Montgomery v Lanarkshire Health Board [2015] UKSC11
Reviewed by Michaela Christie
Background and Complications
This landmark medical negligence case highlighted the circumstances pertaining to a diabetic mother who had not been forewarned of the complications likely to arise during her future labour. Following the discovery that she was carrying an above average sized baby which subsequently resulted in her newborn baby suffering from shoulder dystocia, the notion of informed consent to medical treatment was notably taken into further consideration by the Court. Sadly, the pursuer’s baby was born with cerebral palsy consequent to an obstruction of the umbilical cord caused by shoulder dystocia, a particular form of complication experienced by women during childbirth.
Allegations and Choices
The pursuer affirmed that she should have been made aware of the potential risk of shoulder dystocia, further stating that she had never been presented with the choice of a caesarean section before giving birth, which would have ultimately prevented these risks from manifesting, similarly protecting her baby from suffering permanent injury.
Accordingly, the expert evidence which was heard confirmed a 9-10% risk of the pursuer’s child suffering from shoulder dystocia if she delivered her baby without receiving a caesarean section. Additionally, the pursuer should have been made aware that generally, there is an expectation of diabetic mothers giving birth to larger than average babies in comparison to non-diabetic mothers.
Legal Proceedings
Unfortunately, legal proceedings in this case were rather extensive as the case progressed to appeal. Initially, application of the Bolam test was upheld, and the claim was dismissed. This test referred to the premise that the actions of medical professionals are proportionate to the actions of others in the same situation. Furthermore, this decision continued to be upheld on appeal to the Inner House of the Court of Session. However, Mrs Montgomery then appealed to the Supreme Court who then meticulously reviewed the law on informed consent and upheld the appeal.
Evolution of Doctor-Patient Relationship
Interestingly, the Court reasoned that the previously accepted concept of the doctor-patient relationship no longer reflected reality, thus citing that patients were competent enough to form a clear understanding of medical issues on their own terms. It was held that doctors have a duty to take reasonable care to ensure that a patient exhibiting clarity of mind is made fully aware of any material risks which may be anticipated during treatment. Moreover, patients should always be informed of reasonable alternatives to standard forms of practice. Evidently in this case, it appears that there had been a clear failure to provide the patient with the choice of an alternative recommended procedure. The Court also found that the assessment of risk to a patient should be based on the relevancy to the circumstances of each of their own personal situations. It was further held that a doctor must engage in clear communication with their patient thus enabling them to make an informed decision about whether to undergo a proposed procedure, despite this being contrary to their best interests in the eyes of the physician
Personalised Risk Assessment
The Court highlighted the importance of assessing risks based on individual circumstances. Clear communication and the provision of alternative procedures were deemed essential, even if against the physician’s perceived best interests.
Collaborative Decision-Making
The ruling in Montgomery successfully emphasised the importance of doctors and patients reaching their decisions collaboratively, as well as the requirement for doctors to consider when risks may potentially pose a critical outcome to an individual patient’s position. On this merit, it is formerly what a “reasonable doctor” would consider important that is held to be paramount when the issue of informed consent is addressed by the Courts.
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