- Bookmark
- Share
- CaseIQ
Sidaway v Board of Governors of the Bethlem Royal Hospital
Factual and Procedural Background
The Appellant suffered chronic cervical pain and in 1974 consented to neurosurgery performed at The Hospital by the late neuro-surgeon, “Respondent Surgeon.” The operation was technically successful but resulted in spinal-cord damage that left the Appellant partially paralysed. The Appellant alleged that the Respondent Surgeon failed to warn her of that specific risk. At first instance Judge [Last Name] dismissed the action; the Court of Appeal affirmed. The present judgment is the decision of the House of Lords on the Appellant’s further appeal.
Legal Issues Presented
- Does a doctor’s duty of care include a legal obligation to warn a patient of material risks inherent in proposed treatment?
- Should that duty be measured by the professional-practice standard in Bolam or by an objective “prudent patient” standard (the so-called doctrine of informed consent)?
- If a duty exists, did the Respondent Surgeon breach it on the facts proved?
Arguments of the Parties
Appellant's Arguments
- Even on the Bolam test the omission to mention spinal-cord risk was negligent.
- Alternatively, English law recognises an independent right of self-determination; failure to disclose a material risk is actionable regardless of prevailing medical practice (the “informed consent” doctrine).
- Had the risk been disclosed, the Appellant would have refused the operation and avoided injury.
Respondents' Arguments
- The scope of any duty to warn is governed by Bolam; evidence showed the Respondent Surgeon’s practice accorded with a responsible body of competent neuro-surgeons.
- No reliable evidence established what was said between surgeon and patient; the burden of proof lay on the Appellant.
- Even if an “informed consent” principle were recognised, the risk here (less than 1 %) was not “material.”
Table of Precedents Cited
| Precedent | Rule or Principle Cited For | Application by the Court |
|---|---|---|
| Bolam v. Friern Hospital Management Committee [1957] 1 W.L.R. 582 | A doctor is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical opinion. | Majority applied Bolam to advice/warning as well as to diagnosis and treatment. |
| Whitehouse v. Jordan [1981] 1 W.L.R. 246 | House of Lords endorsement of the Bolam standard for treatment decisions. | Cited as recent authority confirming Bolam. |
| Maynard v. West Midland RHA [1984] 1 W.L.R. 634 | Courts should not prefer one responsible body of professional opinion over another. | Reinforced reluctance to substitute judicial opinion for medical judgment. |
| Hunter v. Hanley 1955 S.L.T. 213 | Scottish statement of the Bolam principle. | Cited as parallel authority. |
| Nocton v. Lord Ashburton [1914] A.C. 932 | Judicial development of duties in special relationships. | Used by Judge [Scarman] to illustrate common-law adaptability, but fiduciary analogy rejected. |
| Slater v. Baker (1767) 2 Wils. 359 | Early recognition that surgical negligence lies in “case,” not trespass. | Referenced by Judge [Diplock] in historical review. |
| McLoughlin v. O’Brian [1983] 1 A.C. 410 | Policy issues are for Parliament where necessary. | Cited to dismiss fears of “defensive medicine” as legislative, not judicial, concerns. |
| Canterbury v. Spence 464 F.2d 772 (D.C. Cir. 1972) | U.S. authority for objective “prudent patient” disclosure standard. | Discussed at length; majority declined to adopt its approach. |
| Reibl v. Hughes (1980) 114 D.L.R. (3d) 1 | Supreme Court of Canada acceptance of modified informed-consent doctrine. | Considered but not followed. |
| Bly v. Rhoads 222 S.E.2d 783 (Va 1976) | U.S. rejection of Canterbury doctrine. | Quoted approvingly by Judge [Bridge]. |
Court's Reasoning and Analysis
Five Law Lords gave separate speeches.
- Judge [Scarman]: Recognised a patient’s legal right to be warned of “material” risks and favoured an objective “prudent patient” test qualified by therapeutic privilege. Nevertheless, the Appellant failed on evidence: the risk of catastrophic cord damage was under 1 % and no proof showed it was “material” to a reasonable patient in her position.
- Judge [Diplock]: Emphasised that all aspects of a doctor’s duty, including warnings, are governed by Bolam; deciding what to disclose is itself a matter of professional judgment. As expert evidence showed the non-disclosure accorded with responsible practice, negligence was not proved.
- Judge [Keith]: Agreed with Judge [Bridge] that the appeal should fail.
- Judge [Bridge]: Analysed U.S. and Canadian cases, rejected the impracticability of an objective disclosure rule, and concluded that the patient’s right is adequately protected by applying Bolam, subject to the possibility that exceptionally obvious dangers might require disclosure even if customarily omitted. The present risk was not such an exception.
- Judge [Templeman]: Focused on contractual and professional obligations: a doctor must give information sufficient for a balanced judgment but need not enumerate remote risks unless special. On the facts, the general explanation was adequate.
Holding and Implications
APPEAL DISMISSED – ORDER OF THE COURT OF APPEAL AFFIRMED.
Direct Consequences: The Appellant recovers no damages; her costs are to be taxed under the Legal Aid Act 1974 and Respondents’ costs paid from the Legal Aid Fund.
Broader Implications: The House of Lords confirmed that warnings about medical risks are ordinarily judged by the Bolam professional-practice standard. Although Judge [Scarman] articulated a potential “material risk” test, the majority declined to adopt the U.S./Canadian informed-consent doctrine, thereby signalling that English law remains anchored in professional custom while leaving limited scope for future judicial scrutiny where a risk is “obviously” significant.
Alert