Montgomery and informed consent: where are we now?
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2224 (Published 12 May 2017) Cite this as: BMJ 2017;357:j2224
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Dear Editor
How very sad that on entering the sixth year since the Judgement in Montgomery vs Lanarkshire Health Board was published, reporting on a July 2020 Review chaired by Baroness Julia Cumberlege, “Analysing the Cumberlege Review: who should join the dots for patient safety?” evidences the fact that huge failings are still taking place with patient consent not being properly engaged for many medical interventions, patients not receiving the correct level of information and being excluded from the decision making.(1)
How can it be, after all this time, we as nation still have not effectively learnt from past failures re informed consent and imposed higher standards and tighter controls since Montgomery? The legal and ethical requirements re the correct standards of pre intervention care, dialogue and discussion to ensure informed consent, are clearly laid out in Montgomery.
Why are there still an inexcusable number of occasions where informed consent has not been properly obtained, often with disastrous consequences for the patient and huge fines for the health care professionals and their employers for failing to do so? Research undertaken at Queen Mary University of London found that while the rate of increase of other claims has remained steady, cases relating to consent have risen four-fold since March 2015. (2)
Is it not time for the many bodies who support, insure and regulate health care professionals to take determined action to not only identify the root cause of this persistent failing but to effectively deal with it once and for all so as to protect patients and their rights hereafter?
How many more years of reports, reviews, findings and recommendations identifying failures associated with informed consent and the remedies required to tackle the problem will it take to bring an effective change in procedures and a resultant downward trend in the statistics?.
The Cumberlege Review focussed specifically on three interventions all of which have been in the news; hormone pregnancy tests, Sodium Valproate and pelvic mesh implants.
With regard to pelvic mesh implants, the authors of the Review stated that that they were “appalled by the numbers of women who have come forward to say they never knew they had had mesh inserted, or where they gave consent for ‘tape’ insertion they did not know they were being implanted with polypropylene mesh”
Patients who took Sodium Valproate for their epilepsy during pregnancy did so without knowing that they could harm their unborn babies.
Hormone pregnancy tests, such as Primodos, which were withdrawn from the market in the late 1970s and which are thought to be associated with birth defects and miscarriages were the third intervention considered in the review.
Reporting on the Review included Baroness Cumberlege’s assessment of the impact on patients.
“Commenting on the report’s publication, its Chair Baroness Julia Cumberlege emphasised the impact on those involved, reflecting on harrowing stories of “relationships destroyed, careers broken, and as a result financial ruin, with no income, many lost their homes, and faced their children being taken into care” (3)
Perhaps one of the most shocking revelations lies in doctors still failing to respect patient autonomy in excluding them from decision making processes.
There was evidence of……
“Patients not being informed of risks involved, with doctors giving “advice based on their own assumptions, without involving patients in the decision-making process”(4)
Paragraph 87 of the Judgement from Montgomery determined the right of the patient to decide which treatment to undergo with the doctors role confined to ensuring that the patient was made aware of the scope of treatments available and the risks involved.
“An adult person of sound mind is entitled to decide which, if any, of the available forms of treatment to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken. The doctor is therefore under a duty 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.”
The MDDUS following Montgomery advised their membership that……..
"The judgment also states that it cannot be left to the doctor to determine what is reasonable to disclose; the move is to what a patient would attach importance to”(5)
The Review, raises further concerns in highlighting the fact that since Montgomery there had been “a significant increase in patient safety leaflets sharing information on risks of specific treatments but that the sheer variety of these and differing consent forms can be “bewildering and a major source of confusion”, a practice which was not supported by the findings in Montgomery in 2015 and definitely incapable of satisfying the legal requirements today.
Paragraph 90 of the Judgement states that “bombarding” patients with technical information with they cannot be reasonably expected to grasp does not absolve the practitioner of his role in providing patient specific information so tailored so as to be comprehensible to the individual patient.
“This role will only be performed effectively if the information provided is comprehensible. The doctor’s duty is not therefore fulfilled by bombarding the patient with technical information which she cannot reasonably be expected to grasp….”
It would be a matter of grave concern, particularly when considered in light of the findings from the Review, if the profession had sought to comply with Montgomery, not by improving personal doctor - patient access, and information sharing etc but by churning out an increased number of patient safety leaflets as a substitute.
