Introduction
In English civil law, the responsibility of a doctor towards their patient is primarily governed by the tort of negligence. For a patient to succeed in a claim for clinical negligence, they must establish that the doctor owed them a duty of care, that this duty was breached by falling below the required standard, and that this breach caused the patient to suffer actionable damage (Horsey and Rackley, 2021). While all elements are crucial, the nature of the duty and the specific standard of care applied to medical professionals are central to defining a doctor’s legal responsibility. This essay will outline the basis of the doctor-patient duty and explain the development of the legal standard used to assess a doctor's conduct.
The Duty of Care
The existence of a duty of care between a doctor and a patient is rarely a contentious issue in law. As soon as a doctor accepts a patient for treatment, a duty of care is established. This principle is so well-accepted that it is often taken for granted in clinical negligence cases. The foundational case of Donoghue v Stevenson [1932] AC 562 established the 'neighbour principle' for determining a duty of care in novel situations. However, the doctor-patient relationship is an established category where a duty is automatically recognised. For example, in Barnett v Chelsea & Kensington Hospital Management Committee [1969] 1 QB 428, the hospital was found to owe a duty of care to a patient who presented himself at the accident and emergency department, even though the doctor who was contacted by phone did not see him. The acceptance of the patient by the hospital created the necessary relationship for the duty to arise.
The Standard of Care: The Bolam Test
The most significant aspect of a doctor's responsibility is the standard of care against which their actions are judged. The classic test was established in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582. In this case, McNair J stated that a doctor is not negligent if they have “acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art”. This means a doctor is not expected to be perfect, but must meet the standard of a reasonably competent professional in their field. The Bolam test allowed for differing medical opinions, meaning a doctor would not be in breach of their duty if they followed one of several accepted professional approaches, even if another approach existed.
However, the courts later clarified that the professional opinion must be logical. In Bolitho v City and Hackney Health Authority [1998] AC 232, the House of Lords held that a court could find a medical opinion to be unreasonable if it could not be logically supported. This gave the court a greater role in scrutinising medical practice, preventing doctors from relying on an expert opinion that was not demonstrably sensible.
The Shift Towards Patient Autonomy: Duty to Inform
For many years, the Bolam test was also applied to the duty to inform patients about risks. However, the Supreme Court decision in Montgomery v Lanarkshire Health Board [2015] UKSC 11 marked a significant shift in medical law, moving away from medical paternalism towards patient autonomy. The court held that the question of what risks to disclose to a patient is not a matter of professional judgment alone. Instead, a doctor is under a duty to take "reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments".
A risk is considered 'material' if a reasonable person in the patient's position would be likely to attach significance to it, or if the doctor knows or should reasonably know that the particular patient would be likely to attach significance to it. This ruling fundamentally changed the doctor's responsibility, making the dialogue with the patient and the patient's own values central to the process of giving consent.
Conclusion
In conclusion, a doctor's responsibility to a patient in civil law is defined by an established duty of care and a specific professional standard. While the Bolam test has long provided the benchmark for assessing the quality of diagnosis and treatment, subject to the Bolitho qualification, the law has evolved significantly. The decision in Montgomery has reshaped a key area of a doctor's responsibility, imposing a patient-focused duty to inform and advise. This reflects a broader legal and social shift towards recognising the importance of individual autonomy in medical decision-making. Therefore, a modern understanding of a doctor's responsibility requires an appreciation of both the standard of professional skill and the duty to ensure the patient is a properly informed partner in their own care.
References
Barnett v Chelsea & Kensington Hospital Management Committee [1969] 1 QB 428
Bolam v Friern Hospital Management Committee [1957] 1 WLR 582
Bolitho v City and Hackney Health authority [1998] AC 232
Donoghue v Stevenson [1932] AC 562
Horsey, K. and Rackley, E. (2021) Tort Law. 7th edn. Oxford University Press.
Montgomery v Lanarkshire Health Board [2015] UKSC 11
