As those who know me will attest, I have always been an advocate for patient autonomy, and informed and involved decision-making by patients, aided (but not dictated) by their clinician. In other words, a fan of the Rogers v Whittaker sanctioned ‘approach’ to medicine following the High Court’s decision.

Recently, with the growth of claims arising in the expanding elective/cosmetic medicine arena, the flip side of autonomy has been highlighted.

It is clear that with autonomy, there comes responsibility….

I have seen several cases of late that we have investigated, where on reflection it is clear that our clients were well informed as to their choices, but simply made ‘foolish’ decisions concerning their care and are now left with very poor outcomes/disfigurement.

Most obviously, breast augmentation surgery gone wrong, when no such surgery was sensibly justified, or lap band surgery for weight loss that could have been achievable by far less radical means.

In a former era of ‘doctor knows best,’ and medical paternalism, such patients would not have proceeded. The doctor would simply have said ‘no.’

Whilst I do not advocate in any form a return to such era, this result is interesting. The High Court’s recognition that the patient should be informed and make choices concerning their health care etc, also results in their having to accept responsibility for such choice (and consequences), if poorly made…. A result I had not foreseen… But.. you can’t have it both ways. Either this is right and the patient must ‘wear’ the consequences of their poor choice, or we return to a process where their decision-making is in form only….