As for the question “who should join the dots for patient safety?” The Cumberlege Review of 2020 clearly provides the answer just as Montgomery did back in 2015………….
“ patients or their families should not be left to “join up the dots of patient safety” for patient safety”
The importance is not in asking the question over and over with similar debate and outcome but in asking…………who will heed the answer?
(1) https://www.patientsafetylearning.org/blog/analysing-the-cumberlege-revi...
(2) https://www.expressandstar.com/news/uk-news/2020/03/19/increase-in-negli...
(3) https://www.pslhub.org/learn/patient-engagement/consent-and-privacy/cons...
(4) https://www.patientsafetylearning.org/blog/analysing-the-cumberlege-revi...
(5) https://www.mddus.com/resources/resource-library/risk-articles/2015/marc...
Competing interests: No competing interests
It might be time, four years on from Montgomery, to consider this question again. More importantly it might be prudent to question whether or not Montgomery has had a significant impact on patient autonomy and compliance with the legal requirements to secure informed consent. Have the findings contributed to an overall drop in the number of cases where there is a failure to obtain informed consent or merely provided an up to date legal basis to prosecute those who fail to do so?
A visit to the Scottish Public Services Ombudsman’s (SPSO) November news sheet suggests that failure to obtain informed consent is still very prevalent irrespective of how consent law has been clarified.
Recognising poor communication and a failure to discuss treatment options as a “recurrent theme” in submitted complaints, the SPSO noted the following ………..
“The recurring themes this month remained around the standard of communication, particularly a failure to discuss treatment options with patients, and record-keeping”
A sample case was provided where it was found that ……………..
“a dentist failed to communicate the treatment plan and options to a patient in a reasonable way. The patient was not in a position to give informed consent….” (1)
A quick search of the SPSO website uncovers numerous other complaints since Montgomery which have been determined re a failure to obtain informed consent.
From June 2019……………..
“Mr A suffered serious complications during the surgery, resulting in a long period of recuperation and life altering consequences. Mrs C said they accepted that what had happened was a recognised risk of the surgery, however, she complained that Mr A had not been provided with adequate information during the consent process”.
In September 2019 ………….
“a patient had not been told of the potential risks of major vascular injury in advance of gallbladder removal surgery, or what actions may be necessary in the event of a serious complication”
And August 2018………..
“The complication that Mr A experienced is a rare but recognised risk of the TACE procedure. We found that there was no documentary evidence that the risks of the chemotherapy drug affecting another area of the body or death were appropriately covered during the consent process.”
Earlier this month, a lady was awarded £90,000 in a “complex negligence case” against Rotherham NHS Trust who admitted that she had “not adequately consented for the surgery in March 2013 and that surgery should not have been carried out at this time”.(2)
In yet another case, the patients of a Dr Michael Watt were noted to have “underwent procedures such as lumbar punctures and epidural blood patches without proper and informed consent.”(3)
In February 2019 a newspaper reported on a “plethora” of errors by NHS Shetland resulting in £325,000 being paid in compensation for among other things, “failure to obtain informed consent” (4)
In the 2017 case Shaw vs Kovac, the judges determined that “it has long been the law that where a doctor has failed to provide proper information as to risk prior to a medical procedure and that failure leads to consent being given which otherwise would have been with held, and loss results, then that is actionable in negligence”(5)
The gravity of the situation in failing to obtain informed consent is perfectly clear for both patient and doctor so one has to wonder why it is still occurring with such apparent frequency.
More recently there has been much discussion re the practice of “nudging” and one has to wonder what impact it might be having on the number of cases where there has been a failure to obtain informed consent.
In an article “Informed Consent and Nudging” by William Simkulet, the practice of “nudging” was defined as “any influence designed to predictably alter a person's behavior without limiting their options or giving them reasons to act” with the author arguing that “nudging is incompatible with genuine informed consent, as it violates a physician's obligation to tell their patients the truth, the whole truth, and nothing but the truth during adequate disclosure”.(6)
Simkulet concludes that “for nudges to be consistent with obtaining genuine informed consent, by assumption they would have to be intended to both tell the truth about the patient's options and to persuade the target to choose the option she has the most reasons to do independently of those reasons.”
