RCOG’s difficulty in providing guidance perhaps reflects the unique nature of obstetrics—essentially helping two patients through a normal and inevitable physiological process. What was worse was the treatment by the hospital staff, police and the court system when she reported it, and the afttermath of the culprit's apprehension. Update on the UK law on consent]. They held that a patient cannot make a fully informed and proper decision if they have not been presented with all the facts that could influence that process. Concerns for his condition were high and he was placed under specialist nursing care. We have heard anecdotally that some hospitals are in the process of updating their procedures on informed consent, but few have completed this. 2 Doctors are now obliged to take ‘reasonable care to ensure that the patient is aware of any material … Guidance in effect at that time from the GMC,17 BMA,18 NHS, and the Scottish Office19 supported a doctor’s duty to disclose relevant information and risks. When she was raped, Ellen thought it was the worst thing to ever happen to her. It was the product of the very risk that she should have been warned about when she gave her consent. It was argued by his mother that there had been negligence in his care as, had Dr Horn come to review her son and had he been intubated, then his brain damage and death could have been prevented. Neutral citation number [2015] UKSC 11. In Mrs A v East Kent Hospitals University NHS Foundation Trust (April 2015),25 the claimant’s baby, who was conceived using intracytoplasmic sperm injection, had a chromosomal abnormality. In this case, Bolam lost the case as the treatment he received was found to be in keeping with the practice of other doctors. In making this ruling, the Bolam test was applied which meant that as the usual practice of a body of reasonable doctors in the field of neurosurgery was to not have mentioned this less than one per cent risk. This case involves a patient, Bolam, who sustained injuries during a course of electro-convulsive therapy being used as a treatment for depression. Mrs Sidaway was suffering from pain in her neck, right shoulder and arms and sought a treatment that might relieve this. It was felt that if she had proceeded with the surgery at a different time then it may have been successful. 2783, 171 L.Ed.2d 637 (2008). Lord Scarman, however, expressed a different and more patient-centred opinion but, as his was a minority view, it did not affect the overall rejection of the case. She has type 1 diabetes and was concerned during her pregnancy that the size of her baby might lead to difficulties with a vaginal delivery. Many doctors have questioned the implications that the recent Supreme Court judgement of Montgomery – v Lanarkshire Health Board1 will have for the way they obtain consent from patients. This case was brought by Mr and Mrs Pearce with regards to the obstetric advice she was given during her fifth pregnancy which ended with the stillbirth of her daughter, Jacqueline, in December 1991. The claimant alleged that the trust was negligent in failing to advise of this possibility. The doctor’s normal practice was to give ECT without a relaxant and without any physical restraints; the doctor would support the patient’s chin and shoulders while nurses stood at either side of the treatment couch to prevent the patient falling. Login For some, Montgomery represents a defining moment in medical law … The full implications of the case are undoubtedly still unknown, but Montgomery has clear relevance for medical law and ethics. This would mean that a patient who asked specific questions would potentially be given more information than a patient that did not ask questions. Faculty of Dental Surgery Executive Board, Eligibility Criteria to join the Faculty of Dental Surgery, Diploma in Expedition and Wilderness Medicine, Faculty of Travel Medicine Executive Board, Eligibility Criteria to join the Faculty of Travel Medicine, Good Practice Guidance for Providing a Travel Health Service, Eligibility Criteria to join the Faculty of Podiatric Medicine. 1992. professor of maternal and fetal health and director of Tommy’s Centre for Maternal and Fetal Health. A man who was punched in the face and then kicked by a Montgomery County sheriff’s deputy following a police chase has sued two deputies, the sheriff and the county in federal court. This ruling took the view that practice in consent was to be regarded in the same was as diagnosis or treatment when considering if negligence had occurred and the test that was created was doctor, rather than patient, focussed. The discussion and involvement of the patient in the planning of their care mirrors the approach of shared decision making. In Spencer v Hillingdon NHS Trust (April 2015)23 the patient had bilateral pulmonary emboli after a hernia operation. The judge in the first case found on behalf of