A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law

O'Brien, John; Natarajan, M.; Shaikh, Imran

doi:10.1016/j.amsu.2017.04.013

Cited by 11 publications

(15 citation statements)

References 20 publications

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“…Montgomery is viewed as a landmark case in consent practice, it triggered intense professional debate, so it was encouraging that most of the HCPS were aware of it. Additionally, contrary to the findings of O'Brien et al 21 all the obstetricians in this study were familiar with the details of the case. By contrast, however, their midwifery colleagues had limited knowledge.…”

Section: Main Findingscontrasting

confidence: 99%

Consent in pregnancy: A qualitative study of the views and experiences of women and their healthcare professionals

Nicholls

David

Iskaros

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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Objective: Consent in antenatal settings is contentious, poorly understood and recognised as problematic for pregnant women. This study aimed to investigate participants' views and experiences of the consent process. Design: Qualitative research performed in a large urban teaching hospital in London. Sixteen pregnant women and fifteen healthcare professionals (obstetricians and midwives) participated. Consent consultations were observed and in-depth interviews carried out with healthcare professionals and pregnant women using semi-structured interview guides. Data were collectively analysed to identify themes in the experiences of the consent process. Results: Four themes were identified: 1) Choice and shared decision-making. Pregnant women do not always experience consent in a choice-making way and often do not understand information provided to them. 2) Contextualising information disclosure. What is important to women is not only the information but the relational context in which consent is obtained. 3) Quality of HCP-woman relationship. Trust in their healthcare professional sometimes makes women seek less information and conversely. Individualised information is desired by women but professionals found it difficult to ensure that women receive this in practice. 4) Law and professional practice. Doctors are more aware of legal developments in consent related to the Montgomery case than their midwifery colleagues, but they are not always certain of the implications. Conclusion: Results suggest that an effective antenatal consent process which empowers pregnant women requires their understanding of provided information to be elicited. There is a delicate balance to be struck between the trust of a patient in their professional and information-based consent, rather than a simple focus on improving information provision. Whilst recognising women's desire for bespoke consent professionals acknowledged the difficulty of ensuring this in practice. If consent is to remain the legal yardstick of autonomous choice-making, women's understanding and that shared with their healthcare professional needs to be more explicitly addressed.

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Section: Main Findingscontrasting

confidence: 99%

Consent in pregnancy: A qualitative study of the views and experiences of women and their healthcare professionals

Nicholls

David

Iskaros

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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“…They found that the majority of responding doctors were not familiar with their current medicolegal requirements with respect to material risk. 6 Approximately two-thirds of respondents were not aware, or were only vaguely aware, of pertinent legal cases that had recently redefined a doctor's legal requirements for consent. 6 Currently in Australia, there is a paucity of evidence regarding practising doctors' understanding of consent in medical law and their awareness of the medicolegal cases that have shaped it.…”

Section: Introductionmentioning

confidence: 99%

“…6 Approximately two-thirds of respondents were not aware, or were only vaguely aware, of pertinent legal cases that had recently redefined a doctor's legal requirements for consent. 6 Currently in Australia, there is a paucity of evidence regarding practising doctors' understanding of consent in medical law and their awareness of the medicolegal cases that have shaped it. Rogers v Whitaker (1992) is one of the most pertinent medicolegal cases in Australia; however, it is now 27 years old.…”

Section: Introductionmentioning

confidence: 99%

“…recently conducted a survey of doctors at a single university hospital in the United Kingdom. They found that the majority of responding doctors were not familiar with their current medicolegal requirements with respect to material risk 6 . Approximately two‐thirds of respondents were not aware, or were only vaguely aware, of pertinent legal cases that had recently redefined a doctor's legal requirements for consent 6 …”

Section: Introductionmentioning

confidence: 99%

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Doctors' understanding of consent law

