How Montgomery is reconfiguring consent in the UK

Harrison, Natalie; Hewitt, Hilary; Pandya, Pranav; Reisel, Daniel

doi:10.1016/s0140-6736(18)31124-3

Cited by 18 publications

(22 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Advice has been published regarding maintenance of Montgomery principles for informed consent. 19 It has been suggested the increased risk of morbidity and mortality associated with T&O procedures when complicated by COVID-19 may limit the breadth and scope of T&O operative practice during the pandemic until these risks can be confidently mitigated. 20 …”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on trauma and orthopaedic patients requiring surgery during the peak of the pandemic

et al. 2020

View full text Add to dashboard Cite

Aims COVID-19 represents one of the greatest global healthcare challenges in a generation. Orthopaedic departments within the UK have shifted care to manage trauma in ways that minimize exposure to COVID-19. As the incidence of COVID-19 decreases, we explore the impact and risk factors of COVID-19 on patient outcomes within our department. Methods We retrospectively included all patients who underwent a trauma or urgent orthopaedic procedure from 23 March to 23 April 2020. Electronic records were reviewed for COVID-19 swab results and mortality, and patients were screened by telephone a minimum 14 days postoperatively for symptoms of COVID-19. Results A total of 214 patients had orthopaedic surgical procedures, with 166 included for analysis. Patients undergoing procedures under general or spinal anaesthesia had a higher risk of contracting perioperative COVID-19 compared to regional/local anaesthesia (p = 0.0058 and p = 0.0007, respectively). In all, 15 patients (9%) had a perioperative diagnosis of COVID-19, 14 of whom had fragility fractures; six died within 30 days of their procedure (40%, 30-day mortality). For proximal femoral fractures, our 30-day mortality was 18.2%, compared to 7% in 2019. Conclusion Based on our findings, patients undergoing procedures under regional or local anaesthesia have minimal risk of developing COVID-19 perioperatively. Those with multiple comorbidities and fragility fractures have a higher morbidity and mortality if they contract COVID-19 perioperatively; therefore, protective care pathways could go some way to mitigate the risk. Our 30-day mortality of proximal femoral fractures was 18.2% during the COVID-19 pandemic in comparison to the annual national average of 6.1% in 2018 and the University Hospital Coventry average of 7% for the same period in 2019, as reported in the National Hip Fracture Database. Patients undergoing procedures under general or spinal anaesthesia at the peak of the pandemic had a higher risk of contracting perioperative COVID-19 compared to regional block or local anaesthesia. We question whether young patients undergoing day-case procedures under regional block or local anaesthesia with minimal comorbidities require fourteen days self-isolation; instead, we advocate that compliance with personal protective equipment, a negative COVID-19 swab three days prior to surgery, and screening questionnaire may be sufficient. Cite this article: Bone Joint Open 2020;1-9:520–529.

show abstract

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on trauma and orthopaedic patients requiring surgery during the peak of the pandemic

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Doctors have expressed concern about how adhering to Montgomery may affect their practice [ 24 , 39 , 46 , 56 ]. John Reynard provides the example of a rare but profound outcome of a common surgical procedure (Fournier’s gangrene occurring after elective circumcision, with an estimated risk of 1 in 50,000) and his practice in providing a 100-word description about this risk to every patient scheduled for circumcision, specifically mentioning the 30% chance of death if it does materialise [ 50 ].…”

Section: Montgomery and The Mca: Key Elementsmentioning

confidence: 99%

Ensuring Risk Awareness of Vulnerable Patients in the Post-Montgomery Era: Treading a Fine Line

Talukdar

2020

Health Care Anal

View full text Add to dashboard Cite

The 2015 UK Supreme Court judgment in Montgomery v Lanarkshire reinforces the importance of informed consent to medical treatment. This paper suggests that Montgomery recognises the challenge faced by vulnerable individuals in choosing between treatment options and making decisions with appreciation of information about material risks. The judgment endorses a form of weak paternalism to safeguard such persons, which is not disrespectful of the aggregate principles of the Mental Capacity Act 2005. But ethical practice requires professionals to tread carefully between weak and hard paternalism in the context of therapeutic interactions with vulnerable patients, while ensuring their awareness of material risks.

show abstract

“…Despite being an obstetric ruling, the Montgomery ruling applies to all medical and surgical specialties. There is much published opinion and theory on this topic, 2 3 9–25 but currently, little research, 26 27 especially in trauma surgery, looking at what patients attribute significance to when providing consent and therefore what common material risks may exist in the specialty. An understanding of any common material risks will help guide the consenting surgeon to apply the Montgomery ruling to their practice.…”

Section: Introductionmentioning

confidence: 99%

‘Hobson’s choice’: a qualitative study of consent in acute surgery

et al. 2020

View full text Add to dashboard Cite

ObjectivesThe study aimed to understand through qualitative research what patients considered material in their decision to consent to an acute surgical intervention.Participants, setting and interventionThe patients selected aged between 18 and 90, having been admitted to a major trauma centre to undergo an acute surgical intervention within 14 days of injury, where English was their first language. Data saturation point was reached after 21 patients had been recruited. Data collection and analysis were conducted simultaneously, through interviews undertaken immediately prior to surgery. The data were coded using NVIVO V.12 software.ResultsThe key theme that originated from the data analysis was patients were unable to identify any individual risk that would modify their decision-making process around giving consent. The patient’s previous experience and the experience of others around them were a further theme. Patients sensed that there were no non-operative options for their injuries.ConclusionThis is the first study investigating what patient considered a material risk in the consent process. Patients in this study did attribute significance to past experiences of friends and family as material, prompting us to suggest that the surgeon asks about these experiences as part of the consent process. Concern about functional recovery was important to patients but insufficient to stop them from consenting to surgery, thus could not be classified as material risk.

show abstract

How Montgomery is reconfiguring consent in the UK

Cited by 18 publications

References 7 publications

The impact of COVID-19 on trauma and orthopaedic patients requiring surgery during the peak of the pandemic

The impact of COVID-19 on trauma and orthopaedic patients requiring surgery during the peak of the pandemic

Ensuring Risk Awareness of Vulnerable Patients in the Post-Montgomery Era: Treading a Fine Line

‘Hobson’s choice’: a qualitative study of consent in acute surgery

Contact Info

Product

Resources

About