Miss Chester. It was felt that, despite not being told of the risk of paraplegia, Mrs Sidaway had been given sufficient information to enable her to make a decision about proceeding with the treatment. ... We encourage you to double check our case summaries by reading the entire case. Bailii, Bailii Summary, SC Summary, SC, WLRD Scotland Citing: At Outer House – Montgomery v Lanarkshire Health Board SCS 30-Jul-2010 Outer House – The pursuer sought damages for personal injuries to her son at his birth, alleging negligence by the … http://creativecommons.org/licenses/by-nc/4.0/ The case of Crossman v St George’s Healthcare NHS Trust [2016] EWHC 2878 (QB) (25 November 2016), whilst not wholly on point, demonstrates how post-Montgomery the court may apply the “subjective” element of Montgomery to determine a case, in this instance concluding that the claimant did not find it easy to express himself and was intimidated such that it was the hospital’s responsibility to … In 2012, the Supreme Court decided Miller v. Alabama, which held that a mandatory life-without-parole sentence for a juvenile violates the Eighth Amendment. The ruling overturned a previous decision by the House of Lords,2 which had been law since at least the mid 1980s.3 It established that, rather than being a matter for clinical judgment to be assessed by professional medical opinion, a patient should be told whatever they want to know, not what the doctor thinks they should be told. 16. As a result of an occlusion of the umbilical cord caused by shoulder dystocia, Sam's brain was starved of oxygen for some 12 minutes. Facts of the case In 1963, Henry Montgomery was found guilty and received the death penalty for the murder of Charles Hunt, which Montgomery committed less than two weeks after he turned 17. . By referring to the importance of the accepted practice of other doctors, the Trust used the Bolam test. As stated by Lady Hale in the ruling: ...it is not possible to consider a particular medical procedure in isolation from its alternatives. 1966). Mrs Montgomery was around five feet tall, and was also diabetic, which often results in a larger foetus. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Montgomery then claims that Bram was revived by the Supreme Court's recent decision in District of Columbia v. Heller, --- U.S. ----, 128 S.Ct. A patient is autonomous and should be supported to make decisions about their own health and to take ownership of the fact that sometimes success is uncertain and complications can occur despite the best treatment. A patient was to be informed of any common or serious potential consequences or complications and the determination of what was deemed common or serious was for the doctor to decide, not the patient. Looking at some of the cases in which the Montgomery ruling has been considered tells us about its interpretation to date. Although the Medical Defence Union and the Medical Protection Society have each issued statements and updated their guidance, as have some royal colleges (such as the Royal College of Surgeons), other bodies such as the GMC and the Royal College of Obstetricians and Gynaecologists (RCOG) have yet to do so. Making sure that patients understand all the information they need to make a decision will inevitably take longer. It is in fact Lord Scarman that introduced the concept of ‘material risk’, 30 years before the Montgomery ruling. The Montgomery case was framed as a clash of values—patient autonomy versus medical paternalism. Thus, although the test is focused on patients, doctors are not liable for every omission of disclosure to which a patient later objects.”25. Others have raised questions about the implications for the legal treatment of clinical judgment, suggesting that it represents “a radical move away from English law’s traditional respect for clinical expertise.”9. But allocation of health resources should be tackled systematically rather than individually. In 1999, Nadine Montgomery gave birth by vaginal delivery to Sam. Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (Scotland) Judgment date. In this case, the assertion that Dr Horn would not have intubated Patrick if she had been present was felt to be a logical one and, therefore, not negligent. He was convicted and received a mandatory life-without-parole sentence. Clark v Greater Glasgow Health Board [2016] CSOH 25. Lord Diplock felt that the right amount of information to be disclosed was to be decided by the medical profession and that the right of the patient at that time was a right to be treated in the best way that a doctor thought they should be. Summary of implications of Montgomery What is the Montgomery Test? The Montgomery v Lanarkshire case of March 20151 drew fresh attention to informed consent. All were in agreement that there was a body of medical opinion the supported the use of ECT without relaxants and without physical restraints as it was thought these could compromise the airway or increase the chance of injury. Log in using your username or email address. He finally appealed to the House of Lords. Written and curated by real attorneys at Quimbee. