasion for his engagement. In terms of duty, it may be said there is none owed the fireman to exercise care so as not to require the special services for which he is trained and paid.

[.Ibid. (quoting Kmuth v. Geller, 31 N.J. 270, 273-74, 157 A.2d 129, 131 (1960)).]

Second, the Florida court noted the existence of workers’ compensation for the injured plaintiff. Ibid. Third, while analyzing the defendant’s condition, the court opined that it would be unjust to impose liability on a defendant, “who has no control over his actions and is thus innocent in any wrongdoing in the most basic sense of the term.” Ibid. Finally, the court recognized that the defendant, his relatives, and society did as much as they could to protect others from the defendant’s violence by confining him in the most restricted area of a restricted institution. Ibid.; see also Mujica v. Turner, 582 So.2d 24, 25 (Fla.Dist.Ct.App.), review denied, 592 So.2d 681 (Fla.1991) (following Anicet to conclude that no liability attaches “when the incompetent has been institutionalized ... because of her mental ineompetency and injures one of her caretakers while in such institution.”)

In Gould v. American Family Mut. Ins. Co., 198 Wis.2d 450, 543 N.W.2d 282, 283 (1996), the Supreme Court of Wisconsin addressed whether an institutionalized individual who has a mental disability and who does not have the capacity to control or appreciate his or her conduct can be liable for injuries caused to his or her paid caretaker. There, the plaintiff was the head nurse at a health center’s dementia unit and took care of the defendant, an Alzheimer’s patient. Ibid. The center’s records indicated that the defendant was often disoriented, resistant to care, and occasionally combative. Ibid. On one occasion, the plaintiff attempted to redirect the defendant to his own room by touching him on the elbow. Ibid. In response, he knocked her to the floor, causing the plaintiff to suffer personal injuries. Ibid.

*300The plaintiff sued the defendant’s insurer. Id. at 284. At trial, the court instructed the jury to disregard any evidence related to the defendant’s mental condition and to determine his negligence under the objective, reasonable person standard. Ibid. On interlocutory appeal, the appellate court reversed the judgment, holding that “a person may not be held civilly liable where a mental condition deprives that person of the ability to control his or her conduct.” Gould v. American Family Mut. Ins. Co., 187 Wis. 2d 671, 528 N.W.2d 295, 296 (Ct.App.1994). The Supreme Court of Wisconsin affirmed and held that “an individual institutionalized ... with a mental disability, and who does not have the capacity to control or appreciate his or her conduct cannot be liable for injuries caused to caretakers who are employed for financial compensation.” Gould, supra, 543 N.W.2d at 283.

First, the court reasoned that “[the plaintiff], as head nurse of the secured dementia unit and [the defendant’s] caretaker, had express knowledge of the potential danger inherent in dealing with Alzheimer’s patients in general and [the defendant] in particular.” Id. at 287. Second, the court declared that it would be unfair to find the defendant negligent under those circumstances because his disorientation and potential for violence were the very reasons he was institutionalized. Ibid. Third, the court noted that the defendant’s relatives should not be held responsible because they did everything they could to restrain him when they placed him in a secured dementia unit of a restricted health care center. Ibid. Lastly, the court rejected the argument that the Restatement’s objective standard of care should be applied to prevent tortfeasors from “simulat[ing] or pretending] insanity to defend their wrongful acts.” Ibid, (quoting German Mut. Fire Ins. Soc’y v. Meyer, 218 Wis. 381, 261 N.W. 211, 215 (1935) (internal quotation marks omitted)). The court explained that the notion of a person simulating the symptoms of Alzheimer’s disease over a period of years in order to avoid future liability was simply not believable. Ibid.

