Medicolegal update on consent
M R C O G PA R T 2 · S O S P O C K E T C A R D · K N O W L E D G E A R E A 2 – T E A C H I N G A N D R E S E A R C H
Medicolegal Update on Consent: The Montgomery Ruling Cheung E, Goodyear G, Yoong W. Medicolegal update on consent: the Montgomery Ruling. TOG 2016;18:171–2. doi:10.1111/tog.12303
2015 9–10% 16% SUPREME COURT RULING (UK) SHOULDER DYSTOCIA RISK, DIABETIC DYSTOCIA PREDICTED BY RISK FACTORS MOTHERS
DO N' T-M IS S FA C TS
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Standard is now the reasonable patient, not the reasonable doctor — Bolam/Sidaway no longer governs consent
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Disclose all material risks plus all reasonable alternative or variant treatments — legal and professional duty
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Materiality = significance to a reasonable person in this patient’s position, or to this particular patient as the doctor should know
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A patient’s specific question must always be answered (Chester v Afshar) — no size threshold
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The old ‘<10% need not be disclosed’ Sidaway rule is dead — do not rely on it
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Shoulder dystocia: 9–10% in diabetic mothers; offer elective caesarean if diabetes or previous dystocia
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16% of dystocia predicted by risk factors; 84% unpredicted in low-risk labours
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Document the discussion — PPH and severe perineal tears likewise occur when the only risk is childbirth itself
OLD LAW VS NEW LAW
Sidaway/Bolam: doctor-centred, <10% risk non-disclosable Montgomery: patient-centred, all material risks + alternatives
Chester v Afshar: always answer a direct question
ABBREVIATION KEY
GMC — General Medical Council Sidaway — Sidaway v Bethlem
NICE — National Institute for Health and Care Excellence Chester — Chester v Afshar
Bolam — Bolam v Friern
Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — doi:10.1111/tog.12303
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