Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 established the “Bolam test” for professional breach of duty.
Facts of the Case
The claimant underwent electro-convulsive therapy without a relaxant drug or physical restraints, and suffered a fractured hip — a possible consequence of which he had not been warned. At the time, the profession held conflicting views about relaxants, restraints, and warning of risks.
The Judgment and the “Bolam Test”
The court held the defendant was not in breach, having acted consistently with other responsible doctors. McNair J said a professional need not have the “highest expert skill” but must show the “ordinary skill of an ordinary competent man exercising that particular art”. The Bolam test: a professional is not negligent if they act in accordance with a practice accepted as proper by a responsible body of skilled opinion, even if another body would take a contrary view.
Wider Context of the Time
The decision gave professionals significant latitude to set the standards by which they are judged, reflecting a view that judges are not qualified to make specialised technical judgments. This “doctor knows best” approach has been criticised for prioritising professional standards over patient autonomy.
Related Cases
- Bolitho v City and Hackney Health Authority: added a “gloss” — a professional opinion must withstand “logical analysis”.
- Wilsher v Essex Area Health Authority: the standard is based on the post occupied, not individual experience.
- Montgomery v Lanarkshire Health Board: rejected Bolam for the disclosure of risks, recognising patients’ right to make an informed choice.
- McCulloch v Forth Valley Health Board: Bolam still applies to the clinical judgment of which alternative treatments are “reasonable” to discuss.