- Published on
Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital (1985): A Study Guide
This case concerns the standard of care required for disclosing risks to patients before medical procedures.
I. Facts of the Case:
This case concerns the standard of care required for disclosing risks to patients before medical procedures.
I. Facts of the Case:
- Procedure: The plaintiff underwent surgery for neck and shoulder pain.
- Risks: The surgery carried a 1-2% risk of nerve root damage and a smaller risk of spinal cord damage (leading to paralysis).
- Disclosure: The surgeon informed the plaintiff about the nerve root risk but not the spinal cord risk.
- Outcome: The surgery was competently performed, but the plaintiff suffered spinal cord damage and paralysis.
- Lawsuit: The plaintiff sued for failure to inform her of the spinal cord damage risk.
- Majority Ruling: The surgeon was not liable. The House of Lords applied the Bolam test, finding that the surgeon's actions conformed to accepted medical practice at the time. This means the surgeon acted in accordance with a responsible body of medical opinion.
- Key Point: The Bolam test assesses the standard of care based on what a responsible body of medical professionals would do. This is a professional standard, not a lay standard.
- Lord Scarman's Dissent: He rejected the Bolam test in this context and argued for a "prudent patient" test (similar to the US case Canterbury v Spence). This test centers on whether a reasonable person in the patient's position would consider the risk significant enough to warrant disclosure. This is a patient-centric approach, focusing on the patient's right to information.
- Lord Diplock's Opinion: He fully supported the unqualified application of the Bolam test.
- Other Lords' Opinion: While agreeing with the Bolam test, they acknowledged judicial oversight, implying that even if a medical practice is accepted, a court can still find it wanting if it's demonstrably unreasonable to withhold information about a particular risk. This means there's a degree of judicial control over the medical profession's self-regulation.
- Lord Bridge's Qualification: He suggested that if the necessity of disclosure was so obvious that any reasonably prudent doctor would disclose, then the Bolam test might not apply. This hints at a "common sense" exception to the Bolam test.
- Bolam Test: Focuses on medical professional standards. Did the doctor act in accordance with a responsible body of medical opinion?
- Prudent Patient Test: Focuses on the patient's perspective. Would a reasonable patient consider the risk significant enough to warrant disclosure?
- Understand the difference between the Bolam test and the prudent patient test. What are the strengths and weaknesses of each?
- Analyze the differing viewpoints of the Lords. Why did they disagree, and what are the implications of each position?
- Consider how the case reflects the tension between medical professional autonomy and patient autonomy.
- Note the limitations and potential evolution of the Bolam test following this case. The judges seemed to acknowledge that the Bolam test is not absolute and may be subject to judicial oversight.
0 Comments