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Patient consent: do doctors really know best? But this is a false dichotomy—the idea of a fully autonomous patient making choices completely independent of the doctor’s input does not reflect the complex reality of medical decision making, nor does the caricature of a paternalistic doctor riding roughshod over patients’ objections. The Bolam test was affirmed in Sidaway v Bethlem Royal Hospital Governors and others,2 although the ruling was not unanimous, with judges placing different weight on the patient’s right to make informed treatment decisions versus the doctor’s professional judgment in disclosing information. His comments also included the concept of the therapeutic exception where it would be acceptable for a doctor to withhold some information if it was felt that disclosure would harm the patient. It was also noted that the consultant stated that the risks would have been mentioned if specific questions had been asked. Her two-year-old son had been admitted to hospital with croup under the care of two doctors, Dr Rodger and Dr Horn. Summary: Justin reviews the issues of consent in clinical negligence cases in, and subsequent to, the case of Montgomery. Doctors may have been treating patients as they understood the law to be, as in the Sidaway case, but the Supreme Court has told us that this was wrong3 and that anyone who practised according to Sidaway was also wrong. The patient alleged that the defendants were negligent in not administering a muscle relaxant, in not using restraints in the absence of a relaxant and in not informing him of the risks of injury as a result of the procedure. To the extent that I have indicated I think that English law must recognise a duty of the doctor to warn his patient of risk inherent in the treatment which he is proposing: and especially so, if the treatment be surgery. The case was made that as the consultant had not discussed the risk of shoulder dystocia, the potential significant consequences of it occurring and the alternative option of a Caesarean section that negligence had occurred as far as consent is considered; Mrs Montgomery was not able to make a fully informed decision without full information on all the options. These issues are not always pursued, but obstetric litigation practice has noticeably changed, making professional training and clarity with respect to guidelines an even higher priority. See: Post navigation. In reality, medical decision making involves a nuanced negotiation of information. The patient had their ECT without the use of a muscle relaxant or physical restraints. Montgomery v Lanarkshire Health Board [2015] SC 11 [2015] 1 AC 1430. Finally, doctors criticised the focus of patient autonomy over medical paternalism. In 1999, Nadine Montgomery was pregnant with her first child, Sam. With regards to the disclosure of the risk of fracture, it was the doctor’s practice not to discuss the risk unless directly asked, in which case he would say the risk was very slight. 11 Mar 2015. Nadine Montgomery has won a 16-year legal fight for damages for her son Sam A Lanarkshire woman whose baby suffered brain damage during birth has won a 16-year fight for £5.25m compensation. The UK Supreme Court judgement in ‘ Montgomery v Lanarkshire Health Board ’ 1 has become the landmark case in consolidating the law on standard of care of doctors with regard to duty on disclosure of information to patients on the risks of proposed treatment and possible alternatives. Lord Neuberger, Lady Hale, Lord Kerr, Lord Clarke, Lord Wilson, Lord Reed, Lord Hodge. The competence of the surgery itself was never in doubt. 59 results for maddox v montgomery case brief. Montgomery v Lanarkshire Health Board [2015] UKSC 11 is a Scottish delict, medical negligence and English tort law case on doctors and pharmacists that outlines the rule on the disclosure of risks to satisfy the criteria of an informed consent. You can also use your College Personal ID (PID) if you have one. Documentation of this discussion and the options offered is important and is required by the GMC guidance on the same. Mr Afshar appealed to the Court of Appeal which again found in favour of Miss Chester. Montgomery principles have been known—or should have been known—by doctors for many years practice should in... Doctors should have been known—or should have been mentioned if specific questions had been asked Afshar a! A rare one be a rare one condition were high and he was convicted and a! Being given by her doctor when the hypodermic needle broke, rendering his arm useless a worsening in her.... 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