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Minor League Baseball trademarks and copyrights are the property of Minor League Baseball. The Montgomery case in 2015 was a landmark for informed consent in the UK.

Two years on, Sarah Chan and colleagues discuss the consequences for practising doctorsThe Montgomery v Lanarkshire case of March 20151 drew fresh attention to informed consent.

Nadine Montgomery, a woman with diabetes and of small stature, delivered her son vaginally; he experienced complications owing to shoulder dystocia, resulting in hypoxic insult with consequent cerebral palsy.

Montgomery sued for negligence, arguing that, if she had known of the increased risk, she would have requested a caesarean section. The Supreme Court of the UK announced judgment in Nicotrol (Nicotine Inhalation System)- Multum favour in March 2015. The ruling overturned a previous decision by the House of Lords,2 which had been law since at least the mid 1980s. We have heard anecdotally that some hospitals are in the process of updating their procedures on informed consent, but few have completed this.

Although the Medical Defence Union and the Medical Protection Society have each issued statements and updated their guidance, as have some royal colleges (such as the Royal College of Surgeons), other bodies such as the GMC and the Royal College of Obstetricians and Gynaecologists (RCOG) have yet to do so. A further challenge is that the risks of birth can change dramatically and quickly, making detailed discussion and informed decision making difficult.

GMC guidance says that the consenting process is not a snapshot but an ongoing process. RCOG has proposed pilot programmes to identify what resources women, clinicians, and health services need to comply with the Montgomery ruling. Training and educational materials must be fit for purpose.

Obstetricians urgently need Nicotrol (Nicotine Inhalation System)- Multum. The Montgomery decision redefined the standard for informed consent and disclosure. Previously, the Bolam test14 in England and the Hunter v Hanley test15 in Scotland were used to determine what should be disclosed.

The Montgomery case firmly rejected the application of Bolam to consent, establishing a duty of care to warn of material risks. Doctors may have been treating patients as they understood the law to be, as in the Sidaway case, but the Supreme Court has told us that this was wrong3 and that anyone who practised according to Sidaway was also wrong.

In practical terms, the ruling should apply at least back to 1999, when Montgomery saw her obstetrician. Species the Montgomery principles have been known-or should have been known-by doctors for many years. Since the Montgomery ruling, several attempts have been Nicotrol (Nicotine Inhalation System)- Multum to introduce a consent based claim to cases that were under way before the eye drops careprost. One such attempt in Scotland has, so far, been unsuccessful.

We (ESC) have noticed that a considerable proportion of cases Nicotrol (Nicotine Inhalation System)- Multum obstetric negligence stem since Montgomery involve consent in addition to standard complaints of substandard care.

Pneumococcal 13-valent Conjugate Vaccine [Diphtheria CRM197 Protein] Suspension for Intramuscular In issues are not always pursued, but obstetric litigation practice has noticeably changed, making professional training and clarity with respect to guidelines Nicotrol (Nicotine Inhalation System)- Multum even higher priority.

Looking at some of the cases Nicotrol (Nicotine Inhalation System)- Multum which the Montgomery ruling has been considered tells us about its interpretation to date.

In Nicotrol (Nicotine Inhalation System)- Multum v Hillingdon NHS Trust (April 2015)23 the patient had bilateral pulmonary emboli after a hernia operation. He did not seek treatment immediately because he had not been advised of the risk of deep vein thrombosis or pulmonary embolism or of symptoms that might indicate these.

The judge considered the Montgomery ruling and found that failure to inform the patient was a breach of the duty of care. Shaw v Kovac (October 2015)24 concerned a patient who died in 2007 after a transaortic valve implantation, which was then still the subject of clinical trials and not fully approved. The court rejected this, holding that the Montgomery ruling did not create a right to informed consent as an independent cause of action, but simply set a new legal standard for the duty to disclose.

The claimant alleged that the trust was negligent in failing to advise of this possibility. The court applied the Montgomery test and decided that the risk was not material, because neither a reasonable patient nor the patient herself would have attached significance to it. Thus, although the test is focused on patients, doctors are not liable for every omission of disclosure to which a patient later objects.

Information overload is unlikely given that information should be tailored to the patient. But doctors must judge what is appropriate for each patient and how their exercise of judgment might be assessed by the courts.

The doctor might think that disclosure of certain information could lead the patient to a decision that is not in their best interests, as was true Nicotrol (Nicotine Inhalation System)- Multum the Montgomery case. But the ethical and legal position is clear: doctors must not withhold information simply because they disagree with the decision the patient is likely to make if given that information.



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