Bolam v Friern Hospital Management Committee [1957] 1 WLR 58...

Facts

• The claimant suffered injuries during electro-convulsive therapy administered without muscle-relaxant drugs or restraints.
• The defendant, a hospital management committee employing the doctor, was sued for negligently causing the injuries.
• Evidence showed that a significant portion of the medical profession at the time did not routinely use such drugs or restraints, and manual restraints could pose further risks.
• The court considered whether the defendant's actions met the standard of care expected of a reasonably competent professional in that field.

Issues

1. Whether the doctor’s actions, supported by a responsible body of medical opinion, constituted negligence.
2. Whether varying accepted practices within the medical profession can each satisfy the standard of care.
3. Whether patient autonomy and informed consent are sufficiently protected under the Bolam test.
4. Whether the test for professional negligence should differ from a simple cost-benefit analysis, considering social costs and special categories (e.g., children, professionals).

Decision

• The court held that a medical professional is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical professionals skilled in that art.
• It was emphasized that adherence to one of several accepted professional methods is sufficient to meet the standard of care.
• The Bolitho qualification clarified that the accepted practice must also have a logical and defensible basis.
• The court found no breach of duty by the defendant given the prevailing medical practices.
• Subsequent cases noted limits to the Bolam approach regarding patient rights and standards of information disclosure.

Legal Principles

• The Bolam test: a professional is not negligent if their conduct is supported by a responsible body of professional opinion, even if other professionals might differ.
• The Bolitho qualification: professional practices must also be logically defensible and not accepted unquestioningly.
• Courts must assess whether a practice is rational and defensible before accepting it as satisfying the standard of care.
• The standard of care must incorporate considerations of patient autonomy and adequate risk disclosure, as reinforced by later case law.
• The "simple principle" or cost-benefit analysis is insufficient for measuring professional negligence, as it does not address special categories or social costs.

Conclusion

Bolam v Friern Hospital Management Committee established that medical professionals are judged by peer-accepted standards, provided the practice has a logical basis. Later developments, notably Bolitho and Montgomery, highlighted the need to ensure practices are rational and that patient autonomy, especially informed consent, is protected. The Bolam test remains central to professional negligence assessment, subject to judicial scrutiny of the reasonableness and logic of professional practices.