Death or serious harm

1. Seek patients’ consent to disclosure of any information wherever possible, whether or not you judge that patients can be identified from the disclosure. 2. Anonymise data where unidentifiable data will serve the purpose. 3. Keep disclosures to the minimum necessary. 26 Point 1, above cannot be achieved due to Frank being unconscious, therefore consent could not be obtained. Disclosures may be made only where they can be justified in the public interest.

27 Once all means have been satisfied and it is found that the patient is not competent, only then personal information may be disclosed in the public interest, the benefits of the public outweigh those of the patient in keeping the information confidential. The courts alone can determine the ‘public interest’. 28 Disclosure of personal information without consent may be justified where failure to do so may expose the patient or others to risk of death or serious harm. 29 The disclosure should be promptly made to an appropriate person or authority.

Taking this point into account, Mr Blewitt’s actions to disclose the information are justified, in that, he was notifying others who worked at the Chemical Plant and local residents of the potential risks. Lord Goff, stated, “… public interest may be outweighed by some other countervailing public interest which favours disclosure” 30 In W v Egdell31, the court justified disclosing information of a patient who was a danger to the public, however the court held that there was a public interest in maintaining confidentiality. It is in the public interest that the press report on matters that concerns the public interest.

With regards to medical confidentiality, the public interest for the freedom of the press must be balanced against the public interest in maintaining patient confidentiality, this was established here, as Franks name was not published. There is a duty to inform the local authority under the “Reporting of Injuries, Disease and Dangerous Occurrences Regulations 1985. Mr Blewitt will be guilty of an offence if he failed to disclose such information as it is for the good of society. If Mr Blewitt failed to pass on the relevant information and as a result a third party suffers injury.

32 In light of this would the other employees at the chemical plant have been affected in negligence if Mr Blewitt had failed to inform them. Duties of care are normally expressed in such more restricted terms, are the other workers are likely to be directly affected by the defendant’s failure to exercise reasonable care. 33 Employees at Chemco are a foreseeable group who are likely to be endangered. Although the public is too wide to hold a duty of care in negligence, Egdell, identifiable group of workers may not. In conclusion I would not hold Mr Blewitt liable for the consent and also the liability issues raised above.

In the Harvinder case, Mr Blewitt used a technique, which was criticised by over 30 surgeons. Certain practices are normal and accepted by the medical profession. It does not signify that doctors’ cannot try innovative treatments. If the circumstances indicate that there were no good reasons for departing from the accepted practice, then Mr Blewitt will be found liable. In Maynard v West Midland Regional HA34 the House of Lords held, the defendants’ were not negligent, as they had conformed to a practice, which was approved by one responsible body of medical opinion.

Otton LJ, stated that in Defreitas v O Brien35, “Given that two of the 11 spinal specialists’ had appeared and supported the defendant’s actions, the plaintiff had therefore failed to discharge the burden of proof … From this it would be quite proper to conclude that, in English law, a minimum of two is needed to constitute a group for the purposes of the Bolam rule. ” 37 Where as in Thake v Maurice38, the defendant failed to comply with his usual practice and he was found negligent.

Criticism of Bolam arose in Hills v Potter39 Hirst J, said that, ‘I do not accept that …by adopting the Bolam principle, the court in effect abdicates its power of decision to the doctors. In every case the court must be satisfied that the standard . . . upheld by a substantial body of medical opinion, and that this body of medical opinion is both respectable and responsible… ’40 It is said, numbers play a part in determining whether the practice is accepted and therefore responsible. In examining the practice the courts must see who has adopted the practice – thus the court counts heads … the greater the number of followers … the more likely the practice is to be regarded as being accepted and responsible.

This implies that the higher the number of followers for the practice, the higher the degree of respectability. 41 This information suggest that if a body of two people indicate that the pioneering methods of surgery is acceptable, then it must be accepted practice. In conclusion to this stance taken in Defreitas suggests with the backing of two other surgeon, Mr Blewitt is not be liable for using the innovative practivce. 42 Dillon LJ said in Bolitho v City & Hackney HA43 that the courts could only reject the medical practice if, ‘ . . . the court, fully conscious of its own lack of medical knowledge and clinical experience …

i. e. views such as no reasonable body of doctors could have held’. 44 The House of Lords adopted a revised explanation of Bolam. They emphasised that only ‘responsible’ medical opinion was relevant and stated that where expert opinion was not capable of withstanding logical analysis then the judge would have authority to reject it. Which in turn, makes a strong statement of law that courts should set the standards for the medical profession. 45 Dillon LJ continued, the judiciary themselves have no clinical expertise and therefore very few judges would be daring enough to question medical matters due to their lack of knowledge.

