The case of Montgomery v Lanarkshire Health Board (2015) was a landmark ruling in the UK regarding informed consent in healthcare.
Nadine Montgomery, a diabetic woman of short stature, gave birth vaginally. Her son suffered complications due to shoulder dystocia, leading to cerebral palsy.
Mrs. Montgomery argued her doctor hadn't properly explained the risks of vaginal delivery for a diabetic mother, including shoulder dystocia and the option of a cesarean section.
Previously, the "Bolam Test" determined negligence based on whether a doctor followed practices accepted by other professionals.
The court ruled in favor of Montgomery, establishing a new standard for informed consent:
Doctors must disclose "material risks" to patients in a way they can understand.
Patients, not doctors, decide what information is material to their decision.
Simply providing information or having a signed consent form isn't enough.
This case changed the doctor-patient dynamic in the UK, requiring doctors to have a more open dialogue with patients about treatment options and risks.
The Bolam case, legally known as Bolam v Friern Hospital Management Committee (1957), established a key principle in UK medical negligence law. Here's what happened:
Mr. Bolam, a patient, underwent electroconvulsive therapy (ECT) for a mental illness.
He suffered fractures after the treatment due to the way it was administered.
Mr. Bolam sued the hospital, claiming the doctor who performed the ECT was negligent.
The legal question centered on the standard of care:
The court introduced the Bolam Test.
To win the case, Mr. Bolam's lawyers had to prove the doctor fell below the standard of care accepted by a responsible body of medical practitioners in the same field.
The outcome:
The court found in favor of the hospital.
Even though Mr. Bolam suffered fractures, evidence showed some doctors used the same method for ECT, so the doctor wasn't considered negligent under the Bolam Test.
Significance of the Bolam Test:
It established a doctor's duty of care is based on what other doctors would typically do in a similar situation.
This offered a clear benchmark for medical negligence cases.
The Bolam Test is a legal test used in medical negligence cases in the UK to assess whether a medical professional breached their duty of care to a patient. Here's a breakdown:
Established in: Bolam v Friern Hospital Management Committee (1957) case
Purpose: Determine if a doctor acted with reasonable skill and care.
Focuses on: The actions of a responsible body of other medical professionals in the same field.
Essentially, a doctor isn't negligent if they can show a respected group of their peers would have acted the same way in the same situation.
Imagine a group of qualified doctors specializing in the relevant area.
If the doctor's actions would be considered acceptable by a significant number of these peers, they likely pass the Bolam Test.
However, the Bolam Test has limitations:
Doesn't consider the patient's perspective: The focus is on what other doctors would do, not what the patient might have wanted if they were fully informed.
Doesn't account for evolving practices: Medicine is constantly progressing, so what was once considered acceptable practice might become negligent over time.
Due to these limitations, the Montgomery v Lanarkshire Health Board case (2015) established a new standard for informed consent, placing more emphasis on the patient's right to understand the risks and benefits of treatment options.
Themdu.com. (2024). Montgomery and informed consent - The MDU. [online] Available at: https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent [Accessed 23 Jun. 2024].
Chan, S.W., Tulloch, E., E Sarah Cooper, Smith, A., Wojcik, W. and Norman, J.E. (2017). Montgomery and informed consent: where are we now? BMJ. British medical journal, [online] pp.j2224–j2224. https://doi.org/10.1136/bmj.j2224