*301Recently, the Supreme Court of Indiana held that no duty of care exists between a mentally disabled individual residing in a nursing home and a professional health care worker employed by the nursing home. Creasy v. Rusk, 730 N.E.2d 659 (Ind.2000). There, the plaintiff, a certified nursing assistant, sued the defendant, a patient with Alzheimer’s disease, for personal injuries that resulted when he kicked her while she was trying to put him to bed. Id. at 660-61. The plaintiff knew the defendant had Alzheimer’s disease and was aware of his combative and resistant behavior resulting from the disease. Id. at 661. The court held that, due to the relationship between the parties and public policy concerns, the defendant owed no duty of care to the plaintiff. Id. at 667. The court further found the fireman’s rule to be an analogous situation. Id. at 668; see also Herrle v. Estate of Marshall, 45 Cal.AppAth 1761, 53 Cal.Rptr.2d 713, 719 (1996) (holding “mentally incompetent patients should not owe a legal duty to protect caregivers from injuries suffered in attending to them”); Colman v. Notre Dame Convalescent Home, Inc., 968 F.Supp. 809, 814 (D.Conn.1997) (observing that “although a mentally disabled adult ordinarily is responsible for the injuries resulting from her negligence, no such duty of care arises between an institutionalized patient and her paid caregiver”).

D.

Several legal commentators favor the use of a no-duty rule in the relationship between the mentally disabled patient and his or her caregiver. See Edward P. Richards, Public Policy Implications of Liability Regimes for Injuries Caused by Persons with Alzheimer’s Disease, 35 Ga. L. Rev. 621, 639-47 (2001); Sarah Light, Rejecting the Logic of Confinement: Care Relationships and the Mentally Disabled Under Tort Law, 109 Yale L.J. 381, 400 (1999). Professor Richards argues in favor of the no-duty rule and, like the decisions analyzed above, recognizes some commonalities between the caregiver’s situation and that of a fireman, who is subject to the fireman’s rule. Richards, supra, 35 Ga. L. Rev. *302at 641-47. He notes that taxpayers who contract for fire services are similar to nursing home residents who contract for care with nursing homes. Id. at 646. However, he points out the nursing home then enters into a contract with the caregivers to perform the hands on care the residents need. See Ibid, (citations omitted). Noting there is no direct contract between the residents and the caregivers, he states that “caregivers accept that their compensation [for any injuries caused by a patients aggression] will be limited to that available through workers’ compensation.” Ibid. Thus, the burden of compensating health care workers injured by mentally disabled patients shifts to the employer through the patients’ contract for care. Ibid. Professor Richards favors that approach because it focuses on “the contractual reallocation of the method and form of compensation, ... obviates the need to assess the competence of the patient[,] and ... removes the patient as a party to the litigation.” Id. at 646-47.

III.

We are persuaded by the reasoning of Judge Lintner and the out-of-state authorities. We hold that a mentally disabled patient, who does not have the capacity to control his or her conduct, does not owe his or her caregiver a duty of care.

Here, Gernannt was declared mentally incompetent by a probate court and his daughter was appointed guardian prior to his institutionalization. Thus, there is no dispute that Gernannt did not have the mental capacity to appreciate the consequence of his conduct, and there is no concern that he was feigning his symptoms. Most important, Gernannt was involuntarily admitted to Bergen Pines to prevent the very type of injury that is at the center of this lawsuit.

Conversely, plaintiff had knowledge of Gernannt’s potential for violence and was trained to enlist the assistance of security when necessary. Plaintiff could readily control her behavior to deal with the foreseeable harm. In these circumstances, it would not be fair to impose a duty of care on Gernannt to his professional *303caregiver when the caregiver’s job duties included preventing Gernannt from injuring himself and others. Moreover, plaintiff has the benefit of worker’s compensation for her work-related injuries.

In sum, the professional caregiver’s situation poses concerns much like those underlying the fireman’s rule. Like a fireman who chooses his or her profession and accepts the risks engendered by another’s negligence in starting fires, see Krauth v. Getter, 31 N.J. 270, 273-74, 157 A.2d 129, 130-31 (1960) (holding a homeowner does not owe a firefighter a duty of care with respect to a negligently caused fire), the professional caregiver chooses his or her profession and willingly accepts the risk engendered by another’s poor mental health. Just as a fireman has an obligation to deal with the hazards of another’s burning building, see ibid., the professional caregiver has the obligation to deal with the hazards of a patient’s uncontrollable conduct. Thus, the professional caregiver may not recover for the conduct of a patient when this conduct is, in part, the reason for the caregiver’s role. Consequently, the trial court should have granted' defendant’s motion for an involuntary dismissal.

IY.

As modified, the judgment of the Appellate Division is affirmed.

