We are posting this report written by Laura Able, Survivor Researcher Network member, on a recent conference attended with financial support from SRN from our Community Fund Awards for All project.
Montgomery to McCulloch – What now?
Collaborating Centre for Values-Based Practice in Health and Social Care conference, Wednesday 25 October 2025, St Catherines College, Oxford
Why it’s important for everyone as a “seismic shift in informed consent” -according to the medical lecturer in this video. He explains the Montgomery Ruling more accurately than I can and because it is about the law, I do not want to get it wrong. Please see the video.
Nadine Montgomery talks about her lived experience here. She describes what happened to her and her fight for information, choice and rights.
I watched these before the event, as I had no prior knowledge about this ruling. I knew it was relevant to rights and principles like patient autonomy, disclosure and shared decision making for all, in health and mental health care. The highpoint of being there, was amazingly the King’s Counsel (KC) who fought for it, Lauren Sunderland KC gave the first presentation. It was inspiring to have such a passionate historical explanation of the Montgomery Ruling and the tribulations.
Nadine Montgomery is Scottish (as is her KC) and the case started in the early 2000 after her son was born with shoulder dystocia, which led to cerebral palsy. Nadine is diabetic and had a higher chance of shoulder dystocia and this information was withheld. She was never given the right to determine whether she needed or wanted a caesarean. This is the bare bones of the story.
The case was taken to the Court of Session (the Highest Court in Scotland) where it was thrown out, so they took it to the Supreme Court in England where they won the landmark case known as Montgomery v Lanarkshire Health Board, March 2015.
The KC said before this “you would always do what the doctor told you.” She discussed issues with the term “informed consent.” She said it is about the relationship between patient and doctor and about choice, disclosure and shared information, where the ultimate decision is the patients, that is the “ethical core” of the Montgomery Ruling
It took 15 years. I really want to pay tribute to both – Nadine for her courage and perseverance and to the KC for fighting on behalf of Nadine without payment because it was the right thing to do.
The second speaker was Gaynor Savarnejad who brought her relevant personal story, which you can watch here.
The issues surround disclosure and what is reasonable. There were references to Bolam test throughout the discussion, described as the Professional Practice test. Bolam was a 1957 House of Lords case concerning ECT treatment.‘The “Bolam test” is a legal standard used to determine if a professional, particularly a medical one, has breached their duty of care in England and Wales. It holds that a professional is not negligent if they have acted in a way that would be supported by a “responsible body of professional opinion” in their field. This test essentially asks if the professional’s actions would be deemed acceptable by a competent group of their peers, even if other professionals might have taken a different approach’.(AI accessed via Google 2.11.2025). The Montgomery decision said this should no longer apply to issues of advising patients about risks and alternative treatments.
The third speaker Prof Jonathen Herrings discussed interpreting the McCulloch Judgement, which gave further consideration to duties to advise patients of alternative treatments. Please see this case note on the NHS Resolution website.
The questions and concerns are around who gets to decide for example, what an overload of information for the patient is. Factors such as cost, time, pressure and transparency were considered. Ideally the doctor knows their patient and their individual characteristics for example a Jehovah Witness would not want a blood transfusion.
Here Lauren Sunderland KC pointed again to the relationship between patient and doctor as being the key.
The impact of the recent, Martha’s Rule was touched on at the end of the session. ‘Martha’s Rule is a patient safety initiative in England that gives patients, their families, and carers the right to a rapid review by a senior clinician if they are worried about a patient’s worsening condition’ (AI accessed via Google 2.11.2025).
The notion of the “reasonable patient” is inherent in much of the discussion and if I had stayed in the afternoon, I would have asked whether there is a legal definition of what constitutes “reasonable.” Obviously, the Mental Capacity Act (2005) was touched on….
Laura Able
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