Giubilini et al defined a nudge as “a way of structuring the range of options that are available to a person, or the “choice architecture”, in such a way as to sway a person’s choices by utilizing certain biases and heuristics that characterize human decision making, without the need to provide people with reasons or to enforce coercive measures”.
They also conceded that “ nudges can to a certain extent diminish individuals’ autonomy”. (7)
Montgomery endorsed the fact that it is not for the doctor to determine which information should be disclosed to the patient (8) and the practice of nudging, although perhaps a preferred practice by some professionals, may not comply with what is required in law to secure informed consent in “swaying” a person’s choices and diminishing patient autonomy.
Given that there is no ambiguity left surrounding the law on informed consent (and hasn’t been since 2015), now might be a good time to investigate why, as the SPSO notes, failure to adequately inform and obtain informed consent is a “recurrent theme” in the complaints he receives.
(1) www.spso.org.uk › commentary › SPSOCommentaryNovember2019
(2) https://www.fletcherssolicitors.co.uk/news/lack-of-informed-consent-for-...
(3) https://www.hhdsolicitors.com/dr-watt-update-19-november-2019/
(4) https://www.pressandjournal.co.uk/fp/news/highlands/1660995/nhs-shetland...
(5) https://www.casemine.com/judgement/uk/5b2897a62c94e06b9e197ec5
(6) https://onlinelibrary.wiley.com/doi/full/10.1111/bioe.12449
(7) https://link.springer.com/article/10.1007/s10730-019-09383-7
(8) http://www.mddus.com/risk-management/risk-blogs/2015/march/landmark-case...
Competing interests: No competing interests
As Hugo Wellesley (response 26 May) has commented, Montgomery is in line with other recent court rulings, in placing the emphasis on the situation as viewed from the perspective of the specific patient:
'a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.;
As Wellesley points out, the 'the particular patient would be likely to attach significance to it' wording is interesting 'logically' - 'this can seem like an impossibly high bar for doctors who cannot know exactly which details the particular patient in front of them may or may not consider significant'.
This 'doctors cannot know' is even more relevant when instead of Informed Consent the MCA's best-interests process is thought about, because recent rulings are making it increasingly clear that this same 'patient individuality' principle should guide best-interests decisions-making: logically therefore the people 'close to the patient' [the patient's close family and close friends], who do understand the patient's individuality far better than the patient's clinicians understand that individuality, should in fact be able to make better-considered best-interests decisions than the clinicians who are involved.
Professionals are resistant to that implication, which is one of many 'inconvenient conclusions' which follow if one reads the Mental Capacity Act in the context of its ethos of patient autonomy and 'patient individuality'. As I have pointed out previously, this change from an emphasis on clinical situations, to 'the autonomous decision of a mentally-capable patient [and for best-interests we have a similar if more complex situation, but still requiring an understanding of 'patient individuality'] within a clinical and wider-life situation' is something very challenging for working clinicians. In particular, one 'inconvenient conclusion' is that the MCA is a very hard read, if you are trying to fit it into a context of 'safeguarding'.
There is one fundamental difference between the application of 'individuality' within Informed Consent, or within best-interests decision-making. If the consultation had no time restriction and the patient is capacitous, then in theory an unlimited number of 'if you decide that, then '...' will be the result - do you understand that?' explanations/questions from the doctor, satisfy informed consent by eventually 'covering everything the patient needs to be aware of, in order to make an informed decision'. But this is not true, during best-interests decision-making: because during informed consent the patient only needs to express yes/no answers (consent or not) and the patient does not need to explain 'why I'm deciding as I am'. Whereas best-interests does require 'an understanding of the patient's mind' (that phrase is inexact - I can think of no precise and short phrase!) because the decision-maker has to incorporate that understanding into his own decision-making: during best-interests you cannot simply 'keep throwing in more clinical information, and finding out if the new information alters the patient's decision by simply asking the patient and seeing if his/her decision changes'
Competing interests: No competing interests
The Montgomery v Lanarkshire case [1] discussed by Chan and colleagues [2] (one of whom was directly involved in the case) has focused the attention of the medical profession on consent, but it does not represent a seismic shift in the landscape. As Lords Kerr and Reed commented in Montgomery, English courts had already largely stopped using the Bolam test to decide on consent cases. Instead the standard for the duty to disclose was generally taken to be that “if there is a significant risk that would affect the judgment of a reasonable patient, then in the normal course it is the responsibility of a doctor to inform the patient of that significant risk”, as set out by Lord Woolf in the Court of Appeal in 1998 - almost twenty years ago, and before the events in Lanarkshire. [3]