For affirming — Chief Justice PORITZ and Justices LONG, VERNIERO, LaVECCHIA, ZAZZALI, WALLACE, and ALBIN — 7.

Opposed — None.

¶1

Cox, C.J.

— Insanity and other mental incapacities are not generally recognized as defenses to a claim of negligence.1 Some jurisdictions permit a limited exception to this rule by permitting sudden mental incapacity as a defense for a tortfeasor.2 This defense requires a defendant to establish “(1) [they had] no prior notice or forewarning of [their] potential for becoming disabled, and (2) the disability renders [them] incapable of conforming to the standards of ordinary care.”3 We hold that there is no legally sufficient evidentiary basis for a jury to find that Nancy Knorr (Knorr) was entitled to the defense of sudden mental incapacity. Thus, the trial court properly granted Lanette Ramey’s (Ramey) motion for judgment as a matter of law. Moreover, the court properly exercised its discretion in refusing the jury instructions Knorr offered and in giving the jury instructions that it gave. We also hold that the trial court correctly denied Knorr’s motion for summary judg*675ment as well as her alternative posttrial motions. We affirm.

¶2 This personal injury action arises from a head-on automobile collision on 1-405. While in a delusional state, Knorr turned her car around toward oncoming traffic, removed her seat belt, and drove head-on into Ramey’s car. At the time of the incident, Knorr believed she was the object of a conspiracy to attack her. She was trying to commit suicide.

¶3 Ramey suffered substantial injuries from the collision. She sued Knorr for negligence. Knorr raised the defense of sudden mental incapacity.

f4 Pretrial, the trial court denied Knorr’s motion for summary judgment. At the close of all the evidence at trial, both Knorr and Ramey moved for directed verdicts. The trial court granted a directed verdict for Ramey, ruling that as a matter of law, Knorr’s sudden mental incapacity defense could not be sustained on the basis of the evidence. The jury returned a verdict for Ramey in the amount of $497,578. The trial court denied Knorr’s posttrial motion for judgment as a matter of law or, alternatively, a new trial.

¶5 Following entry of judgment on the jury verdict, Knorr appealed.

CR 50 MOTIONS

¶6 Knorr argues that the trial court erred in denying her motions for a judgment as a matter of law and in granting Ramey’s motion for a directed verdict. We disagree.

¶7 A directed verdict may be granted only if “there is no legally sufficient evidentiary basis for a reasonable jury to find or have found for that party with respect to that issue.”4 A motion for a directed verdict admits the truth of the evidence of the nonmoving party and all inferences that *676reasonably can be drawn therefrom.5 The evidence must be considered in the light most favorable to the nonmoving party.6 The trial court may grant a directed verdict only when it can be held that as a matter of law there is no evidence, nor reasonable inferences from the evidence, to sustain the verdict.7 This court reviews a motion for a directed verdict de novo.8

Insanity and Other Mental Deficiencies as Defenses

¶8 Both for historical and other reasons, insanity or other mental deficiencies generally are not recognized as defenses to negligence.9 Washington, along with the majority of states, holds the mentally ill to the standard of a reasonable person under like circumstances.10

¶9 Traditionally, courts have relied on several rationales to hold the mentally ill to an objective standard of liability for negligence. The most common justification is that innocent victims should be compensated for their injuries.11 Another common reason is that the existence and degree of one’s mental illness can be difficult to measure and is a major obstacle for applying a mental deficiency defense.12 Other rationales include the belief that liability of the mentally ill will encourage caretakers to look after them and the difficulty of drawing a line between mental illness *677and variations of temperaments, intellect, and emotional balance.13

¶10 Knorr expressly disclaims an insanity defense or an argument that mental illness alone is a defense to negligence. Instead, she maintains that “a driver who suffers an acute psychotic episode, which incapacitates the driver, is not chargeable with negligence.” While noting that Washington has not addressed this issue, Knorr primarily relies on authority from the state of Wisconsin, Breunig v. American Family Insurance Co.14 Accordingly, we consider whether that case is applicable to the matter before us.

