Derecho médico y sanitario
Consentimiento al tratamiento, negligencia clínica, salud mental y derechos del paciente.
Introducción
El derecho médico rige la relación entre profesionales sanitarios y pacientes, incluyendo consentimiento y negligencia.
Principios fundamentales
Consent — A competent adult has an absolute right to refuse medical treatment, even if refusal will lead to death (Re B (Adult: Refusal of Treatment) [2002]). Treatment without valid consent constitutes battery or negligence.
Clinical Negligence — Healthcare professionals owe a duty of care to patients. Breach is assessed against the standard of a responsible body of medical opinion (Bolam v Friern Hospital [1957]), as modified by Bolitho v City and Hackney HA [1998] (the court can reject expert opinion that is not logically defensible).
Informed Consent — Following Montgomery v Lanarkshire [2015], a doctor must inform the patient of any material risk involved in treatment and any reasonable alternative treatments. A risk is 'material' if a reasonable patient would attach significance to it.
Mental Capacity — The Mental Capacity Act 2005 provides a statutory framework for decision-making on behalf of adults who lack capacity. Capacity is assessed functionally and decision-specifically. Best interests must guide decisions made on behalf of incapacitated adults.
Mental Health Detention — The Mental Health Act 1983 provides for the compulsory admission and treatment of persons with mental disorders. Patients have rights to tribunals, independent mental health advocates, and safeguards against prolonged detention.
Confidentiality — Healthcare professionals owe a duty of confidentiality to patients. Disclosure without consent is justified in limited circumstances: where required by law, in the public interest, or with the patient's consent.
End of Life — Euthanasia and assisted suicide remain unlawful (Suicide Act 1961, s.2). However, withdrawal of life-sustaining treatment is lawful where it is in the patient's best interests (Airedale NHS Trust v Bland [1993]).
NHS Constitution — The NHS Constitution for England sets out the principles and values of the NHS, the rights and pledges to patients, and the responsibilities of patients, staff, and the public.
Leyes clave
Casos principales
Airedale NHS Trust v Bland
[1993] AC 789
Escenarios comunes
Patient refuses life-saving blood transfusion
A competent adult has an absolute right to refuse treatment, including life-saving treatment, for any reason. The refusal must be informed and voluntary. If the patient lacks capacity, the decision must be made in their best interests under the Mental Capacity Act 2005.
Surgeon fails to warn of a rare complication
Following Montgomery v Lanarkshire [2015], a doctor must disclose material risks of treatment. Failure to warn of a risk that the patient would have considered significant may give rise to a negligence claim, even if the surgery was performed competently.
Sectioning a family member under the Mental Health Act
Compulsory admission under s.2 (assessment, up to 28 days) or s.3 (treatment, up to 6 months) requires an application by an Approved Mental Health Professional, supported by two medical recommendations. The patient has the right to apply to a Mental Health Tribunal for discharge.