From Bolam to Montgomery – A Landmark Shift in Medical Negligence and Patient Consent and How it Applies to Claimants
Before Montgomery, doctors in the UK largely relied on the Bolam test to defend negligence claims meaning that a clinician’s conduct in advising patients was judged against what a responsible body of medical opinion would do to determine negligence.
But Montgomery changed everything: the Supreme Court made it clear that decisions about what risks to disclose are not a matter of professional opinion, but of patient autonomy and choice.
Unlike the earlier Sidaway v Board of Governors of the Bethlem Royal Hospital (1985), which permitted the Bolam approach to consent, Montgomery firmly placed the patient not the doctor at the centre of the consent process.
The Facts Behind the Ruling
Mrs Nadine Montgomery, a diabetic woman of smaller stature, was advised that vaginal delivery was appropriate. Her consultant did not inform her of a 9-10% risk of shoulder dystocia a serious complication that occurred, leading to her child’s injury.
Mrs Montgomery argued that, had she been told of this risk and the alternative of a caesarean section, she would have chosen the latter a choice the Supreme Court found credible.
What the Supreme Court Held
In Montgomery v Lanarkshire Health Board [2015] UKSC 11, the UK Supreme Court unanimously ruled that:
- Doctors must take reasonable care to ensure patients are aware of any “material risks” in proposed treatments.
- Patients must also be informed about reasonable alternative treatments or variants.
- The traditional Bolam test no longer applies to the disclosure of risks; it is not enough for the information to align with clinical opinion.
The court explained that materiality depends on two aspects:
- Whether a reasonable person in the patient’s position would likely regard the risk as significant, or
- Whether the doctor should reasonably know that the particular patient would find it significant.
This dual test combines an objective baseline with a subjective understanding of the individual patient.
What “Material Risk” Really Means
Under Montgomery, it isn’t about statistical probabilities alone even risks that might seem low in numerical terms can be material if their consequences matter to the patient.
For example:
- A 3% risk might be insignificant to one patient but entirely unreasonable for another, depending on individual circumstances.
- A rare but catastrophic consequence (such as paralysis in childbirth) becomes material because of its severity and impact.
Doctors are no longer justified in merely relying on what other clinicians might consider “adequate” disclosure; the law now requires genuine dialogue and understanding.
The Legal Landscape After Montgomery
Sidaway (1985) which applied Bolam to risk disclosure has been effectively overtaken by Montgomery.
Bolam still applies in clinical negligence claims involving technical skill or treatment decisions, but not when it comes to informing patients about risks.
Subsequent cases such as McCulloch v Forth Valley Health Board have further clarified how the “reasonable alternative treatment” limb works, showing courts continue to refine the Montgomery framework.
Why MontgomeryIs a Landmark Ruling
- Patient autonomy is now a core legal principle in UK medical law.
- The decision aligns UK law with international jurisdictions that prioritise patient rights.
- It requires doctors to tailor risk discussions to the individual, not rely on broad medical consensus.
For medical negligence claimants, Montgomery provides a powerful legal foundation to pursue compensation where a lack of proper information deprived them of meaningful choice and resulted in harm.
How We Can Help You
At Step Legal, we specialise in clinical negligence and personal injury claims. If you or a loved one believe that inadequate risk disclosure contributed to a poor medical outcome, Montgomery may form the basis of a strong claim.
We can help you:
- Understand whether the risks omitted were material in your circumstances.
- Assess whether reasonable alternatives were available and should have been disclosed.
- Build your case with experienced medical expert support.
- Seek the compensation you deserve for avoidable suffering.
Final Thoughts
Montgomery v Lanarkshire Health Board didn’t just tweak medical law it reset the relationship between doctors and patients in the UK. The ruling recognises that patients today are informed adults, entitled to meaningful participation in decisions about their own bodies and futures.
If you have concerns about medical treatment or believe that inadequate consent has caused you harm, don’t navigate it alone get expert legal advice and explore your options with a team that knows how to advocate on your behalf.
Contact Step Legal today on 01270254064, visit our website and make an enquiry, or email us via enquiries@steplegal.co.uk.