“Sudden Mental Incapacity” Defense

¶[11 In Breunig, the defendant, Erma Veith was driving her car when she believed that God was taking control of the steering wheel and directing her car.15 Believing she could fly because Batman can, Mrs. Veith stepped on the gas and collided with an oncoming truck.16 At trial, a psychiatrist testified that Mrs. Veith was unable to operate the vehicle with her conscious mind.17 A jury returned a verdict in the plaintiff’s favor.

¶12 The Wisconsin Supreme Court in Breunig recognized an exception for sudden mental incapacity and adopted a two part test stating,

[the] disorder must be such as to [1(a)] affect the person’s ability to understand and appreciate the duty which rests upon him to drive his car with ordinary care, or [1(b)] if the insanity does not affect such understanding and appreciation, it must affect his ability to control his car in an ordinarily prudent manner. And ... [2] there must be an absence of notice or forewarning *678to the person that he may be suddenly subject to such a type of insanity or mental illness.[18]

The Breunig test was further explained by the same court in Jankee v. Clark County.19 Sudden mental incapacity is a “rare exception [and] applies only when two conditions are met: (1) the person has no prior notice or forewarning of his or her potential for becoming disabled, and (2) the disability renders the person incapable of conforming to the standards of ordinary care.”20

¶13 The Breunig court upheld the jury’s verdict, finding Mrs. Veith did have knowledge or forewarning that her hallucinations could affect her driving.21 Mrs. Veith had previously experienced delusional visions and should have known she posed a risk to others if she drove.22 The Wisconsin Supreme Court later limited the Breunig rule stating, “ ‘[a] 11 we hold is that a sudden mental incapacity equivalent in its effect to such physical causes as a sudden heart attack, epileptic seizure, stroke, or fainting should be treated alike and not under the general rule of insanity.’ ”23

Absence of Notice or Forewarning

¶[14 Whether Knorr had notice or forewarning that her paranoia could affect her driving is the more difficult question presented. In order to meet the first prong of sudden mental incapacity, the defendant must have “no prior notice or forewarning of his or her potential for becoming disabled.”24

¶15 The standard of whether a defendant had notice or forewarning of the mental incapacity depends on whether *679the defendant had any forewarning or knowledge of a prior mental disability or disorder that incapacitates him from conforming his conduct to the standard of care.25 The driver must have been incapable of knowing that a mental incapacity could occur while driving, preventing the driver from avoiding a collision.26

¶16 Whether a person has knowledge or forewarning of their condition is based on an objective standard.27 When the occurrence of an illness or loss of consciousness should have been reasonably foreseen by a person of ordinary intelligence and prudence, the driver of a motor vehicle is negligent as a matter of law.28 “ ‘The negligence is not in the manner of driving, but rather in driving at all, if such person should reasonably have foreseen that such illness or lack of consciousness might occur and affect his manner of driving.’ ”29

f 17 The Wisconsin cases provide several examples defining notice and forewarning. In Jankee, the court declared that forewarning exists when a person is under the treatment of medication.30 The court discussed Stuyvesant Associates v. John Doe31 to illustrate when forewarning is satisfied with regard to taking medication. In Stuyvesant Associates, a schizophrenic man was receiving injections every other week for his illness and knew if he missed an injection, deterioration would result.32 The defendant also *680knew of the risks he posed if he fell into a psychotic state.33 The defendant missed an appointment for his medication and committed vandalism while in a psychotic state.34 “The court held the defendant to an objective standard of care and found him liable, reasoning that the patient was cognizant of his condition and the risks posed by refraining from the medication . . . .”35

¶18 In Johnson v. Lambotte, the defendant was being treated for “chronic schizophrenic state of paranoid type” when she left the hospital and, having little or no apparent control of her vehicle, collided with another car.36 In Breunig, the court stated that “Johnson is not a case of sudden mental seizure with no forewarning [because the] defendant knew she was being treated for a mental disorder and hence would not have come under the nonliability rule herein stated.”37

¶19 In addition, symptoms of a mental disability provide adequate notice and forewarning. In Breunig, Mrs. Veith was found to have had notice and forewarning of her mental condition because she had previously experienced delusional visions.38 The issue of forewarning went to the jury in Breunig because there was not substantial evidence whether Mrs. Veith had knowledge or forewarning.39 Mrs. Veith was not previously treated for a mental disorder and her friends testified that she was normal for some months prior to the accident.

