Also known as: NM v Lanarkshire Health Board
Court: Supreme Court (Scotland)
Judgment Date: 11 March 2015
Where Reported: [2015] UKSC 11; [2015] A.C. 1430
Legal Issue in Montgomery v Lanarkshire Health Board
Montgomery v Lanarkshire Health Board explored the extent of a medical practitioner’s duty to advise a patient on the risks associated with a medical procedure.
The main legal question was whether the doctor was negligent in failing to inform the patient, Nadine Montgomery, of the risks of vaginal delivery, specifically the risk of shoulder dystocia, and the alternative option of a caesarean section.
Montgomery v Lanarkshire Health Board examined the boundary between a patient’s right to be informed and a doctor’s professional judgment in advising patients about medical treatments and their inherent risks.
Material Facts in Montgomery v Lanarkshire Health Board
Nadine Montgomery, a diabetic and of small stature, was expecting her first child and was under the care of a doctor employed by the Lanarkshire Health Board. She was considered a high-risk pregnancy patient.
When informed that her baby was larger than usual, Montgomery expressed concerns about vaginal delivery.
However, her doctor did not inform her about the 9-10% risk of shoulder dystocia, a condition where the baby’s shoulders cannot pass through the pelvis, which can occur during vaginal delivery in diabetic women.
The doctor believed that if this condition was mentioned, most women would opt for a caesarean section, which the doctor did not deem in their best interest.
Montgomery delivered her son via vaginal birth, resulting in the baby suffering severe disabilities due to complications from shoulder dystocia.
Montgomery claimed damages against the health board, alleging that the doctor’s failure to advise her of the risks constituted negligence.
Judgment in Montgomery v Lanarkshire Health Board
The Supreme Court allowed Montgomery’s appeal, departing from the traditional approach in Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and the Bolam v Friern Hospital Management Committee.
It held that an adult of sound mind is entitled to decide on their medical treatment, and doctors have a duty to take reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, including reasonable alternatives.
The Court found that the doctor had a duty to advise Montgomery of the risk of shoulder dystocia associated with vaginal delivery and to discuss the alternative of a caesarean section.
The Court concluded that there was no evidence to suggest that Montgomery, if properly advised, would have chosen to proceed with a vaginal delivery.
It was held that the test of materiality in advising patients is whether a reasonable person in the patient’s position would likely attach significance to the risk or if the doctor should reasonably be aware that the particular patient would find it significant.
The Reason for the Decision in Montgomery v Lanarkshire Health Board
The decision in Montgomery v Lanarkshire Health Board marked a significant shift in medical negligence law, emphasizing patient autonomy and informed consent.
The Court recognised that the Bolam test, which previously dictated the extent of a doctor’s duty to advise based on accepted medical practice, was not suitable for advice and warning cases.
This was because medical practices vary, and relying on them could create inconsistencies in the law of consent.
The Court emphasised that every adult of sound mind should have the right to determine what may be done with their own body, a principle deeply embedded in law and reflective of social attitudes towards individual human rights.
The Court highlighted the importance of clear and comprehensive communication between doctors and patients.
It stressed that doctors have a duty to ensure patients understand the seriousness of their condition, the anticipated benefits and risks of proposed treatments, and any reasonable alternatives, enabling patients to make informed decisions.
This duty is not fulfilled merely by providing technical information or obtaining a signature on a consent form.
The Court also noted the need for a patient-centered approach to the duty of care, where the assessment of material risks cannot be solely based on medical opinion but must also consider the patient’s perspective.
The Court recognised that a doctor’s advisory role involves a dialogue to ensure the patient is in a position to make an informed decision, and this role is effectively performed only if the information provided is comprehensible to the patient.
In conclusion, the Supreme Court’s decision in Montgomery v Lanarkshire Health Board signified a move away from the paternalistic approach of the Bolam test towards a more patient-centred approach.
It established that doctors have a duty to inform patients about material risks associated with treatments and reasonable alternatives, with the assessment of materiality based on both the patient’s and doctor’s perspectives.
Conclusion
Montgomery v Lanarkshire Health Board represents a landmark shift in medical negligence law, emphasising the importance of patient autonomy and informed consent.
The decision underscored the necessity for doctors to adequately inform patients about material risks and alternatives associated with medical treatments, thereby empowering patients to make informed decisions about their health care.
Montgomery v Lanarkshire Health Board departed from previous reliance on medical opinion to determine the standard of care in advising patients, placing greater emphasis on considering the patient’s perspective.
