Informed consent in medical treatment – what does it mean, how has it evolved, and what are the differences in its application between the UK and Ireland?
J Mergi Hernandez BL analyses consent in medical practice and the case law that has influenced its evolution over the years.
Consent in medical treatment is a fundament principle of patient autonomy and ethical medical practice. Ireland and the UK established a legal framework to ensure patients are fully informed about their treatment, risks, options, and alternatives to ensure that patients can make informed decisions about their healthcare.
Dunne Principles
In Ireland, the landmark case Dunne v National Maternity Hospital [1989] IR 91 established six principles for assessing medical negligence, known as the “Dunne principles.” These principles dictate that a medical practitioner can only be considered negligent if their actions deviate significantly from what any reasonable practitioner of the same status would do in similar circumstances.
Evolving Standards
Both Geoghegan v. Harris [2000] 3 I.R. 536 and Fitzpatrick v. White [2007] 2 I.R. 551 have shaped the understanding of informed consent in Ireland. These rulings introduced the “reasonable patient” standard, requiring that doctors disclose risks and alternatives that a reasonable patient would consider significant. This shift emphasises patient autonomy and aligns with the principles of bodily integrity enshrined in the Constitution of Ireland.
Montgomery v. Lanarkshire Health Board
The Montgomery v. Lanarkshire Health Board [2015] UKSC 11 case marked a significant shift towards a patient-centred approach in the UK. The Supreme Court ruled that doctors must inform patients of any material risks involved in a proposed treatment and any reasonable alternatives. The materiality of a risk is determined by whether a reasonable person in the patient’s position would consider it significant.
Key issues in Montgomery included:
1. The obligation to disclose significant risks.
2. What a reasonable patient would need to know.
This case overturned the earlier standard set by Bolam v. Friern Hospital Management Committee [1957] 1 WLR 582, which focused on professional judgment rather than patient autonomy.
McCullough v. Forth Valley Health Board
In McCullough v. Forth Valley Health Board [2023] UKSC 26, the UK Supreme Court addressed the legal standards for a doctor’s duty to inform a patient of reasonable alternative treatments. The court upheld the professional practice test from Bolam, stating that doctors are not required to discuss treatments they do not consider clinically proper based on a responsible body of medical opinion.
Ireland Approach
Ireland’s legal framework balances professional judgment with patient rights. The Dunne principles emphasise adherence to accepted medical practices while ensuring that deviations from these standards are carefully scrutinised. The shift towards considering what a reasonable patient would want to know highlights a growing recognition of patient autonomy.
The UK’s Patient-Centered Shift
The UK has taken a more definitive stance towards patient-centred care with the Montgomery ruling. This case mandates that doctors inform patients of all material risks and reasonable alternatives, ensuring that patients make informed decisions. The McCullough case, however, reaffirms that doctors’ professional judgment is still paramount when deciding what constitutes a reasonable alternative treatment.
The evolution of informed consent in Ireland and the UK reflects a broader shift towards prioritising patient autonomy in medical decision-making. While Ireland balances professional judgment and patient rights, recent cases emphasise the importance of understanding what a reasonable patient would need to know.
In the UK, the Montgomery ruling in 2015 fundamentally transformed the duty of disclosure, aligning legal obligations with contemporary expectations of ethical medical practice. However, the McCullough decision in 2023 underlines that doctors do not have to discuss all possible treatments, thus, only those considered reasonable by a responsible body of medical opinion. The distinction is crucial as it supports the integrity of professional medical judgment while ensuring that patients are informed about significant risks and workable alternatives.
Legal professionals navigating medical negligence cases understand these nuance standards to effectively advocate for their clients. The emphasis on patient-centred care in the UK and the balanced approach in Ireland, aims to enhance patient autonomy, ensuring that patients are empowered to make informed decisions about their healthcare.
The views expressed above are the author’s own and do not reflect the views of The Bar of Ireland.
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