The Montgomery ruling requires that all reasonable options are discussed with patients to help them make a decision:
- This does not mean that you are required to discuss all options available if they are not all appropriate/reasonable in a particular patient's case
- You are not expected to be able to offer any and all treatments that can be found globally/in research settings
- If a patient requests a treatment/procedure that you do not think is a reasonable or appropriate option, you can refer on to another clinician for a second opinion
Patients may still say 'You decide, I don't know what's best' and, as long as the different options have been considered and compared, you can guide the patient.
The 'therapeutic exception' should be not be abused
- The circumstances where a patient will be harmed by being informed of the choices open to them and risks associated with the options, will not be rare
Patients are allowed to choose no treatment or to pick an option that may not be the best option in your professional opinion
A patient can say ‘I don’t want to know the risks’
- Discuss and try to find out if there is anything underlying this position
- If the patient genuinely does not wish to know and they understand that they may not be able to make a balanced decision as a result, they do not have to be told
- It is important to document all discussions carefully
Medical Consent The Montgomery Case
