Do I Need to Give Consent for Surgery?

Made Aware of the Risks

Doctors and surgeons must ensure that a patient is made aware of the risks of any treatments they offer, and whether there are any alternatives. This is particularly important in cases involving plastic surgery, where the patient has a real choice compared to, for example, a life-saving surgical operation to remove a malignant tumour.

The inevitable question that arises is “if the warnings had been given, what would the patient have done?” The case of Montgomery v Lanarkshire Health Board can help us answer this question.

Mrs Montgomery was diabetic, a condition that can often lead to a pregnant woman having larger than normal babies. This in turn leads to an increased risk of shoulder dystocia, where the baby’s head may descend through the pelvis but cannot pass through without medical intervention.

Her doctor didn’t warn her that normal vaginal delivery carried a 9-10% risk of shoulder dystocia, and didn’t offer a caesarean section as an alternative. Mrs Montgomery gave birth by way of vaginal delivery and there was shoulder dystocia leading to her son being born with cerebral palsy. Had he been delivered by caesarean section, he would not have suffered the birth injury and been a healthy baby.

The Court held that the Consultant should have warned of the risk of shoulder dystocia and discussed alternatives such as having a caesarean section.

In this type of situation, there are three questions that need to be explored:

• What warnings were given?
• What warnings should have been given?
• If those warnings had been given, would the patient have consented to the surgery?

Informed consent is a live issue in medical law. So wherever possible, patients and relatives should continue to ask questions and demand information before elective procedures to ensure that they have the best possible information before deciding to proceed to surgery.