Observations Ethics Man

Update on the UK law on consent

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1481 (Published 16 March 2015) Cite this as: BMJ 2015;350:h1481
  1. Daniel K Sokol, practising barrister and medical ethicist, 12 King’s Bench Walk, London
  1. Sokol{at}12kbw.co.uk

Last week’s case of Montgomery v Lanarkshire Health Board has important implications for doctors

All doctors should be aware of the landmark decision in Montgomery v Lanarkshire Health Board, given by the UK Supreme Court on 11 March 2015.1 2

Nadine Montgomery was a woman with diabetes who gave birth by vaginal delivery. Her baby, Sam, was born with serious disabilities after shoulder dystocia during delivery. The doctor, Dina McLellan, did not tell Montgomery of the 9-10% risk of shoulder dystocia. McLellan said that she did not routinely discuss the risk of shoulder dystocia with women with diabetes for fear that, if told, such women would opt for a caesarean section. The court held that McLellan should have informed Montgomery of the risk and discussed with her the option of a caesarean section.

Bolam test is out

After the Montgomery case, the so called Bolam test, which asks whether a doctor’s conduct would be supported by a responsible body of medical opinion, no longer applies to the issue of consent. The law now requires a doctor to take “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments.”

So doctors must now ask themselves three questions:

  • Does the patient know about the material risks …

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