¶20 In the case at hand, Knorr does not meet the test of sudden mental incapacity because the evidence clearly establishes she had notice and forewarning of her mental *681condition. The testimony at trial showed that in 1994, Knorr had a mental breakdown and was hospitalized for 10 days. During that period, Knorr believed the person she worked for was conspiring to steal her and her husband’s assets, was going to kill them, and was poisoning her. She also had concerns about her brother being a murderer. The delusions escalated to a point where she believed the neighbors were part of this scheme of “taking them out.” Knorr was diagnosed with possible delusional disorder, was put on medication, and was advised to see a psychiatrist.

¶21 When Knorr was released from the hospital she was given lithium along with other medication, which helped end her delusional thoughts. The hospital directed Knorr to see a psychiatrist, and she saw Dr. McConnaughy. After three months, Knorr quit seeing Dr. McConnaughy and quit taking her medication. Knorr testified at trial that in July of 1994, she “started to get real anxious again” and had to go back to the hospital. At the admittance office, Knorr “started snapping out of it” and decided to go back home and see how she felt. When Knorr returned home she felt fine and no longer had anxiety or other symptoms until 2001.

¶22 The testimony at trial further showed that beginning in March 2001, Knorr’s delusional thoughts about her brother being a murderer came back. Knorr and her family testified that by November 2001, her thoughts escalated and Mr. Knorr tried to get her to agree to go to the hospital. Knorr wanted to wait until after the holidays to go to the hospital and had an appointment scheduled for two days after the accident.

¶23 The day before the accident Knorr believed intruders were coming to her house and were going to kidnap her and her husband and rape them. The morning of the accident a friend offered to take Knorr to the hospital, but she refused to go. At trial, Dr. Young testified that people with delusional beliefs almost never believe something is wrong with them. He further testified that on the day of the accident, Knorr’s delusional beliefs caused her to panic, and *682“it’s at that point that erratic or dangerous behavior can occur.” Dr. Young testified that Knorr’s delusional beliefs that caused her to panic were “relatively sudden.”

f 24 The trial court concluded that under Breunig and Johnson, Knorr had forewarning because she knew she had been treated for a mental condition in 1994 and chose not to continue with the medication, and therefore did not fall within the sudden mental incapacity exception. We agree. We note further that the episodes continued and existed in this case as recently as the day preceding the auto collision. The record shows that Knorr was forewarned of the condition that again arose on the day of the accident.

¶25 Knorr heavily relies on the expert testimony of Dr. Young, which she describes as “unrebutted.” However, the question before the court at the time of the motions was whether there was a legally sufficient evidentiary basis to allow the defense. The court was neither required to only consider the evidence of the expert nor to believe that evidence.

¶26 More importantly, when one views the testimony by Dr. Young and the other witnesses in the light most favorable to Knorr, there is substantial evidence to conclude that Knorr had knowledge and forewarning of her mental disorder. Knorr was treated for delusional beliefs in 1994, decided to stop that treatment, including taking her medication, began experiencing delusions again almost a year prior to the accident, and had ample opportunity to go to the hospital and seek help. Knorr also agreed to go to the hospital, which further supports her knowledge of her mental disorder. Therefore, the trial court properly granted a directed verdict in favor of Ramey.

¶27 Although Knorr had no history of being dangerous or violent, or any problems with her driving, that is not required under Breunig. Knorr experienced delusional beliefs for several months prior to the accident and believed the night before the accident that intruders were going to come into her family’s home and rape and kill them. Under an objective standard, a reasonable person would have *683foreseen that Knorr’s mental condition could affect her driving. Therefore, Knorr’s mental incapacity while driving was foreseeable.

