• Informed consent
• Montgomery judgement
• Bolam judgement

Professor Lees's paper asks important questions concerning the medical implications of a court ruling concerning the adequacy or otherwise of informed consent.1

If local attempts at resolution fail, then patients who are aggrieved have two major options. Involvement of the General Medical Council (GMC), a body funded by doctors to regulate medical standards, or legal action through courts (involvement of the media is usually unpredictable and unproductive). A recent UK Supreme court judgement ‘Montgomery’,2 is apparently an ‘evolutionary change’ from a previous (Bolam) court judgement3 and has created a precedent with regard to informed consent.

What were these judgements and what are their implications?

Both Bolam and Montgomery were court judgements. The Bolam judgement was that ‘a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art’ but this seemingly no longer applies, at least, to the issue of informed consent as decided by Montgomery4 (of course 60 years later, this would be a responsible body of medical men and women). The Montgomery judgement involved a diabetic lady who was not informed in advance about her increased risk of shoulder dystocia in labour and was not informed about an option of pre-emptive Caesarean section. The UK Supreme Court judged she should have been so informed and awarded damages of £5.25 million (the baby having sustained permanent damage). Montgomery was a judgement on a particular set of circumstances in a particular patient and it may not be appropriate to generalise a principle from this particular precedent. Montgomery ‘focuses on ensuring that patients are adequately informed’ and ‘reasonable care is taken to ensure that the patient is aware of any material risks involved in any recommended treatment, and …