The question of consent
A Scottish Dental round-table examines the effect of the landmark ‘Montgomery Ruling’ and its consequences for healthcare professionals
In 2015, the Supreme Court handed down a ruling in the appeal case of a mother who had taken an action against Lanarkshire Health Board after her son was born with cerebral palsy due to complications at birth.
The mother was small in stature and diabetic. She had raised concerns that these factors may cause problems with a vaginal delivery. However, she had not asked about the ‘exact risks’, which, for shoulder dystocia, the complication her baby experienced, was about 9-10 per cent; the risk of cerebral palsy as a result of shoulder dystocia is cited as 0.1 per cent.
It was the opinion of the treating obstetrician that the risks were minimal but, if told of the risk, the mother would have opted for a caesarean section and they did not believe that this was in her best interests.
The mother claimed for negligence, arguing that she should have been told of the risks. The Supreme Court found in her favour, overturning a previous ruling by the House of Lords which had been law since the mid-1980s.
The mother, Mrs Nadine Montgomery, was awarded more than £5 million in damages and the ‘Montgomery Ruling’ was to transform the way patients and healthcare professionals understood ‘consent’.
Reactions to the ruling were diverse. Some believing it made no difference at all, and simply enshrined in law those practices, which regulators already propounded and those behaviours which the majority of clinicians were already displaying.
Others felt that it would open the floodgates for historic claims and bring a new tension into healthcare professionals’ relationship with their patients blurring the lines between clinical judgement and professional opinion and discretion, and the patient’s right to choose.
Effectively, the ruling established that, rather than being a matter for clinical judgment to be assessed by professional medical opinion, a patient should be told whatever they want to know, not what the doctor thinks they should be told.
In September 2018, with the support of the Royal College of Physicians and Surgeons of Glasgow who have been looking into the issue in detail, Scottish Dental magazine brought together a group from across the dental world in a round-table discussion on what consent means in a post-Montgomery world. The group considered what ‘informed consent’ means from all their perspectives and how it impacts them on a day-to-day basis. Among the issues they discussed were the reality of record-keeping and the consent pathway between primary and secondary care as well as what it means for different members of the dental team.