Montgomery v. Lanarkshire Health Board (2015): Reshaping Informed Consent in Medical Law
In the realm of medical law, the landmark case of Montgomery v. Lanarkshire Health Board [2015] UKSC 11 has significantly reshaped the landscape of informed consent. This pivotal ruling, delivered by the UK Supreme Court, established a new patient-centered standard for the disclosure of risks associated with medical treatment, marking a departure from the previously prevailing doctor-centered approach. But what exactly did this case entail, and what are its implications for patients and medical practitioners alike?
The Backstory: Nadine Montgomery’s Experience
The case revolves around Nadine Montgomery, a woman of small stature and with diabetes, who was under the care of Lanarkshire Health Board during her pregnancy in 1999. Because of her diabetes, there was a higher chance of her baby being larger than average. During labour, her baby experienced shoulder dystocia (where the baby’s shoulder gets stuck during delivery), resulting in the baby being born with cerebral palsy. Ms. Montgomery argued she was not properly advised of the risks of vaginal delivery given her circumstances, nor was she offered a Cesarean section as an alternative.
Prior to Montgomery, the Bolam test was typically applied. This meant a doctor’s duty to warn patients of risks was based on whether they acted in line with a responsible body of medical opinion. The court accepted that if Mrs Montgomery had been told about the risk of dystocia, she would have chosen to have a caesarean. Her appeal was successful, and the judgment held that the assessment of whether consent was adequate in a clinical negligence claim would not be assessed by the Bolam test.
The Ruling: A Patient-Centred Approach to Informed Consent
The Supreme Court sided with Ms. Montgomery, asserting that healthcare professionals have a duty to ensure patients are aware of “material risks” involved in any recommended treatment, as well as any reasonable alternative treatments. This duty extends beyond simply providing information; it requires a dialogue between the doctor and patient to ensure the patient understands the risks and benefits, enabling them to make an informed decision.
The court defined a “material risk” as one to which a reasonable person in the patient’s position would attach significance, or one that the doctor knows or should reasonably know the particular patient would attach significance. This definition acknowledges that what constitutes a material risk can vary from patient to patient, depending on their individual circumstances, values, and concerns.
Key Implications of the Montgomery Ruling
The Montgomery ruling has had far-reaching implications for medical practice and patient rights:
- Shift in Focus: It shifted the focus from what a doctor believes a patient needs to know to what a patient wants to know to make an informed decision.
- Patient Autonomy: The ruling reinforces the principle of patient autonomy, recognizing the right of individuals to make their own decisions about their medical care.
- Informed Dialogue: It emphasizes the importance of a meaningful dialogue between doctors and patients, where information is shared, questions are answered, and concerns are addressed.
- Material Risk Disclosure: Doctors must now proactively disclose material risks, taking into account the individual patient’s circumstances and concerns.
- End of Medical Paternalism?: The verdict has been characterised as supporting patient autonomy over medical paternalism.
Exceptions to the Duty of Disclosure
While the Montgomery ruling establishes a clear duty to disclose material risks, there are limited exceptions:
- Patient’s Wish Not to Know: A doctor is not obliged to discuss risks with a patient who makes it clear they do not wish to discuss the matter.
- Therapeutic Exception: Information may be withheld if the doctor reasonably believes that its disclosure would be seriously detrimental to the patient’s health. However, this exception is narrowly defined and should only be invoked in rare circumstances.
- Necessity: If the patient requires treatment urgently but is unconscious or unable to make a decision.
The Montgomery Test
The Montgomery test places a legal obligation upon clinicians to provide information to patients about their treatment. The Montgomery test was defined in the case of Montgomery v Lanarkshire Health Board. Lanarkshire Health Board was found liable in negligence as Mrs. Montgomery was not adequately informed about the risks associated with a vaginal delivery and her baby suffered harm as a result of this undisclosed risk.
What is a Material Risk?
The test of materiality is whether, in the circumstances of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should be reasonably aware that the particular patient would be likely to attach significance to it.
Practical Considerations for Medical Professionals
In light of the Montgomery ruling, medical professionals should:
- Engage in Open Communication: Foster open and honest communication with patients, encouraging them to ask questions and express their concerns.
- Provide Clear and Understandable Information: Present information in a clear, concise, and understandable manner, avoiding technical jargon.
- Tailor Information to the Individual: Take into account the individual patient’s circumstances, values, and concerns when discussing risks and benefits.
- Document Discussions: Maintain accurate and detailed records of discussions with patients, including the information provided and the patient’s understanding.
The Ongoing Impact of Montgomery
The Montgomery case continues to shape medical law and ethics in the UK and beyond. While it has been praised for promoting patient autonomy and informed decision-making, it has also raised questions about the practical implications for medical practice and the potential for increased litigation. As the legal and medical communities continue to grapple with the nuances of the ruling, it is clear that Montgomery v. Lanarkshire Health Board has left an indelible mark on the doctor-patient relationship, emphasizing the importance of shared decision-making and respect for patient autonomy.
Do you feel you were not properly informed of the risks associated with a medical procedure? Contact us today for a consultation to discuss your legal options.