Skiba¹,

Sikotra²,

Wilson³

et al. 2021

Internal Medicine Journal

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Background: Obtaining informed consent is an important responsibility of all doctors and is a major component of their day-to-day practice. However, little is known regarding practising doctors' understanding of consent in relation to medical law. Aims: To gain insights into current doctors' understanding of the legal requisites that underpin the consent of patients to medical procedures in Australia. Methods: A cross-sectional survey of Western Australian medical practitioners was conducted. A 15-question online questionnaire (SurveyMonkey, USA) was developed and distributed to Western Australia medical practitioners via social media, hospitalbased Junior doctor society pages and through the email accounts of practitioners registered with MDA National -a large medical defence organisation. Doctors were questioned on their understanding of medicolegal responsibilities, informed consent practice and knowledge of a historically significant Australian medicolegal case (Rogers v Whitaker, 1992). Results: A total of 172 responses was received during the survey period. The respondents came from various levels of seniority and from a variety of subspecialist areas. The survey demonstrated that among the respondents, the understanding of their medicolegal responsibilities around the issues of informed consent was deficient. Only 31% of respondents were aware that it is a court of law that defines the reasonable standard of care in relation to obtaining informed consent. Less than half of the respondents (48%) were aware of the High Court of Australia's definition by which the standard of reasonable care is defined. Conclusion:The results from our survey suggest that there is a requirement to enhance the education of medical practitioners to meet the medicolegal requirements and optimise consent.

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“…For example, O'Brien argues that the GMC guidance was actually shaped by legal cases questioning Bolam from the mid‐1990s. He argues that when the 2008 GMC guidance ‘explicitly called for a patient‐centred approach’, it was ‘reflecting the process of departure from Bolam started by Chester v Afshar and Pearce ’ 55 . In his view, it is clinical practice that has been slow to catch up with legal paradigm shifts on risk disclosure and patient consent.…”

Section: Resultsmentioning

confidence: 99%

Montgomery's legal and practical impact: A systematic review at 6 years

Gallez

Skopek

Liddell

et al. 2021

Evaluation Clinical Practice

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Rationale, Aims and Objectives Six years ago, the Supreme Court judgement in Montgomery v Lanarkshire changed medical law. It introduced a new patient‐based standard of care for the communication of treatment risks and alternatives, rejecting the doctor‐based standard that had long governed all aspects of medical negligence. This is the first systematic review to analyse the literature on Montgomery. Our aim is to appraise and synthesize the literature on Montgomery's impact on medicine and the law and to identify areas for further academic enquiry and implications for professional guidance and training. Methods Searches were run in Medline, Embase, PsycINFO, Web of Science, Scopus, Westlaw UK, HeinOnline, and LexisNexis. Two reviewers screened papers. Extracted data was analysed and discussed by an interdisciplinary team. PRISMA guidelines were followed. Results Of the 1134 papers identified, 100 met the inclusion criteria. These papers revealed significant disagreement on four core sets of issues, focusing on Montgomery's impact on: (1) legal and professional duties; (2) medical practice; (3) the patient experience; and (4) litigation. The first set addresses whether the case actually changed doctors' legal and professional duties, the relationship between GMC guidance and medical law, and the boundaries of Montgomery. The second explores whether the decision has incentivized defensive medicine, its resource implications, and doctors' knowledge of it. The third concerns whether and how the decision has promoted patient autonomy and involvement in their own care. The fourth focuses on whether the case has caused an increase in litigation. Conclusions Despite the abundance of legal and medical literature on Montgomery, many issues remain unresolved. Empirical research is required for many of the questions. Doctrinal analysis informed by medical knowledge is also required to assess whether Montgomery may have unrecognized ramifications—for example, whether it will require the disclosure of risks associated with diagnostic uncertainty, where doctors advise patients without performing procedures.

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A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law

Cited by 11 publications

References 20 publications

Consent in pregnancy: A qualitative study of the views and experiences of women and their healthcare professionals

Consent in pregnancy: A qualitative study of the views and experiences of women and their healthcare professionals

Doctors' understanding of consent law

Montgomery's legal and practical impact: A systematic review at 6 years

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