Greenway Fay, Tulloch Isabel, Laban James
Atkinson Morley Department of Neurosurgery, St George's Hospital, London, UK.
Department of Neurosurgery, King's College Hospital, London, UK.
Br J Neurosurg. 2018 Dec;32(6):604-609. doi: 10.1080/02688697.2018.1519111. Epub 2018 Dec 18.
In March 2015, the Supreme Court's landmark ruling on the common law case of Montgomery vs Lanarkshire Health Board established the doctrine of informed patient consent, setting the legal standards that doctors should abide by. In this review, our primary aim has been to establish whether, despite the well-publicised implications of the ruling in the legal community, the medical profession has altered its practice. To do this, we reviewed the consenting methods applied by surgeons within our field of neurosurgery. We chose the rare, but disabling, material risk of prone spinal surgery: post-operative visual loss (POVL), as our tool for assessment. Departmental and national surveys both identified a common theme - the vast majority of doctors consenting patients for prone spinal surgery either do not consider POVL to be a serious material risk, or alternatively are not aware that current legal standards require them to ensure that patients are made aware of material risk involved in their treatment. In light of this finding, we discuss the legal implications of the Montgomery ruling, the current regulatory guidance available to support doctors, suggest some strategies to align clinical practice with the legal standards advocated by the ruling, and highlight some of the challenges surrounding the consent process given the legal framework in which we now practice.
2015年3月，最高法院对蒙哥马利诉拉纳克郡健康委员会这起普通法案件作出具有里程碑意义的裁决，确立了患者知情同意原则，设定了医生应遵循的法律标准。在本综述中，我们的主要目的是确定，尽管该裁决在法律界的影响已广为人知，但医学界的做法是否有所改变。为此，我们回顾了神经外科领域外科医生采用的同意方法。我们选择了俯卧位脊柱手术罕见但会导致残疾的重大风险——术后视力丧失（POVL），作为我们的评估工具。部门和全国性调查都发现了一个共同主题——绝大多数为患者进行俯卧位脊柱手术的医生要么不认为POVL是严重的重大风险，要么不知道当前法律标准要求他们确保患者知晓其治疗中涉及的重大风险。鉴于这一发现，我们讨论了蒙哥马利裁决的法律影响、当前支持医生的监管指南，提出了一些使临床实践与该裁决所倡导的法律标准保持一致的策略，并强调了在我们目前所处的法律框架下，围绕同意过程存在的一些挑战。
