Global differences in informed consent - a review of recent legal changes in the UK and comparisons abroad

NMUH Staff Publications

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<span style="font-size: 10pt;">Patient autonomy and informed consent are fundamental principles in all areas of medicine. In the diverse field of obstetrics and gynaecology, consenting patients is a key skill in many aspects of daily practice. It is essential for clinicians to have a firm understanding of their legal and ethical duties. Although the founding principles of consent are the same, there are wide variations in the detail both recently in the UK and abroad. In 2015 a case law, (Montgomery 2015), was passed in the UK that could potentially expose major challenges to practising obstetricians. Mrs Montgomery was a diabetic primigravida who developed shoulder dystocia during delivery of her son and resulting cerebral palsy. She successfully argued that she had not been adequately informed about the risks of vaginal delivery in diabetic mothers and was not offered an elective caesarean section. The General Medical Council's Good Medical Practice document (2008) states that patients must be given adequate information on serious risks, however rare, although UK doctors are currently under no duty to act on patient requests if they are not deemed in their best interests. As a result of the Montgomery case law, patients must now be given information on all risks, however rare, and the focus has shifted further towards patient choice and independence. The responsibility now lies with the patient to decide whether a small risk of shoulder dystocia, or the unpredictability of a vaginal delivery are more hazardous than an elective caesarean section. We aim to explore the difficulties that the UK profession may face as a consequence of this ruling. We will review consenting guidance in the USA and India for comparison and evaluate how factors such as cultural doctor-patient relationships, medico-legal implications and the cost of healthcare may influence consent. We will also consider the impact that this ruling may have over patient autonomy versus clinical judgment and the effects of different perceptions of risk between obstetricians and patients. Lastly, we hypothesise that this ruling will increase the rate of elective caesarean section and will explore potential consequences. (Conference abstract)</span>