The landmark case of Montgomery v Lanarkshire Health Board [2015] UKSC 11 represents a pivotal moment in the development of medical negligence law in the United Kingdom. It fundamentally redefined the legal duties of doctors regarding patient consent and disclosure of risks before medical treatment.
The Supreme Court in this case overruled the previous standard established in Sidaway v Board of Governors of the Bethlem Royal Hospital [1985], which had largely deferred to medical opinion on what risks doctors must disclose to patients.
Instead, Montgomery v Lanarkshire Health Board shifted the focus towards patient autonomy, imposing a duty on doctors to ensure patients are properly informed about material risks and reasonable alternatives. This case brief will explore the facts, legal issues, judgment, and the significant implications of this decision on the practice of informed consent in medical law.
Facts of Montgomery v Lanarkshire Health Board
The claimant, Mrs. Nadine Montgomery, was a diabetic woman of relatively small stature who was under the care of the Lanarkshire Health Board during her pregnancy and labour. Mrs. Montgomery’s diabetes placed her at an increased risk of developing shoulder dystocia during delivery, a condition where the baby’s shoulders fail to pass through the mother’s pelvis, which can cause serious injury to the child. It was established that the risk of shoulder dystocia for diabetic mothers like Mrs. Montgomery was approximately 9-10%.
Despite this, the doctor responsible for Mrs. Montgomery’s care did not inform her of this risk. The doctor judged the likelihood of shoulder dystocia as very low and believed that advising Mrs. Montgomery of this risk, or offering the alternative option of an elective caesarean section, was not in her best interest. The baby was subsequently born with severe disabilities caused by shoulder dystocia.
Mrs. Montgomery brought a claim against the Lanarkshire Health Board alleging negligence for failing to inform her of the material risk and the option of an elective caesarean. The case initially proceeded in the Court of Session, Scotland’s supreme civil court, where the judge applied the traditional Hunter v Hanley test for medical negligence. The Court held there was no negligence because the doctor’s decision fell within a responsible body of medical opinion, and further found that causation was lacking as Mrs. Montgomery stated she would not have chosen a caesarean section even if she had been informed of the risk.
Legal Issues
The case raised two fundamental questions relating to medical negligence and consent:
- What is the scope of a doctor’s duty to disclose risks to a patient before treatment?
- Does the traditional Bolam test apply to the duty of disclosure, or should a different standard govern this aspect of medical negligence?
At the heart of the dispute was whether the doctor’s failure to inform Mrs. Montgomery of the risk of shoulder dystocia and alternative treatment options amounted to a breach of duty, considering the standard established by the earlier House of Lords decision in Sidaway.
The Bolam test, derived from Bolam v Friern Hospital Management Committee [1957], had long been used to determine medical negligence by deferring to a responsible body of medical opinion. In Sidaway (1985), this test was applied to the issue of risk disclosure, meaning that doctors were only required to inform patients of risks that a responsible body of medical practitioners would deem necessary to disclose.
Montgomery v Lanarkshire Health Board Judgment
The Supreme Court in Montgomery v Lanarkshire Health Board emphatically departed from the Sidaway approach. The court rejected the application of the Bolam test to the disclosure of risks and held that the law must recognise the principle of patient autonomy. The ruling established that an adult patient of sound mind has the right to make an informed decision about which medical treatment to undergo and must be given sufficient information to exercise this right effectively.
Lords Kerr and Reed provided the leading judgment. They explained that the extent to which a doctor discusses risks is not a matter solely for medical expertise but involves a value judgment about the respect owed to patients. They reasoned that the Bolam test was inappropriate in this context because it merely endorsed variations in medical practice based on different doctors’ attitudes, rather than focusing on the patient’s right to be informed.
The court laid down the following key principles:
- Doctors have a duty to take reasonable care to ensure that patients are aware of any material risks involved in the proposed treatment.
- They must also inform patients about any reasonable alternatives or variants to the treatment.
- A risk is material if, in the circumstances of the case:
- A reasonable person in the patient’s position would likely consider it significant; or
- The doctor is, or should reasonably be, aware that the particular patient would attach significance to it.
The Supreme Court recognised the therapeutic exception — where a doctor may withhold information if disclosure would cause serious harm to the patient’s health — but emphasised that this exception is narrow and does not undermine the general duty of disclosure.
Conclusion
In conclusion, Montgomery v Lanarkshire Health Board [2015] UKSC 11 represents a fundamental evolution in medical negligence law in the United Kingdom. By overturning Sidaway and rejecting the Bolam test for risk disclosure, the Supreme Court prioritised patient autonomy and informed consent as essential components of lawful medical treatment. The ruling mandates that doctors provide patients with clear, relevant information about material risks and reasonable alternatives, allowing individuals to make informed choices about their healthcare.