This was reformulated by the Supreme Court in Montgomery to state that a doctor must make a patient aware of any material risks, and the test of materiality is whether “a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonably be aware that the particular patient would be likely to attach significance to it.” [1] The two main difficulties for doctors (and ultimately the courts) are knowing which risks “a reasonable person in the patient’s position” would consider significant, and when a doctor should “reasonably be aware” of their particular patient’s priorities. With regards the first of these, a reasonable approach would seem to be to discuss those risks that might affect the decision of a reasonable patient, as advocated by Lord Woolf. As for the second, this can seem like an impossibly high bar for doctors who cannot know exactly which details the particular patient in front of them may or may not consider significant. There is however, unlikely to be too much cause for alarm. When discussing this part of the test, Lords Kerr and Reed referred to and borrowed heavily from Rogers v Whitaker from the High Court in Australia [4] in which a patient, who was already blind in the eye scheduled for surgery, was not warned of the risk of sympathetic ophthalmia (thought to be the cause of Louis Braille’s blindness) [5] that could (and ultimately did) result in blindness in their good eye. It is very reasonable to presume that being blind in one eye would affect someone’s attitude to the risk of blindness in their other eye, and the surgeon clearly knew about it. What remains to be seen is how our courts interpret this and also how they decide when a doctor “should be reasonably aware” of a particular patient’s priorities, but judges are generally sensible and, if anything, could be accused of having been too lenient on doctors in the past.
Ultimately, if you follow GMC guidance and keep in mind that our role is to give patients the information they need to be able to decide what is right for them, then you should still be very unlikely to fall foul of the law.
1. Montgomery v Lanarkshire Health Board [2015] UKSC 11
2. Chan S, Tulloch E, Cooper ES et al. Montgomery and informed consent; where are we now? BMJ 2017:357:j2224
3. Tina Marie Pearce and Another v United Bristol Healthcare NHS Trust [1999] ECC 167
4. Rogers v Whitaker [1993] 4 Med LR 79; [1992] ALMD 6993
5. Bullock J, Galst J. The story of Louis Braille. JAMA Ophthalmology 2009;127:1532-3. Available at: http://jamanetwork.com/journals/jamaophthalmology/fullarticle/424447 (accessed 26.5.2017)
Competing interests: No competing interests
Interesting judgment and discussion about the ethics of not informing pregnant patients about facts that are relevant to them. Here in the Netherlands, I am hoping women (or their descendants) will start a few court cases about this, in particular because they were not informed antenatally about the option of a tubal ligation (TL) in case their deliveries became a caesarean section (CS), as FIGO advises to discuss long before term (1), and a study in the Netherlands shows most women with ≥1 children would desire (2). This can have serious consequences because without the TL there is of course much more risk of an unintended/ unwanted pregnancy (such women are regularly seen in abortion clinics, and are often particularly upset (2)). Risks related to pregnancy are larger for these if-given-the-option-would-have-chosen-a-TL-women compared to the risks in average pregnancies because of the uterine scar, because of possible recurrent complications related to the CS indication (e.g. diabetes, hypertension, >BMI) and because these women are on average older(3). On top of that, there are the costs and side effects (e.g. thrombosis on the pill especially in smokers when they get older) and anxieties related to contraception for the next 10-15 years. With leftover sutures from the uterine closure, the TL is gratis, unlike with clips or with hysteroscopic sterilisations later on: and at least as reliable (3). Moreover, a very likely benefit of TL, i.e. a significant reduction in subsequent ovarian carcinoma risk, is withheld ― bilateral total salpingectomy is probably most effective for this effect, and easily performed during a CS. These malignancies apparently often originate in the tubes and there is no good method (like with breast and cervix carcinoma) to detect with screening these neoplasms when still relatively harmless (3). Conversely, serious TL regret is of course a risk, but many gynaecologists, or their mentors, were trained at a time when regret was more likely: women were more easily coerced; under five mortality was higher; serious congenital abnormalities were easier missed antenatally; IVF was not so mainstream; and women were on average much younger when they delivered their ≥2 child. Indeed, regret is not so much related to parity but very significantly to age (3). One can’t help but wonder if one woman with regret who is offered free IVF is worse: ethically; from a medical-complications perspective; and in light of financial considerations, than say 10 unintended pregnancies.
