Bolam v Friern Hospital Management Committee [1957] 1 WLR 582

Facts

• John Bolam, the plaintiff, underwent electroconvulsive therapy (ECT) at Friern Hospital.
• During the procedure, Bolam sustained fractures, which he attributed to the absence of relaxant drugs and physical restraints.
• Bolam alleged that the hospital staff were negligent for failing to administer relaxants, not restraining him, and not providing warnings about the associated risks.
• The crux of the case was whether the hospital’s procedures met the appropriate standard of care recognised within the psychiatric profession at that time.

Issues

1. Whether the standard of care exercised by the hospital staff in administering ECT, including the decision not to use relaxant drugs, restraints, or warnings, amounted to negligence.
2. Whether following an accepted professional practice can serve as a valid defence against a claim of professional negligence.
3. Whether courts should defer to professional opinion or intervene when disputing professional standards of care.

Decision

• The court held that a medical professional is not negligent if their conduct aligns with a practice accepted as proper by a responsible body of skilled professionals in that field.
• The hospital was found not negligent, as some medical practitioners considered the disputed practice to be acceptable at the time.
• The judgment indicated that the existence of differing professional opinions does not automatically render one practice negligent.
• The test established that judicial intervention is only warranted if a professional opinion is demonstrably irresponsible, illogical, or lacking rational basis.

Legal Principles

• The Bolam test: A professional is not negligent if acting according to a practice accepted as proper by a responsible body of professionals in the relevant field.
• The principle was intended to acknowledge legitimate differences in professional judgment within a discipline.
• The test has broad application across other professions, not solely in medicine, wherever expert knowledge determines standards of care.
• The Bolitho refinement: Courts may reject professional opinion if it is not logically defensible, ensuring professional standards are subject to rational evaluation.

Conclusion

Bolam v Friern Hospital Management Committee established the Bolam test as the standard for determining professional negligence, deferring to responsible bodies of professional opinion while permitting judicial scrutiny of opinions lacking logical justification. This standard continues to influence the law relating to professional duty of care.