Consenting to Medical Treatment – Doctor doesn’t always know best

Posted 16/04/2015

We have long been used to trusting doctors to tell us what treatment we should have and going along with their view of what is best for us. After all, doctors are in a far better position to know than patients. However, with the advent of the internet, we can all now access whatever information we want about our condition and its treatment; society has moved on from the unquestioning days of ‘doctor knows best’.

The highest court in the land, the Supreme Court, recently decided in Mrs Montgomery’s case that it’s not good enough for doctors to decide what is in a patient’s best interests.

Mrs Montgomery was diabetic and so, when she became pregnant, she had an increased risk, in the order of 9-10%, of there being a complication of shoulder dystocia (where the baby gets stuck in the birth canal). Her doctor did not warn her of this risk or advise her about alternative delivery by caesarean section, because he assessed the risk of serious injury from shoulder dystocia as small and thought that, if he did advise her of the risk, she would then choose to have a caesarean. He did not think having a caesarean would be in her best interest. Catastrophe followed when the baby got stuck at delivery and suffered lack of oxygen causing brain injury and cerebral palsy.

The Judges decided that this was not good enough. It was not for the doctor to decide what should and should not be disclosed to the patient. The doctor must take reasonable care to ensure patients are advised of ‘material risks’ involved in a recommended treatment and any reasonable alternative. And it is not just the doctor’s view of what is a ‘material risk’ that counts. There are other factors that have to be taken into account when assessing risks, like the effect on the individual patient’s life if the worst happens and the importance to the patient of the benefit of the treatment.

It follows that a doctor can only fulfil his duty to obtain informed consent if he/she spends some time discussing the patient’s individual situation and the risks of the procedure. The alternative seems to be to go through every risk. It will be interesting to see how this translates into practice, and the impact this will have on an already time-poor NHS.