Incapable of Conforming to Standards of Ordinary Care

¶28 Addressing the other prong of sudden mental incapacity, the Breunig court stated:

[the] disorder must be such as to affect the person’s ability to understand and appreciate the duty which rests upon him to drive his car with ordinary care, or if the insanity does not affect such understanding and appreciation, it must affect his ability to control his car in an ordinarily prudent manner.[40]

The court in Jankee later clarified the rule from Breunig and stated “the disability [must] render[ ] the person incapable of conforming to the standards of ordinary care.”41

¶29 Ramey argues that because Knorr did not lose physical control of her vehicle, she does not meet the second prong of Breunig. However, lack of ordinary care does not only require loss of physical capacity. Lack of ordinary care occurs when there is either an inability to understand and appreciate the duty to drive with ordinary care, or an inability to control the vehicle with ordinary care.42 Although Knorr was in physical control of her vehicle, her delusional beliefs prevented her from understanding and appreciating her duty to drive with ordinary care. Because Knorr was mentally incapable of conforming to the standards of ordinary care while driving, she meets the second prong of Breunig.

¶30 Knorr relies, in part, on Washington authority that holds that, “[a] driver who becomes suddenly stricken by an unforeseen loss of consciousness, and is unable to *684control the vehicle, is not chargeable with negligence.”43 In Kaiser v. Suburban Transportation System, the doctor did not warn the driver of a bus of the side effects of drowsiness or lassitude, and the court held the driver could not be liable for negligence unless he had “knowledge of the pill’s harmful qualities.”44 The general rule from Kaiser applies only to a sudden physical incapacity or loss of consciousness that is unforeseeable and has never applied to a mental incapacity with no loss of consciousness.45 Kaiser is not applicable to the case before us because Knorr remained in physical control of her vehicle and never lost consciousness.

¶31 Furthermore, Knorr relies on Sofie v. Fibreboard Corp 46 to argue the trial court violated her constitutional right to a jury trial by deciding as a matter of law that her mental incapacity was not sudden. Knorr contends that under Sofie all disputed issues of fact must be decided by a jury.47 Knorr further argues that because pretrial the trial court ruled there was an issue of fact whether Knorr’s mental incapacity was sudden, the issue should have been sent to a jury.

¶32 Knorr’s argument is misplaced. First, Sofie held there was a constitutional right for the jury to determine the amount of noneconomic damages.48 Second, whether there is substantial evidence to create an issue of fact for the jury is a question of law.49 After hearing all of the evidence, the trial court properly ruled as a matter of law that there was not substantial evidence to present an issue of fact for the jury under the sudden mental incapacity defense.

*685SUMMARY JUDGMENT

¶33 Knorr next argues that the trial court erred in denying her motion for summary judgment. We disagree.

¶34 A motion for summary judgment may be granted when there is “no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law.”50 The standard of review for a summary judgment order is de novo, applying the same inquiry as the trial court, and viewing the facts and reasonable inferences in the light most favorable to the nonmoving party.51

¶35 Both Ramey and Knorr moved for summary judgment and the trial court denied both motions. The trial court ruled “there is a genuine issue of material fact that must be presented to the jury on the question of the extent to which a reasonable person would, given her prior mental health issues, and her conduct on the days immediately preceding her attempted suicide.”

¶36 Viewing the evidence in the light most favorable to Ramey before trial, the trial court correctly denied Knorr’s motion for summary judgment. Pretrial, there was a genuine issue of material fact whether Knorr’s mental state on the day of the accident would fall under the sudden mental incapacity exception, assuming Washington would adopt the minority rule. Knorr was previously hospitalized in 1994 for delusional behavior and she experienced many paranoid beliefs in the months preceding the accident. The fact that the trial court granted a CR 50 motion at the close of the evidence at trial does not make its prior denial of summary judgment erroneous in any way.

NEW TRIAL MOTION

¶37 Knorr further argues the trial court erred in denying her motion for a new trial under CR 59(a)(8), (1), and (9). We disagree.

*686¶38 A court may grant a motion for a new trial when important rights of the moving party are materially affected because substantial justice has not been done. When the trial court’s basis for denying or granting a motion for a new trial is based on questions of fact, the ruling will not be disturbed absent a manifest abuse of discretion.52 When an order is based on questions of law, the standard of review is de novo and not abuse of discretion.53

¶39 At trial, the court granted a directed verdict in favor of Ramey and ruled as a matter of law that Knorr did not meet the narrow exception of a sudden mental incapacity. Knorr moved for a new trial and the motion was denied. Because the motion for a new trial was based on a question of law, the standard of review is de novo.

