On 11 March 2015, the UK’s Supreme Court judged that doctors (and other health professionals) should ensure that patients are aware of the risks of treatment and alternative options so they can make an informed decision. This ruling will, we believe, have far-reaching implications for health care generally – and perhaps be the nail in the coffin of paternalism.
Nadine Montgomery gave birth on 1 October 1999 and, as a result of complications during delivery, her baby was born with serious disabilities. Mrs Montgomery has diabetes. Women with diabetes are more likely to have large babies and there is a 9-10% risk of shoulder dystocia during vaginal delivery (the baby’s shoulders being too wide to pass through the mother’s pelvis). Though this may be resolved by emergency procedures during labour, shoulder dystocia poses various health risks to the woman and baby. Mrs Montgomery had raised concerns about vaginal delivery but Dr McLellan’s policy was not routinely to advise diabetic women about shoulder dystocia as, in her view, the risk of a grave problem for the baby was very small, but if advised of the risks of shoulder dystocia women would opt for a caesarean section, which was not in the maternal interest.
You can read the ruling in full by clicking here – here are some highlights:
“It would be a mistake to view patients as uninformed, incapable of understanding medical matters, or wholly dependent on information from doctors ….
“Societal and legal changes point towards an approach to the law which treats patients so far as possible as adults capable of understanding that medical treatment is uncertain of success and may involve risks, of accepting responsibility for risks affecting their lives, and of living with the consequences of their choices. This entails a duty on doctors to take reasonable care to ensure that a patient is aware of material risks inherent in treatment ….
“… an adult of sound mind is entitled to decide which, if any, of the available treatments to undergo, and her consent must be obtained before treatment interfering with her bodily integrity is undertaken. The doctor is under a duty to take reasonable care to ensure that the patient is aware of any material risks involved in proposed treatment, and of reasonable alternatives. A risk is “material” if a reasonable person in the patient’s position would be likely to attach significance to it, or if the doctor is or should reasonably be aware that their patient would be likely to attach significance to it ….
” A patient is entitled to take into account her own values and her choices must be respected, unless she lacks capacity. She is at least entitled to information enabling her to take part in the decision.”