Delivering informed consent post-Montgomery: Implications for medical practice and professionalism

This paper will examine some aspects and potential implications of the Supreme Court decision in Montgomery v Lanarkshire Health Board. In doing so, it will briefly chart the shift in the development of the standard of care for doctors in the context of the duty to disclose information about the risks of treatment, culminating in Montgomery in 2015. The case involved a claim against an obstetrician for inadequate disclosure of the risks of a natural birth. There were complications during the delivery and her baby son, who was starved of oxygen, was born with cerebral palsy. The claimant suffered from diabetes and was small in stature, and argued that she would have opted for a caesarean section had she been fully informed of the risks of a natural birth. The Supreme Court found in favour of the claimant and the decision reinforced the central role of patient autonomy, and the requirement for doctors to focus on the needs of the ‘particular patient’ when discussing potential treatment options. There are however some difficulties with this approach (as discussed below) and the courts still hold the trump card as final arbiters. This model undoubtedly challenges the traditional dominance model of the medical profession, associated with the work of medical sociologist Eliot Freidson, by giving the ultimate power to determine appropriate ‘professional’ standards and skills to the court.