Articles recently published in The Lancet outlines the impact of a 2015 ruling involving a case that resulted in a child being born with cerebral palsy. The case, Montgomery vs Lanarkshire Health Board 2015 – often referred to as simply Montgomery — drew attention to the complexity of informed consent. Previously the “Bolam” test in England and the “Hunter v Hanley” test in Scotland determined what should be disclosed to patientd by requiring clinicians to consider whether their actions would be supported by their peers. The Montgomery ruling establishes that health-care practitioners must ensure patients are aware of any material risks involved in a proposed treatment, and also of reasonable alternatives. It asks the clinician to consider whether a reasonable person in the patient’s position would likely attach significant risk to an intervention. This change emphasises the patient-centred direction in which healthcare is travelling.
Notably, clinicians must not withhold information simply because they think the patient will make a decision they disagree with once given that information. Today’s patients are far less amenable to outdated paternalism, and wish to be more deeply involved in the decision-making process. There is a suggestion from the small study mentioned in the Lancet that increased time is required to discuss the complexity of consent with patients, and clinicians might be more cautious in their practice and advice. There are further challenges, including how to effectively communicate with patients and in what level of detail.
The discussion around informed consent runs through all healthcare disciplines, and osteopaths are certainly not alone in engaging with the nuances in this area of communication.
The Lancet article is available in full at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31124-3/fulltext
The BMJ article is available in full at https://www.bmj.com/content/357/bmj.j2224