In the Commonwealth countries, Brazil, Spain, Switzerland (reputed to have the lowest induced abortion rate in the world), and the USA, most women know very well that a TL during a CS for a soon-expected-to-be-complete family is a popular option. This TO option is more or less understood to be on the table antenatally. Many doctors in the Netherlands, France, Germany, Eastern Europe and Belgium think it is unwise, unethical or even financially disadvantageous for them to offer the TO option under the above circumstances and most women are not well-informed enough to demand it or to insist. There is also very subtle TO counter-propaganda by cat food producers, where it hurts most, see photo (3). Not giving the TO option also has serious consequences for, for example, Africa where the medical norms are often related to those in Europe, where there is often no guaranteed access to a repeat CSs let alone NIPT and where millions of women have an unmet need for contraception and save abortion. A few court cases in Europe might help. In sub-Saharan Africa uterine scars can carry a similar risk to landmines: they can “explode” even 10 years after the last CS (3). Who knows whether the medical services will be in that particular region adequate then?
(1) Dickens B. Female contraceptive sterilisation: International Federation of Gynecology and Obstetrics (FIGO) Committee for the Ethical Aspects of Human Reproduction and Women's Health. Int J Gynaecol Obstet 2011;115:88–9.
(2) Verkuyl DA, van Goor GM, Hanssen MJ, Miedema MT, Koppe M. The right to informed choice. A study and opinion poll of women who were or were not given the option of a sterilisation with their Caesarean Section. PLoS ONE 2011;6:e14776. doi:10.1371/journal.pone.0014776. PMID: 21445338 http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014776
(3) Verkuyl DA. Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it. Contraception and Reproductive Medicine (2016) 1:23 DOI 10.1186/s40834-016-0034-1 (open access)
Competing interests: No competing interests
Society has to compensate patients harmed by medical procedures without the added burden of proving negligence. Compensation should not be limited to the tenacious few who can navigate the legal maze and win the litigation lottery. Naturally, the legal profession has a conflict of interest in opposing such “no fault “schemes.[1].
But to frame the recent change of law on informed consent, following the Montgomery case, as a clash of patient autonomy versus medical paternalism is disingenuous.[2]. If anything, it is legal paternalism masquerading as patient autonomy. The judges, based on one single case, have decided what the new legal standard is for millions of other future patients without canvassing anyone else’s views. Furthermore, this new standard applies to everyone except the legal profession. The legal profession will not automatically and retrospectively apply this new standard to past cases where “ the bolam” standard has been applied.
Natural justice demands that a professional knows in advance what is legally compliant and an assurance that their actions are not judged retrospectively by a particular patient outcome and future “case law” standards.
To avoid NHS being overwhelmed, directly and indirectly, by “malpractice” claims, the society and parliament need act urgently and enact a statutory law on medical negligence. [3].
References
1 Capstick B. The future of clinical negligence litigation? BMJ 2004;328:457–9. doi:10.1136/bmj.328.7437.457
2 Chan SW, Tulloch E, Cooper ES, et al. Montgomery and informed consent: where are we now? BMJ 2017;357:j2224. doi:10.1136/bmj.j2224
3 Jena AB, Schoemaker L, Bhattacharya J, et al. Physician spending and subsequent risk of malpractice claims: observational study. BMJ 2015;351:h5516.
Competing interests: No competing interests
I find it strange that David A. Stephenson, Q.C., asks (12 May):
‘First, the decision in Montgomery purports to accord with the current (2008) GMC guidance on consent. If this is so, one might then wonder why change to the GMC’s guidance would be required in the light of Montgomery.’
Well, the Mental Capacity Act’s section 3 enshrined Informed Consent in English and Welsh law just before 2008: although the MCA does not use the term, it clearly did that [even if many people failed to notice].
Montgomery has more recently made it clear that Informed Consent is in fact the law for the whole of the UK (and has been since before the year 2000).
The GMC writes guidance which covers all of the UK.
Did I misunderstand why the question was posed [and I could not read the full article] ?
PS Although the above analysis is I think correct, I would point out that I consider the GMC's '2008 interpretation' of parts of the MCA - in particular how the Act applies to family carers - to be flawed, and therefore that it does need alteration.
