EC Gynaecology

Litigation in obstetrics and gynaecology has changed substantially over the past century, reflecting parallel developments in clinical practice, legal doctrine, bioethics and societal expectations. Historically, the doctor-patient relationship was predominantly paternalistic. Physicians exercised wide discretion over treatment and disclosure, while courts generally deferred to professional judgement. In the United Kingdom, this approach was crystallised in Bolam v Friern Hospital Management Committee (1957), under which clinical conduct was generally defensible when supported by a responsible body of professional opinion. The subsequent rise of bioethics, human rights and patient autonomy progressively challenged professional dominance. The law began to distinguish questions of clinical expertise from decisions that properly belonged to patients. This transition culminated in the United Kingdom Supreme Court judgment in Montgomery v Lanarkshire Health Board (2015), an obstetric case that repositioned informed consent around material risk, reasonable alternatives and the individual patient’s perspective. These developments have particular significance in obstetrics and gynaecology, where decisions are frequently time-critical, outcomes may be catastrophic and questions of bodily integrity, reproduction and personal values are intrinsic to care. Contemporary litigation therefore extends beyond allegations of technical negligence. Claims increasingly involve failures of communication, consent, escalation, multidisciplinary working, organisational governance, respectful maternity care and equity. This special article traces the transition from medical paternalism to patient-centred accountability and examines its implications for contemporary practice. It argues that effective medico-legal risk reduction depends less on defensive medicine than on technically competent care, individualised communication, shared decision-making, reliable clinical systems and transparent learning when harm occurs.

Keywords: Breast Infiltration; Granulomatous Mastitis; Breast Tuberculosis; Invasive Ductal Carcinoma; Diagnostic Pitfalls; MRI

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