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Sidaway v Bethlem Hospital [1985] AC 871

By Oxbridge Law TeamUpdated 07/01/2024 19:58

Judgement for the case Sidaway v Bethlem Hospital

KEY POINTS

  • Negligence in the context of medical practitioners often revolves around their duty to provide information to patients regarding surgical procedures that inherently carry certain risks. When undisclosed risks result in harm, this duty hinges on whether the medical practitioner is responsible for furnishing patients with all the necessary details to obtain informed consent.

  • Where undisclosed risks lead to patient harm, questions arise regarding the viability of a negligence claim for non-disclosure of these risks.

  • The central issue often revolves around whether the accepted professional standard and whether the medical practitioner's actions align with this standard should serve as the decisive factor in such cases.

FACTS

  • In 1974, the plaintiff underwent an operation for persistent neck, shoulder, and arm pain led by a senior neurosurgeon at the first defendant's hospital. The procedure, while well-executed, carried a one to two percent (1-2%) risk of damaging the spinal column and nerve roots. 

  • Post-surgery, the plaintiff experienced severe disability, incurring a £67,500 monetary loss. Her negligence claim against the hospital and the deceased surgeon's executors centered on the surgeon's alleged failure to disclose the operation's risks. 

  • The court determined that while the surgeon didn't mention that the operation was elective, he did not convey the risk of spinal cord damage. 

  • The judge applied the Bolam v Friern Hospital test, ruling that the surgeon's actions aligned with accepted medical practice in 1974, dismissing the claim. 

  • This decision was upheld by the Court of Appeal, leading to the plaintiff's appeal to a higher court.

JUDGEMENT

  • The judgment established that a doctor's duty to warn a patient about the inherent risks of a proposed treatment is determined by the Bolam test. However, exceptions exist, particularly when a treatment carries substantial risks, where a judge may conclude that non-disclosure would be negligent only in emergencies or with sound clinical reasons.

  • The plaintiff's appeal was dismissed because she couldn't prove the surgeon's breach of the duty to warn her about inherent treatment risks. 

  • The decision of the Court of Appeal was upheld.

COMMENTARY

  • This case concerned the duty of medical practitioners to provide patients with comprehensive information regarding inherently risky surgical procedures. This responsibility involves securing patients' informed consent by disclosing all necessary details. With regards to negligence, key considerations involve aligning the medical practitioner's actions with the accepted professional standard, often assessed using the Bolam test.

  • The court's decision hinged on crucial findings: the surgeon didn't mention the elective nature of the operation and omitted the risk of spinal cord damage.

  • Applying the Bolam v Friern Hospital test, the judge assessed the surgeon's actions against accepted medical practices in 1974. Consequently, the negligence claim was dismissed, a decision upheld by the Court of Appeal.

    • The judgment clarified that a doctor's duty to inform patients about inherent treatment risks is evaluated using the Bolam test, but exceptions apply when substantial risks are involved. In such cases, non-disclosure might be considered negligent only in specific circumstances, like emergencies or with sound clinical justifications.

  • The plaintiff's appeal was dismissed because she couldn't prove the surgeon's breach of the duty to disclose inherent treatment risks.

  • The Court of Appeal's decision was upheld.

ORIGINAL ANALYSIS

  • Plaintiff underwent an operation that carried a 1% chance of paralysing the patient. Defendant didn’t warn Plaintiff of this and Plaintiff was paralysed.

  • She sued Defendant for negligence.

  • HL said that the Bolam test was to be applied in deciding whether the doctor was negligent in not disclosing the risks.

    • In this case there was a reasonable body of professional opinion that would not have told Plaintiff of the risk.

    • However there were cases where the risk of grave injury was “substantial” and in that case, even if there was a reasonable body of opinion that would not disclose, the judge could find that such non-disclosure was negligent (unless there was a special reason e.g. emergency).

Lord Diplock

  • It is not the courts’ job to say which body of opinion it thinks preferable since the courts do not have the expertise of the professionals.

  • If a patient asks about the risks directly, a doctor has to tell them honestly. However if the information is unsought, a doctor should not be forced to give info which may deter a patient from undergoing an operation that is in their own interest.

Lord Bridge

  • So as to prevent the medical profession from inhibiting the knowledge of patients, he says that where there is a substantial risk of grave injury, the court may decide that non-disclosure was unreasonable, even if medical professionals think it reasonable.

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