Informed consent & Montgomery v Lanarkshire [2015] UKSC 11

What is informed consent?

Informed consent must be given when consenting to a medical procedure or treatment. Guidance by the Royal College of Nursing and NHS provides requirements in relation to the information patients must receive when providing informed consent for treatment. Chan et al., argue that the ruling in Montgomery v Lanarkshire ‘has simply enabled UK law to catch up with current GMC guidance.’ Departing from the previous law in Bolam and Sidaway,  the landmark decision in Montgomery has drawn ‘fresh attention to informed consent.’  The Supreme Court ruling overturned the previous ruling and essentially reconceptualised the doctor-patient relationship overturning and can be viewed as a ‘triumph for patient autonomy over medical paternalism.’

Background: departure from the previous law

The landmark decision of the Supreme Court in Montgomery had redefined the standard of care for informed consent and disclosure. Montgomery concerned a woman, Nadine Montgomery, her small stature and diabetes in conjunction increased her chance of complications arising from giving birth to a larger than average baby. Consequently, there was a 9-10% risk a natural birth would bring about shoulder dystocia. Unfortunately, this risk arose and her baby was born with complex disabilities. Montgomery’s case ‘hinged on the question of the nature of the obstetrician’s duty to the patient.’

What does the decision mean?

The Montgomery verdict meant that doctors were under a duty to disclose “material” risks and the ‘the materiality of a risk is to be decided by reference to a reasonable person in the patient’s position, or where the medical professional should be reasonably aware that a particular patient is likely to attach significance to that risk.’ The Supreme Court explained that placing a percentage on a risk was not appropriate, because deciding whether a risk was material was contingent on:

the nature of the risk, the effect which its occurrence would have upon the life of the patient, the importance to the patient of the benefits sought to be achieved by the treatment, the alternatives available, and the risks involved in those alternatives.

Conclusion

The ruling has reformed what information a doctor must provide for their patient. The ruling has essentially restructured the doctor-patient relationship, reconceptualising the decision-making and enabling a patients’ autonomous choice in regards to the disclosure of risks and information of what a patient would want to know relating to their treatment.

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