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

Mr Bolam was a voluntary patient at Friern Hospital and agreed to undergo electroconvulsive therapy for mental illness. He was not given a muscle-relaxant drug and was not physically restrained during the treatment. He suffered serious fractures when his body reacted to the electric current. Medical witnesses disagreed about appropriate practice at the time. Some competent practitioners administered relaxants or used restraint, while others considered that those precautions created or increased different risks and did not use them. Mr Bolam alleged negligence in the decision not to give relaxants, the failure to restrain him and the failure to warn him about the risk of fracture. The hospital argued that the treatment accorded with a responsible body of medical practice and that disagreement among doctors did not itself prove negligence.

What standard of care applies to a professional exercising a specialised skill, and is following a responsible body of professional practice sufficient to avoid negligence?

McNair J directed the jury that a doctor is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical opinion skilled in that field. A doctor does not fall below the standard merely because another body of competent opinion would have acted differently. The law did not require the highest possible level of expertise, but the ordinary competence of a person professing the relevant skill. The jury found for the hospital. On the evidence, respectable medical opinion supported giving the treatment without relaxants or restraint, and the risk of fracture was small. The warning allegation was also assessed through professional practice, although that aspect of Bolam has since been displaced by the patient-centred disclosure duty in Montgomery.

A person professing a skilled occupation must exercise the ordinary skill of a reasonably competent member of that profession. Conduct supported as proper by a responsible body of relevant professional opinion will ordinarily satisfy that standard, even where another responsible body would have chosen a different course.

The Bolam test remains fundamental when assessing diagnosis and treatment choices, but it is not conclusive simply because an expert supports the defendant. Bolitho v City and Hackney Health Authority requires the supporting opinion to withstand logical analysis, including a defensible assessment of risks and benefits. Montgomery v Lanarkshire Health Board applies a different, patient-focused standard to disclosure of material risks and reasonable alternatives. Students should therefore identify the nature of the alleged breach before selecting the appropriate approach.