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Comment & Response |

Informed Consent and the Reasonable-Patient Standard

Barry G. Main, PhD, MRCS, MFDS1; Angus McNair, PhD, MRCS1; Jane M. Blazeby, MD, FRCS1
[+] Author Affiliations
1Centre for Surgical Research, University of Bristol, Bristol, United Kingdom
JAMA. 2016;316(9):992-993. doi:10.1001/jama.2016.10555.
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To the Editor Dr Spatz and colleagues1 highlighted important changes in UK law arising in 2015 from the case of Montgomery v Lanarkshire Health Board.2 The Supreme Court’s formal rejection of physician-centered, paternalistic information disclosure in informed consent was welcome and long overdue. Although it is true the ruling set out the rationale for a reasonable-patient standard, our reading of the case suggests that, in fact, the judges were laying out the requirement for physicians to tailor provision of information to meet the needs of the individual patient. As a means of achieving this, the Court emphasized that careful dialogue between physician and patient should be the cornerstone of the informed consent process. However, as Spatz and colleagues discussed, barriers that prevent these ideals of patient-centered communication and decision making from being realized in everyday practice are numerous and complex. Physicians need both skill and time to carefully explore the important beliefs and goals that inform a patient’s decision making about health care. Thus, while welcome, it is uncertain how the ruling in Montgomery helps physicians improve the way they approach informed consent.


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September 6, 2016
Erica S. Spatz, MD, MHS; Harlan M. Krumholz, MD, SM; Benjamin W. Moulton, JD, MPH
1Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
2Informed Medical Decisions Foundation, Healthwise Research and Advocacy, Boston, Massachusetts
JAMA. 2016;316(9):993-994. doi:10.1001/jama.2016.10561.
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