Montgomery v Lanarkshire Health Board [2015] UKSC 11

Facts

• Mrs. Montgomery was a patient who underwent childbirth under the care of Lanarkshire Health Board.
• The case arose from issues regarding the non-disclosure of certain risks associated with childbirth by medical professionals.
• The central question concerned the extent of information about risks and alternatives that doctors are obliged to communicate to patients to ensure informed consent.
• Prior to this case, the standard for disclosure was based on professional medical opinion rather than patient-specific factors.
• The judgment by the Supreme Court addressed the adequacy and nature of risk disclosure in medical practice.

Issues

1. Whether the standard for disclosure of risks and alternatives in medical consent should remain based on professional consensus (the Bolam test) or shift to a patient-centred model.
2. What constitutes a material risk and how should doctors determine which risks to disclose to patients.
3. How to implement a legally sufficient process of consent that enables true patient autonomy within practical limitations of clinical practice.

Decision

• The Supreme Court rejected the exclusive application of the Bolam test for disclosure of risks, holding that the doctor’s duty is to take reasonable care to ensure the patient is aware of material risks and reasonable alternatives.
• A risk is material if a reasonable person in the patient's position would likely consider it significant, or if the doctor is or should be aware that the particular patient would be likely to attach significance to it.
• The Court emphasized the need for dialogue and shared decision-making, requiring doctors to engage with patients' specific concerns and provide tailored information.
• The principles established apply across medical specialties and are not confined to obstetrics or physical risks.

Legal Principles

• Informed consent requires a patient-centred approach, focusing on the information a reasonable patient would want to know, not solely the views of the medical profession.
• The concept of material risk is central; it requires individualized disclosure based on both the probability of harm and the potential severity, factoring in patient circumstances and values.
• Effective doctor-patient communication must involve active engagement and recognition of the patient's autonomy and preferences.
• The standard of care in obtaining consent extends to the disclosure of alternative treatments and their associated risks and benefits.
• Documentation and evidencing the consent process are essential in demonstrating that sufficient individualized information has been provided.

Conclusion

Montgomery v Lanarkshire Health Board fundamentally redefined informed consent in medical law by prioritizing patient autonomy and requiring disclosure of material risks tailored to the individual patient. The case shifted the legal standard away from professional paternalism toward shared decision-making, setting a robust framework for modern consent practices while presenting new challenges for implementation within clinical settings.