BMJ 2015;350:h1796 doi: 10.1136/bmj.h1796 (Published 7 April 2015)
Page 1 of 1
Letters
LETTERS NEW UK LAW ON CONSENT
Consent forms for “no surgery” as ramification of landmark ruling Ossie F Uzoigwe medical writer Harcourt Building, Sheffield S10 1DG, UK
Sokol’s instructive account of the landmark Supreme Court ruling of Montgomery v Lanarkshire Health Board does not mention one ramification of this ruling.1 Clinicians must now give as much attention to consent for patients who follow a non-operative course as for those who undergo an intervention.
Montgomery presages a future where consent forms will be needed for non-operative management. In the case in question an induced vaginal delivery was selected for the mother and child. The court ruled that this was not negligent, but it was deemed a breach of duty that the mother was not informed of the risk of shoulder dystocia. The Supreme Court concluded that had she been adequately alerted to the risks, she would have requested a caesarean section. Hence the mother had not been adequately consented for non-operative treatment. What if consent for non-operative measures is declined? Does Montgomery set a precedent whereby individuals can request treatments? Consider a patient who is worried about the “material risk” of rupture of an aortic aneurysm. He thus requests an endovascular repair for his aneurysm, which is less than the 5.5 cm threshold.2 Is it hyperbole to say that the judgment places pressure on surgeons to operate against their typical practice? Is flexibility more important since Montgomery?
Perhaps the ruling reflects more the medicalisation of pregnancy. In the ruling a Supreme Court Judge states: “once a woman is pregnant, the foetus has . . . to be delivered. The principal choice is between vaginal delivery and caesarean section.” The judge cites a situation where a woman insists on vaginal delivery over caesarean section: “the medical profession must respect her choice . . . There is no good reason why the same should not apply in reverse.”
Although an individual can obviously refuse an intervention, can one insist that clinicians perform a procedure against their routine practice when non-operative management is not negligent? While non-operative treatment requires consent as much as operative intervention, refusal of consent to non-operative treatment is arguably the greater challenge. Competing interests: None declared. Full response at: www.bmj.com/content/350/bmj.h1481/rr-14. 1 2
Sokol DK. Update on the UK law on consent. BMJ 2015;350:h1481. (16 March.) Paraskevas KI, Mikhailidis DP, Andrikopoulos V, et al. Should the size threshold for elective abdominal aortic aneurysm repair be lowered in the endovascular era? Yes. Angiology 2010;61:617-9.
Cite this as: BMJ 2015;350:h1796 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS NEW UK LAW ON CONSENT
Consent forms for “no surgery” as ramification of landmark ruling Ossie F Uzoigwe medical writer Harcourt Building, Sheffield S10 1DG, UK
Sokol’s instructive account of the landmark Supreme Court ruling of Montgomery v Lanarkshire Health Board does not mention one ramification of this ruling.1 Clinicians must now give as much attention to consent for patients who follow a non-operative course as for those who undergo an intervention.
Montgomery presages a future where consent forms will be needed for non-operative management. In the case in question an induced vaginal delivery was selected for the mother and child. The court ruled that this was not negligent, but it was deemed a breach of duty that the mother was not informed of the risk of shoulder dystocia. The Supreme Court concluded that had she been adequately alerted to the risks, she would have requested a caesarean section. Hence the mother had not been adequately consented for non-operative treatment. What if consent for non-operative measures is declined? Does Montgomery set a precedent whereby individuals can request treatments? Consider a patient who is worried about the “material risk” of rupture of an aortic aneurysm. He thus requests an endovascular repair for his aneurysm, which is less than the 5.5 cm threshold.2 Is it hyperbole to say that the judgment places pressure on surgeons to operate against their typical practice? Is flexibility more important since Montgomery?
Perhaps the ruling reflects more the medicalisation of pregnancy. In the ruling a Supreme Court Judge states: “once a woman is pregnant, the foetus has . . . to be delivered. The principal choice is between vaginal delivery and caesarean section.” The judge cites a situation where a woman insists on vaginal delivery over caesarean section: “the medical profession must respect her choice . . . There is no good reason why the same should not apply in reverse.”
Although an individual can obviously refuse an intervention, can one insist that clinicians perform a procedure against their routine practice when non-operative management is not negligent? While non-operative treatment requires consent as much as operative intervention, refusal of consent to non-operative treatment is arguably the greater challenge. Competing interests: None declared. Full response at: www.bmj.com/content/350/bmj.h1481/rr-14. 1 2
Sokol DK. Update on the UK law on consent. BMJ 2015;350:h1481. (16 March.) Paraskevas KI, Mikhailidis DP, Andrikopoulos V, et al. Should the size threshold for elective abdominal aortic aneurysm repair be lowered in the endovascular era? Yes. Angiology 2010;61:617-9.
Cite this as: BMJ 2015;350:h1796 © BMJ Publishing Group Ltd 2015
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
