THIS Institute, University of Cambridge, Cambridge, UK.
Faculty of Law, Centre for Law, Medicine and Life Sciences, University of Cambridge, Cambridge, UK.
J Eval Clin Pract. 2022 Aug;28(4):690-702. doi: 10.1111/jep.13620. Epub 2021 Oct 8.
RATIONALE, AIMS AND OBJECTIVES: Six years ago, the Supreme Court judgement in Montgomery v Lanarkshire changed medical law. It introduced a new patient-based standard of care for the communication of treatment risks and alternatives, rejecting the doctor-based standard that had long governed all aspects of medical negligence. This is the first systematic review to analyse the literature on Montgomery. Our aim is to appraise and synthesize the literature on Montgomery's impact on medicine and the law and to identify areas for further academic enquiry and implications for professional guidance and training.
Searches were run in Medline, Embase, PsycINFO, Web of Science, Scopus, Westlaw UK, HeinOnline, and LexisNexis. Two reviewers screened papers. Extracted data was analysed and discussed by an interdisciplinary team. PRISMA guidelines were followed.
Of the 1134 papers identified, 100 met the inclusion criteria. These papers revealed significant disagreement on four core sets of issues, focusing on Montgomery's impact on: (1) legal and professional duties; (2) medical practice; (3) the patient experience; and (4) litigation. The first set addresses whether the case actually changed doctors' legal and professional duties, the relationship between GMC guidance and medical law, and the boundaries of Montgomery. The second explores whether the decision has incentivized defensive medicine, its resource implications, and doctors' knowledge of it. The third concerns whether and how the decision has promoted patient autonomy and involvement in their own care. The fourth focuses on whether the case has caused an increase in litigation.
Despite the abundance of legal and medical literature on Montgomery, many issues remain unresolved. Empirical research is required for many of the questions. Doctrinal analysis informed by medical knowledge is also required to assess whether Montgomery may have unrecognized ramifications-for example, whether it will require the disclosure of risks associated with diagnostic uncertainty, where doctors advise patients without performing procedures.
背景、目的和目标：六年前，最高法院在 Montgomery v Lanarkshire 的判决改变了医疗法律。它为治疗风险和替代方案的沟通引入了新的以患者为基础的护理标准，摒弃了长期以来一直主导医疗过失各个方面的以医生为基础的标准。这是第一项分析 Montgomery 文献的系统评价。我们的目的是评估和综合关于 Montgomery 对医学和法律影响的文献，并确定进一步学术研究的领域，以及对专业指导和培训的影响。
在 Medline、Embase、PsycINFO、Web of Science、Scopus、Westlaw UK、HeinOnline 和 LexisNexis 中进行了检索。两名审查员筛选了论文。由跨学科团队分析和讨论提取的数据。遵循 PRISMA 指南。
在所确定的 1134 篇论文中，有 100 篇符合纳入标准。这些论文揭示了对四个核心问题的显著分歧，重点是 Montgomery 对以下方面的影响：（1）法律和专业职责；（2）医疗实践；（3）患者体验；和（4）诉讼。第一组涉及该案件是否实际上改变了医生的法律和专业职责、GMC 指南与医疗法之间的关系以及 Montgomery 的界限。第二组探讨了该决定是否激励了防御性医疗、其资源影响以及医生对其的了解。第三组涉及该决定是否以及如何促进了患者的自主权和参与自己的护理。第四组集中讨论该案件是否导致诉讼增加。
尽管有大量关于 Montgomery 的法律和医学文献，但许多问题仍未得到解决。许多问题需要进行实证研究。还需要通过医学知识进行教义分析，以评估 Montgomery 是否可能产生未被认识到的后果，例如，是否需要披露与诊断不确定性相关的风险，医生在不进行手术的情况下向患者提供建议。
