Court: Queen’s Bench Division
Judgment Date: 26 February 1957
Where Reported: [1957] 1 W.L.R. 582; [1957] 2 All E.R. 118; [1957] 2 WLUK 94
Legal Issue in Bolam v Friern Hospital Management Committee
The legal issue in Bolam v Friern Hospital Management Committee focused on the standard of care in medical negligence.
The case examined whether a doctor could be held negligent for not following a treatment method that some medical practitioners considered better, and for not warning a patient about the potential risks of a treatment.
The crucial question was whether the treatment provided and the lack of warning were in accordance with the standards of reasonably competent medical practice at the time​​.
Material Facts in Bolam v Friern Hospital Management Committee
John Hector Bolam, a voluntary patient at Friern Hospital, underwent electro-convulsive therapy (E.C.T.) for depression. During the treatment, he suffered fractures due to violent muscular contractions caused by the electric current passing through his brain.
The treatment was given without a relaxant drug or significant manual restraint. Bolam claimed the hospital was negligent for not using a relaxant or sufficient manual control and for not warning him about the risks, especially the possibility of fractures from the treatment.
Expert witnesses provided diverse opinions on E.C.T. techniques. Some used relaxant drugs or manual control, while others, including those at Friern Hospital, did not, citing minimal risks of fractures and opposing routine relaxant use.
There was also a difference of opinion on whether patients should be warned about the risks of E.C.T. treatment​​​​.
Judgment in Bolam v Friern Hospital Management Committee
The court held that the doctor was not negligent as he had acted in line with a practice accepted as proper by a responsible body of medical opinion skilled in the particular form of treatment.
It was ruled that mere divergence from a body of competent professional opinion does not constitute negligence. Additionally, the court considered whether the failure to warn the patient about the risks involved in the treatment fell below the standard of practice recognised as proper by a competent body of professional opinion.
The court concluded that good medical practice did not necessarily require a warning, and even if it did, it was speculative whether the plaintiff would have refused the treatment if warned. Thus, the defendants were not found negligent for failing to give a warning.
The judgment underlined that a medical practitioner is not negligent if he acts in accordance with a practice accepted by a reasonable body of medical opinion, even if other practitioners adopt a different approach​​.
Reason for the Decision in Bolam v Friern Hospital Management Committee
The court’s decision was influenced by the application of the standard of care in medical negligence, which differs from general negligence. In medical negligence, the standard is not that of the average person but of the ordinary skilled medical practitioner.
The Bolam test, as it became known, established that a doctor is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical opinion, even if there is a differing opinion.
This approach acknowledges the existence of different schools of thought and practices in medicine, allowing for variations in treatment methods.
Regarding the lack of warning, the court took into account the nature of the patient’s condition and the context in which the treatment was given.
The evidence suggested that the risks associated with E.C.T. were minimal and that informing the patient of these risks might not have altered their decision to undergo treatment.
Moreover, the evidence showed that there was no consensus among medical practitioners on the necessity of providing such warnings. The court emphasised that the expectation of warnings must be balanced against the realities of medical practice and the patient’s condition.
The court also highlighted that imposing negligence in such cases could have broader implications for medical practice. It might deter doctors from using their best judgment and adopting innovative techniques due to fear of litigation, which could stifle medical progress and ultimately harm patient care.
This viewpoint aligns with the principle that legal standards should not unduly inhibit the development of medical science and the exercise of professional clinical judgment.
In essence, Bolam v Friern Hospital Management Committee established that the test for negligence in medical treatment involves a peer-professional standard rather than a strict application of what might be deemed best practice by some practitioners.
This approach allows for a range of accepted medical practices and recognises the complexities and uncertainties inherent in medical treatment​​​​.
Conclusion in Bolam v Friern Hospital Management Committee
The Bolam v Friern Hospital Management Committee case significantly influenced the legal standard for medical negligence. It established the ‘Bolam test,’ which set the standard of care based on accepted medical practice rather than a universal best practice.
Bolam v Friern Hospital Management Committee is popular in medical law as it acknowledges the diversity of medical opinion and practices, granting professionals discretion in their clinical judgment. It also underlines the importance of considering the broader implications of legal judgments on medical practice and innovation.
The Bolam test has been fundamental in shaping subsequent legal assessments of medical negligence and professional standards in healthcare​​.
