The Supreme Court acknowledges the value of pat... - Thyroid UK

Thyroid UK
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The Supreme Court acknowledges the value of patient support groups and empowered patients.

8 Replies

"...changes in society, and in the provision of healthcare services, should also be borne in mind. One which is particularly relevant in the present context is that it has become far easier, and far more common, for members of the public to obtain information about symptoms, investigations, treatment options, risks and side-effects via such media as the internet (where, although the information available is of variable quality, reliable sources of information can readily be found), patient support groups, and leaflets issued by healthcare institutions. The labelling of pharmaceutical products and the provision of information sheets is a further example, which is of particular significance because it is required by laws premised on the ability of the citizen to comprehend the information provided.

It would therefore be a mistake to view patients as uninformed, incapable of understanding medical matters, or wholly dependent upon a flow of information from doctors.

The idea that patients were medically uninformed and incapable of understanding medical matters was always a questionable generalisation, as Lord Diplock implicitly acknowledged by making an exception for highly educated men of experience. To make it the default assumption on which the law is to be based is now manifestly untenable."

paragraph 76 Montgomery v Lanarkshire Health Board 2015.

So please don't feel awkward, self conscious or intimidated when advising a doctor of your findings on the internet or from Thyroid UK and how you wish to proceed. The law and the Supreme Court support you.

8 Replies

The idea that patients were medically uninformed and incapable of understanding medical matters was always a questionable generalisation, as Lord Diplock implicitly acknowledged by making an exception for highly educated men of experience.

Men? MEN? MEN? :x

Does Lord Dipstick live in a men-only world? Wtf happened to women in his blinkered existence?

Edit : But I suspect this man is probably dead now. Thank the Lord for small mercies.

in reply to humanbean

Lord Diplock was born in 1907 and died 1985. Maybe that's why he mentioned the "highly educated men of experience" as women began their struggles from 1905 to get the vote and most probably weren't as highly highly educated then. A link:

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Whoah,, Steady on!!

He was referring to himself, in 1985. He said:

"But when it comes to warning about risks, the kind of training and experience that a judge will have undergone at the Bar makes it natural for him to say (correctly) it is my right to decide whether any particular thing is done to my body, and I want to be fully informed of any risks there may be involved of which I am not already aware from my general knowledge as a highly educated man of experience, so that I may form my own judgment as to whether to refuse the advised treatment or not.

No doubt if the patient in fact manifested this attitude by means of questioning, the doctor would tell him whatever it was the patient wanted to know".

But he didn't go as far as to say that a doctor should volunteer information. There was on the other hand no obligation to provide patients with unsolicited information about risks:

“The only effect that mention of risks can have on the patient's mind, if it has any at all, can be in the direction of deterring the patient from undergoing the treatment which in the expert opinion of the doctor it is in the patient's interest to undergo.”

So a doctor should answer any questions honestly but not volunteer anything that might be against the "patients interests". He is locked in the view that doctors act in the patients best interests -the Bolam test.

The important thing to do is to take account of the Montgomery judgement and their Lord and Lady ships ruling that it is a mistake to view patients as uninformed, incapable of understanding medical matters, or wholly dependent upon a flow of information from doctors. NB in these times, their Lord/Ladyships said "patients" not "men".

The VERY important thing about the Montgomery ruling in the highest court of the land is that it does away with the doctor acting in the patients best interests - the Bolam test - on issues of consent. We make the decisions but the doctor should help us with his/her specialist knowledge of all the options and their risks and benefits in conjunction with our own knowledge. Phew!!

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Okay, I take your point. But I always find such sexist terminology is like a red rag to a bull.

Since your post referred to a judgement in 2015 I assumed it was a modern comment.


So ,if ,for some reason ,I am taken unconscious into intensive care,would the hospital Consultant legally be allowed to stop my T3 and substitute T4 (which I can't convert well ) even though my family would tell them that I have been well on it of 6 years?

This scenario lurks in the back of my mind as a worry since a friend collapsed with an aneurism and was unconscious for days.

in reply to WildDeer

WildDeer this has been worrying a lot of people. This is why we're fighting so hard for change in T3 prescribing. You can ask your GP to add it to your patient prescription record, so at least it is documented. My GP has done this, and she says it can be accessed by the hospital as well. The code given to it is Liothyronine 20mcg '1 tablet - buys OTC'. It's the best I can think to do at the moment :-(


That is a good question as it involves the Mental Capacity Act as well as Good Medical Practice Consent: Patients and doctors making decisions together.

The short answer is that a good doctor will act according to GMP Consent, do only what is necessary to save your life or prevent a serious deterioration, take into account your wishes to stay on T3 (as stated in your notes and by asking your friends and family) and keep you on T3. S/he should not then interfere in your T3 therapy after you have regained Mental Capacity.

In detail:

It appears to me that GMP Consent was written taking the Mental Capacity Act into account.

For the purposes of this reply I am going to assume the setting is something like an accident, rather than a thyroid storm.

If you are taken unconscious, you are unable to give your consent to a treatment.

Therefore the guidance in paragraph 79 of Consent: Patients and doctors making decisions together should take precedent. This states:

"The scope of treatment in emergencies

(para) 79

When an emergency arises in a clinical setting and it is not possible to

find out a patient’s wishes, you can treat them without their consent,

provided the treatment is immediately necessary to save their life or to

prevent a serious deterioration of their condition. The treatment you

provide must be the least restrictive of the patient’s future choices. For

as long as the patient lacks capacity, you should provide ongoing care

on the basis of the guidance in paragraphs 75–76. If the patient regains

capacity while in your care, you should tell them what has been done,

and why, as soon as they are sufficiently recovered to understand."

Paragraphs 75-76 state:

Making decisions when a patient lacks capacity

(para) 75

In making decisions about the treatment and care of patients who lack

capacity, you must:

a make the care of your patient your first concern

b treat patients as individuals and respect their dignity

c support and encourage patients to be involved, as far as they want

to an

d are able, in decisions about their treatment and care

d treat patients with respect and not discriminate against them.

(para) 76

You must also consider:

a whether the patient’s lack of capacity is temporary or permanent

b which options for treatment would provide overall clinical benefit

for the patient

c which option, including the option not to treat, would be least

restrictive of the patient’s future choices

d any evidence of the patient’s previously expressed preferences, such

as an advance statement or decision

e the views of anyone the patient asks you to consult, or who has

legal authority to make a decision on their behalf, or has been

appointed to represent them

f the views of people close to the patient on the patient’s

preferences, feelings, beliefs and values, and whether they consider

the proposed treatment to be in the patient’s best interests

g what you and the rest of the healthcare team know about the

patient’s wishes, feelings, beliefs and values.

If you are unconscious, I imagine that doctors would treat the cause of your unconsciousness first. It is possible that a doctor may use 76b to stop substitute T4 for T3 while you are unconscious. But they also have to take into account 76a (you will come round at some point), 76d (your expressed preference which should be in your clinical notes) and 76f (your friends and relatives will tell the doctor that you want to stay on T3).


Thankyou so much for this information. I will make sure my preferences are in writing as soon as possible.


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