Mike Stone mhsatstokelib@yahoo.co.uk @MikeStone_EoL
Competing interests: No competing interests
Lady Hale gives what appears to be ‘a short lecture’ at the end of the Montgomery ruling. Lady Hale concludes with:
117. These additional observations, dealing with the specific example of pregnancy and childbirth, are merely a footnote to the comprehensive judgment of Lord Kerr and Lord Reed, with which I entirely agree. Were anyone to be able to detect a difference between us, I would instantly defer to their way of putting it. I would allow this appeal.
It seems to me, that any interpretation other than ‘my fellow judges have perhaps used different words to express our ruling, but we are in fact all in agreement’ would be perverse: the importance resides in the reasons why rulings were arrived at, and although those reasons can only be expressed by words, the actual words used are merely the tool to try and get across the ‘thinking’.
Sometimes 'the thinking' is clear, and can be clearly expressed: Lady Hale's explanation that 'Bolam' does not apply to consent, is such a situation. She makes it very clear, that 'consensus medical opinion' (my phrase) is not the test of whether a patient was given sufficient clinical information before consenting: so there are few options left, logically, apart from a test which 'looks from the patient-side, as to whether sufficient information was supplied'.
Sometimes 'the thinking' either has not been fully-worked-through, or is inherently so complex as to defy clear expression: exactly how much 'clinical detail' must be divulged within a given consultation, in order that the patient has been sufficiently informed to 'give properly-informed consent' is not something you will be able to 'dig out' [for 'the general case'] from court rulings, because that falls into this category.
Competing interests: No competing interests
We can all 'nit pick the wording' of court rulings for ever.
But it seems very clear to me, that the 'ethos' of the Montgomery ruling [and also the ethos of sections 1-3 of the Mental Capacity Act] is clear:
Patients should normally be provided with all of the clinical information, which might affect the patient's decision to consent or decline an offered intervention: and this applies at the level of individual patients, not at the level of 'the average patient'.
Competing interests: No competing interests
Re: Montgomery and informed consent: where are we now?
Dear Editor
Finally, almost six years after the Judgement in Montgomery vs Lanarkshire Health Board, the GMC have published their updated Decision Making and Consent Guidance (coming into force November 9th 2020) (1)
It is to be hoped that this will have a positive impact on the horrendous rise in the number of claims brought against the NHS for instances where informed consent has not been correctly obtained from patients before receiving treatment and under going procedures. (2)
Hopefully the shocking catalogue of suffering uncovered in the course of the recent Cumberlege Report re patients who were not sufficiently informed by their doctors as to risks and potential adverse events etc with a resultant failure to secure informed consent, will now be a thing of the past.
The publication of the GMC guidance could not be more timely, both to address the current escalating failure to obtain informed consent and recognise patient autonomy but also in view of the fact that an unlicensed Covid-19 vaccine may be marketed in the UK sometime soon.
Principle four of the “seven principles of decision making and consent” in the new guidance states that…………..
“Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action”
Under GMC guidance for the prescribing of unlicensed medicines a doctor is required to advise patients of the fact that the recommended treatment involves an unlicensed product.
“If you intend to prescribe unlicensed medicines where that is not routine or if there are suitably licensed alternatives available, you should explain this to the patient, and your reasons for doing so.”(3)
Presumably that duty of care extends to administering seasonal recommended vaccines when they are unlicensed.
Under the new guidance the responsibility for ensuring that the correct procedures are followed remains with the doctor even in instances where the role is delegated to another.
“If part of the decision-making process has been delegated, you are still responsible for making sure that the patient has been given the information they need to make the decision”
It is to be hoped with the publication of the GMC guidance albeit almost six years after the law was clarified in Montgomery that all practitioners will finally recognise and respect the rights of the patient resulting in a downward trend in the shocking number of claims being brought in respect of a failure to obtain informed consent.
It is to be further hoped that the GMC in tandem with their new guidance, stringently monitor the problem of failure to obtain consent and all that entails for the patient and impose severe sanctions on those who fail to uphold their recommendations.
(1) https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/dec...
(2)https://www.litigationfutures.com/news/sharp-rise-in-nhs-claims-for-lack...
(3)https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/pre...
Competing interests: No competing interests