Medicine, Patients and the Law. Margaret Brazier, Emma Cave and Rob Heywood. Manchester University Press, 2023, PB, 696pp, £39.50, 978-1526157171
Legal obligations explained
The title gives something away about the orientation of this book, but don’t let this put you off if you think you might take offence. The authors are quick to point out that the Hippocratic oath enjoined doctors to foremost look after their teachers and brethren. Doctors, they continue, have perennially sought to regulate their own conduct, and the involvement of philosophers, priests, and lawyers in the discussion of medical ethics and law relatively late in the history of medicine. Medical readers should not be put off by this slightly hostile angle. After all, medical law has developed the way it has because of the manifold manifest harms generated by negligence and malpractice, aided by a historic power differential between doctors and most patients, and latterly between patients and healthcare industries.
This book puts the patient at the centre of an accessible and engaging text focusing on medical law in the UK, with some discussion of professionalism and ethics. It encompasses both parliamentary legislation and key guidance on how laws are to be applied. It naturally examines case law, where legislation and previous legal decisions are applied by courts to the facts of cases and interpreted by judges. It also takes in quasi-law in the form of key regulatory guidance by the General Medical Council (GMC), and the questions explored by the book have real and practical application. For example, I read (p.120) that the GMC say that a GP may (not must) alert a wife to the fact that her husband is HIV-positive. By contrast, the mere fact of a GP being HIV-positive is not (legally speaking) a matter of public interest, because the risk to patients is negligible. Something would need to change that risk in order to warrant a public interest disclosure. I also read that doctors have a special positive duty to confidentiality that is not the same as that of other ‘ordinary’ citizens, something those of us writing memoirs should bear in mind.
I was drawn to the section on overtired and overworked doctors (p.231). During the first waves of the COVID-19 pandemic, many doctors at all levels were working long hours and outside of their usual areas of practice. Naturally there was concern that mistakes would happen and that doctors would be liable for those mistakes. There is no automatic immunity for mistakes made when overworked or overtired, but judges, we are told, do take system failings into account. Readers may choose to reflect on this when asked to go the extra mile. Consider, for example, whether you are fit to do so.
As a GP, I was also drawn to the section on pre-conception advice, having co-authored a commentary on the Toombes v Mitchell (2021) case. I was delighted to find the case referred to (as texts go it is impressively up to date in its seventh edition), even if the commentary was not reassuring. It is sobering to note that decades after inadequate advice, a disabled adult born as a result of that advice can sue a GP in negligence on behalf of their mother who has been harmed in the process of giving birth to and having to care for a disabled child resulting from the negligent advice. Decades later, the testimony regarding advice given may be assumed to be clearer in the mind of the mother than the GP. So I guess we need to a) give good advice, and b) document that we have done so.
The portable and concise text is eminently searchable for focused reading. It seeks to hold clinicians and medical institutions to account. This makes it a good critical sourcebook on the law for GP trainers and registrars looking to flesh out a case-based discussion or tutorial, as well as for the GP looking for reading in response to a patient unmet need and/or doctor’s educational need.
- © British Journal of General Practice 2025
