How much information should patients be given about the risks of treatment? And who decides what a patient needs to know? Until now, in the United Kingdom, doctors have been allowed to decide this, and the 30 year old Bolam test specified that their conduct would be considered acceptable if it would be supported by a responsible body of medical opinion.
But this has all just changed. Last week the UK’s Supreme Court judged that it was for patients to decide whether the risks of treatment and alternative options have been adequately communicated. Nadine Montgomery, who has diabetes, was not told of the risks of shoulder dystocia to her baby boy, who subsequently developed cerebral palsy (doi:10.1136/bmj.h1414). Her obstetrician justified holding back this information on the grounds that it might have discouraged her from having a vaginal delivery.
This will no longer do. As Daniel Sokol explains (doi:10.1136/bmj.h1481), the Montgomery ruling means that doctors will have to take “reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment and of any reasonable alternative or variant treatments.” Sokol advises doctors to make extra sure that the discussion is fully documented.