Montgomery and its impact on current medical practice – good or bad?

Patient autonomy requires full disclosure prior to a valid consent. The 2015 UK Supreme Court ruling in Montgomery has displaced Bolam on this issue and is inducing a disquieting sense of angst in some medico-legally conscious clinicians. For the time being, the Bolam test still applies for treatment and/or diagnosis claims. The very grossness of the defendant in Montgomery’s withholding of information to the patient (remarkably not thought negligent by the lower courts) prompted the judges of the Supreme Court to dispense with the long-standing Bolam test. (The Editor considers the case should have been won using Bolam in any event.) The foreseeable shoulder dystocia that caused catastrophic injury to the claimant's baby would (and should) have been avoided by a planned caesarean section. The claimant’s damage award of £5.25 million as a result of the defendant's obstetrician's failure to provide full disclosure seems to have induced clinicians to over-watch their step, at times to a ridiculous extent. On the one hand, many clinicians’ anxiety may result in a defensive/protective approach: ‘These are the facts, now you choose’, thus leaving a sense of hurtful abandonment in patients. Much harm may be done within Medicine if the facts underlying the decision in Montgomery are not properly considered and evaluated.