Montgomery v Lanarkshire Health Board [2015]
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Montgomery v Lanarkshire Health Board [2015] UKSC 11 holds significant implications for Scottish delict, medical negligence, and English tort law, particularly in the context of doctor-patient relationships. The case marked a departure from the previous legal standards established in the House of Lords case of Sidaway v Board of Governors of the Bethlem Royal Hospital and brought about a notable change in the Bolam test.
The case involves a woman, the claimant, who was diabetic and of small stature, receiving medical care during her pregnancy and labor. The doctor responsible did not disclose the 9-10% risk of shoulder dystocia among diabetic women. The doctor believed the risk was slight and that a caesarean section was not in the claimant's best interest. Subsequently, the baby suffered severe disabilities due to shoulder dystocia, leading the claimant to seek damages from the health board for negligence.
The Court of Session ruled in favour of the health board, stating no negligence based on the Hunter v Hanley test. It also claimed no causation, asserting that the claimant would not have opted for a caesarean birth even if informed of the pregnancy risk. The Supreme Court, however, departed from the House of Lords precedent in Sidaway v Board of Governors of the Bethlem Royal Hospital and altered the Bolam test in medical negligence.
The Supreme Court, in its judgment, affirmed the fundamental requirement of informed choice or informed consent by patients in medical treatment, emphasising the duty of disclosure by medical practitioners. Lords Kerr and Reed pointed out that the Bolam test's application to the disclosure of risks may lead to variations in practice based on doctors' attitudes rather than medical science. The analysis in Sidaway was deemed unsatisfactory, and the Bolam test was considered inappropriate for the doctor's duty to advise patients of treatment risks. Instead, the court adopted the approach from Sidaway by Lord Scarman and Lord Woolf MR in Pearce, refining it with the High Court of Australia's position in Rogers v Whitaker.
The judgment established that an adult person of sound mind is entitled to decide which treatment to undergo, and their consent must be obtained before any treatment affecting bodily integrity is carried out. The doctor is obligated to take reasonable care to ensure the patient is aware of material risks in recommended treatment, as well as any reasonable alternatives. The test of materiality is whether a reasonable person in the patient’s position would likely attach significance to the risk, or if the doctor is aware that the specific patient would likely find it significant.
Lady Hale gave a concurring opinion, supporting the departure from the Bolam test in this context and emphasising the importance of patient autonomy and informed consent in medical treatment. This landmark decision marked a shift towards a greater emphasis on patient involvement in decision-making and a more stringent standard for the disclosure of risks in medical negligence cases.
The case involves a woman, the claimant, who was diabetic and of small stature, receiving medical care during her pregnancy and labor. The doctor responsible did not disclose the 9-10% risk of shoulder dystocia among diabetic women. The doctor believed the risk was slight and that a caesarean section was not in the claimant's best interest. Subsequently, the baby suffered severe disabilities due to shoulder dystocia, leading the claimant to seek damages from the health board for negligence.
The Court of Session ruled in favour of the health board, stating no negligence based on the Hunter v Hanley test. It also claimed no causation, asserting that the claimant would not have opted for a caesarean birth even if informed of the pregnancy risk. The Supreme Court, however, departed from the House of Lords precedent in Sidaway v Board of Governors of the Bethlem Royal Hospital and altered the Bolam test in medical negligence.
The Supreme Court, in its judgment, affirmed the fundamental requirement of informed choice or informed consent by patients in medical treatment, emphasising the duty of disclosure by medical practitioners. Lords Kerr and Reed pointed out that the Bolam test's application to the disclosure of risks may lead to variations in practice based on doctors' attitudes rather than medical science. The analysis in Sidaway was deemed unsatisfactory, and the Bolam test was considered inappropriate for the doctor's duty to advise patients of treatment risks. Instead, the court adopted the approach from Sidaway by Lord Scarman and Lord Woolf MR in Pearce, refining it with the High Court of Australia's position in Rogers v Whitaker.
The judgment established that an adult person of sound mind is entitled to decide which treatment to undergo, and their consent must be obtained before any treatment affecting bodily integrity is carried out. The doctor is obligated to take reasonable care to ensure the patient is aware of material risks in recommended treatment, as well as any reasonable alternatives. The test of materiality is whether a reasonable person in the patient’s position would likely attach significance to the risk, or if the doctor is aware that the specific patient would likely find it significant.
Lady Hale gave a concurring opinion, supporting the departure from the Bolam test in this context and emphasising the importance of patient autonomy and informed consent in medical treatment. This landmark decision marked a shift towards a greater emphasis on patient involvement in decision-making and a more stringent standard for the disclosure of risks in medical negligence cases.
