Mark Professional Medical Consent Made Easy

Digisign professional medical consent

[Music] welcome to this lecture on medical law today we will review the case of Montgomery versus Lana Keisha Health Board we will look into how this case caused the seismic shift in informed consent again here is our legal disclaimer the information I am providing here is intended for education purposes only and with all the information being provided being well documented in the public domain under no circumstances shall we accept any liability for any loss or damage incurred as a result of improper use of this lecture if you require independent legal advice please seek professional legal opinion I am a medical doctor not your lawyer first let's review the legal position of consent as directed by the Bolam case a doctor cannot be found negligent where they have upheld a reasonable standard of care this is determined by whether a doctor's actions can be supported by a body of medical experts ie held in Bolam in the case of consent where a patient claims negligence on behalf of the doctor for inadequate disclosure providing a reasonable body of other medical experts would do the same that doctor could not be considered negligent furthermore the Balan case introduced a concept known as therapeutic privilege whereby a doctor was entitled to withhold information that may scare a patient away from receiving treatment as you will see in the case that follows a drastic change in the law was about to take place Montgomery vs. la Nakia Health Board was such a case in 2015 the case of mrs. Montgomery was taken to the Supreme Court the outcome placed greater emphasis on what a reasonable patient would want to know so what actually happened mrs. Montgomery was a highly intelligent lady who gained a BSC in molecular biology and worked as a hospital specialist for a pharmaceutical company she received obstetric care for her first child by dr. McClellan at Bell's Hill maternity hospital mrs. Montgomery was a lady of relatively short stature and suffered with diabetes as a result her childbirth was considered high-risk as a result the progress of her pregnancy was being monitored in a combined diabetic and obstetric clinic mrs. Montgomery's scans indicated her baby was of a larger than average size a condition known as macrosomia which is common in maternal diabetes however throughout the duration of her antenatal care she was not informed of any increased risk in cases such as mrs. Montgomery there exists around a 10% risk of shoulder dystocia a condition where the infant's shoulders are too wide to pass through the mothers pelvis this condition considered an obstetric emergency is associated with an increase in morbidity and mortality for both mother and child where the condition occurs one in 500 children suffer from an associated brachial plexus injury plus one in a thousand will encounter severe hypoxia which may result in severe disability or even death mrs. Montgomery noticing that her baby was increasingly large during her antenatal follow-up became anxious about her ability to deliver the baby for journal II dr. McClellan noted her apprehension and made the decision not to perform any further exams for fear of perpetuating the mother's concerns much to mrs. Montgomery's fear during the delivery of her child she encountered difficulties during the delivery the obstetric team noted that shoulder dystocia had occurred and attempted appropriate maneuvers to assist the delivery of the child however the 12 minute delay in delivery resulted in infant hypoxia sadly this was extensive enough to cause permanent disability for the child in the form of cerebral palsy concerned regarding the quality of care provided mrs. Montgomery brought the health care team to court on two accounts first she felt that during her antenatal care she should have been informed of the risks of four shoulder dystocia and provided with options for suitable alternatives for example a c-section secondly during her labor she claimed dr. McClellan should have proceeded to cesarean section based upon deteriorating infant observations the case was taken up by the Scottish courts presided by Lord ordinary and Lord Bannatyne they rejected miss Montgomery's claims on the basis that had miss Montgomery been offered a cesarean section she would have still opted for vaginal delivery therefore no difference in the outcome would have occurred dr. McClellan's actions gained support from a reasonable body of medical colleagues who agreed that under the circumstances it was reasonable to withhold information from Miss Montgomery regarding the risks with the aim of avoiding a worsening of her anxiety further they supported the clinical decisions made by dr. McClellan during the delivery of the child therefore the baalam tests supported dr. McClelland clinical practice at that time and he could not be considered negligent mrs. Montgomery unsatisfied with the outcome of the Scottish courts lodged an appeal to the Supreme Court she continued to claim where she fully informed regarding the risk of shoulder dystocia and its associated morbidity she would have chosen to proceed with a cesarean section the Supreme Court accepted her claim the court acknowledged that the Royal College of Obstetricians and Gynaecologists recognized that shoulder dystocia was a major obstetric emergency which carries significant risks to both mother and baby when considering mrs. Montgomery's case this risk was around 10% the Supreme Court ruled that the decision of the House of Lords in mr. Bolin's case should no longer be followed as it was based upon a view of a doctor-patient relationship that ceased to reflect reality they moved on to state that patients should not be viewed as uninformed and incapable of understanding medical terms but as adults capable understanding that medical treatment is uncertain of success and may involve risks of accepting responsibility for those risks that may affect their lives and living with the consequences of those decisions furthermore it was declared that the duty of the doctor is to ensure that their patient is aware of any material risks in proposed treatment plus any alternative options material risk was defined as what a reasonable person in the patient's position would attach significance to or the doctor is aware that a patient is likely to attach significance to the Supreme Court ruled in favor of mrs. Montgomery permitting her to reclaim damages for her child this was based upon the fact that when the Supreme Court applied the above approach to miss Montgomery's case the doctor should have informed the mother of a substantial risk which was known to exist and the alternative of an elective caesarean section if the mother had been so informed she would have elected for a caesarean section and the baby would have been delivered unharmed so in summary this was a landmark case leading to a marked change to the previous baalam test previously the court evaluated whether a doctor's conduct will be supported by a reasonable body of medical this test from this point onwards would no longer apply to the issue of consent although it will continue to be used more widely in cases involving other alleged acts of negligence the current legal position therefore moved away from the paternalistic Boleyn principle now there is a legal duty of the doctor to ensure that the patient is aware of any material risks as determined by what a reasonable person will wish to know in their circumstance and any reasonable alternative treatments thank you for watching this lecture in the next lecture we'll review the case of Gillick versus West Norfolk and wise Beck Area Health Authority again this is another case that sets about changes within the law regarding the standard of care for medical professionals specifically on the grounds of consent in a child if you haven't already don't forget to subscribe click the bell and leave us a comment down below letting us know where you're studying because our team wants to know any questions are of course welcome as well as any topic requests see you next time why not consider watching our other relevant lectures including the bowline test and the balletto test that are linked below