CR 59(a)(8)

¶40 A motion for a new trial may be granted under CR 59(a)(8) if an error in law occurred at trial and was “objected to at the time by the party making the application.”54

f 41 Knorr argues it was error for the trial court to make a pretrial ruling that her sudden illness defense presented a question of fact and later at trial grant Ramey’s motion for a directed verdict, thus preventing Knorr from arguing her defense before the jury. Knorr timely objected to the ruling that her incapacity was not sudden as a matter of law.

¶42 The trial court denied the cross motions for summary judgment because pretrial the trial court believed there was a genuine issue of material fact whether Knorr’s mental illness affected her ability to conform to the standard of care. After hearing all of the evidence and further *687reviewing Breunig and Johnson, the trial court concluded there was substantial evidence that Knorr’s mental disorder did not meet the very narrow exception of sudden mental incapacity. The trial court further ruled as a matter of law that Washington does not recognize the sudden mental incapacity defense and this court does not recognize the defense. The trial court did not make an error of law in declining to adopt the sudden mental incapacity defense. The defense is not recognized in Washington and there was substantial evidence that Knorr had knowledge and forewarning of her mental disorder and would not fall under a sudden mental incapacity exception.

CR 59(a)(1)

¶43 Under CR 59(a)(1), a trial court may grant a verdict and grant a new trial if an irregularity in the proceedings of the court prevented the moving party from receiving a fair trial and materially affected the party’s substantial rights.55

¶44 As stated above, the trial court made no error of law in not adopting a minority rule that is not recognized in Washington and in granting a directed verdict for Ramey. The proceedings were not irregular and Knorr received her day in court and was not denied a fair trial.

CR 59(a)(9)

¶45 A motion for a new trial may be granted under CR 59(a)(9) if substantial justice has not been done.56 Knorr contends that “substantial justice was not done” because she was unable to argue her defense to the jury and was deprived of her day in court.

f46 Knorr’s argument is unconvincing. Knorr had her day in court and there was substantial evidence that she *688did not meet the requirements of the sudden mental incapacity defense.

JURY INSTRUCTIONS

f47 Lastly, Knorr argues the trial court committed reversible error in failing to instruct the jury on the sudden mental incapacity defense and in giving certain jury instructions. Knorr bases this argument on the trial court’s alleged error in granting a directed verdict for Ramey and preventing Knorr from arguing her theory of the case to the jury.

¶48 A party is entitled to have the jury instructed on his or her theory of the case as long as there is evidence to support the theory.57 The trial court has discretion whether to give a particular instruction to the jury and the “trial court’s refusal to give a requested instruction is reviewed only for abuse of discretion.”58 Where there is substantial evidence to support a theory, a trial court must instruct the jury on that theory.59

¶49 Relying on Hawkins v. Marshall,60 Knorr argues the trial court’s refusal to instruct the jury on the sudden mental incapacity defense was reversible error because she was prevented from arguing her theory of the case. In Hawkins, the trial court instructed the jury that if they found in plaintiff’s favor they must award the entire medical expenses claimed.61 The Court of Appeals reversed because the instruction was an “incorrect statement of law, misled the jury, removed the jury’s discretion to determine the proper amount of damages, and precluded [defendant] from arguing her theory of the case.”62

*689¶50 Unlike Hawkins, the trial court did not misstate the law in the instructions to the jury. Sudden mental incapacity generally is not accepted as a defense to negligence and there is substantial evidence that Knorr does not meet the sudden mental incapacity exception. Because it was not error for the trial court to grant a directed verdict for Ramey, the trial court did not abuse its discretion in failing to instruct the jury on the sudden mental incapacity defense. The proposed jury instructions on sudden mental incapacity were properly withheld and the instructions without the defense were properly given.

¶51 To summarize, the trial court properly denied Knorr’s summary judgment motion because there were then genuine issues of material fact. At the close of the evidence at trial, the court properly granted the CR 50 motion. There was no need to either adopt or reject the Breunig exception in ruling on that motion, and we decline to do either here. The trial court properly refused the instructions proposed by Knorr and the instructions the court gave were proper. The CR 59 motion was properly denied.

f52 We affirm the trial court rulings in all respects.

Coleman and Appelwick, JJ., concur.

Review denied at 157 Wn.2d 1024 (2006).