46 Furthermore, in, Hucks v Cole47, Cole was found negligent even though he had support from medical experts. Sachs LJ stated that, it was not a case of conflict between two schools of thought, but a case ‘of doctors who said in one form or another said that they would have acted or might have acted in the same way as the defendant did… ’48 The criticisms continued, courts should examine the medical expert witnesses and not simply except this at face value and agree with whatever is said. As this is law, Harvinder’s claim would fail under medical malpractice, due to the Bolam test.

We will now look to see whether Mr Blewitt should have informed Harvinder of the potential risk of the operation. The general requirements for a valid consent are; 1. Sufficient understanding -mental capacity or competence 2. Decision must be voluntary 3. Sufficient information about the proposed treatment In Rogers v Whitaker49 ‘the doctor had a duty to warn a patient of a ‘material risk’ inherent in a proposed treatment’50 would the patient, have consented to the treatment if they knew of the potential risks involved? If Harvinder had known, would he add importance to whether he wanted this technique to be used?

This is highly unlikely, who in the right mind would choose to be paralysed. The Rogers case may be contrasted to Sidaway v Governors of Bethlem Royal Hospital26, The House of Lord stated, doctors’ will normally not be held for a breach of duty, by failing to warn of risks provided other doctors’ would similarly not have warned of them. 51 In Sidaway, the plaintiff was not informed of the risk of damage to her spinal cord and thus left paralysed. The House of Lords held, the surgeon followed an approved practice of neurosurgeons in not disclosing the risk of damage to the spinal cord therefore they were not held liable.

Lord Scarman commented, ‘… if the material risk were not disclosed, then the doctor would be negligent’ . . . ‘the court should ask whether a reasonable person in the patient’s position would have regarded it as being sufficient’52 Lord Bridge stated, ” … If a responsible body of practitioners would have accepted (at the time) that it was legitimate not to discuss the risk of paralysis, then her case had to fail… “53 Lord Templeton suggested, there was an obvious risk to Sidaway’s spinal cord and there was no need for the doctor to explain this.

Some patients do not want to know the details of their care and place complete trust within the doctor. If the patient would like to know, then surly they would ask the doctor. It would be for the courts to decide whether an explanation would be sufficient to alert patients of potential risks. 54 The final decision lies with patients’, who are entitled to reject medical advice. However, patients were not entitled to all the information available, for to tell them everything might conflict with the doctors’. A court would find a doctor liable in negligence if the patient were deprived of the information necessary to achieve this purpose.

55 For Harvinder’s claim in negligence to be successful, he would have ascertained, there has been a breach, which was the failure to provide adequate information. Furthermore this breach caused injury to Harvinder. In Smith v Tunbridge Wells HA56 where, ‘a body of experienced competent surgeons’ would not have warned the patient of the risk’. The judge regarded this as ‘neither reasonable nor responsible’ and found the surgeon negligent for failing to disclose the risk. 57 The case is not binding on subsequent courts and is arguably inconsistent with the decision of the House of Lords in Maynard.

Harvinder may rely on the outcome of this decision in that he was uninformed of the risk of being paralysed. In Schloendorff v New York Hospital58, Cardoza. J. , stated, “Every human being of adult years and sound has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent, commits an assault”. Now, because all information about the treatment was not provided to Harvinder, then with affect there is no consent. Mr Blewitt failed to comply with the standard of care.

How then does the Doctor decide how much information to tell the patient? The American courts state it is what the prudent and reasonable patient would require. 15 English courts however adopted the Bolam test where reasonable medical opinion became …

‘I will prescribe regimen for the good of my patients according to my ability and my judgement and never do anyone harm’. 59 Harm was already inflicted, thus Harvinder being paralysed. In Gold v Haringey HA60, the Court of Appeal …

I for one, find it particularly interesting, because these same doctors take the Hippocratic Oath: I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil …

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