This is a well written, well timed paper which delivers on its clearly stated aim: to examine the impact of the ruling in the 2015 landmark Montgomery v Lanarkshire Health Board informed consent case with respect to both clinical and medicolegal practice. A review of both cases and the effects of the Montgomery ruling on medical and legal practice after a two year period is appropriate. Although there are no keywords offered, the title is a clear reflection of the paper’s content and would likely be found by anyone seeking information on informed consent and the impact of Montgomery v Lanarkshire case.

The references used to support the arguments presented are, for the most part appropriate, relevant, recent and correctly presented. The 2015 Informed Consent Edinburgh Medical Debate will be of particular interest to readers in this area.

The paper is weakened by References 26 (Byrne et al 1988) and 27 (McNeill et al 1982) which are out of date. More recent research into information retention by patients following the consent process are available and should be used. See for example: Manta, Christine J., et al. "From the patient perspective, consent forms fall short of providing information to guide decision making." Journal of Patient Safety (2016) or Hons, Yvette Godwin BA. "Do they listen? A review of information retained by patients following consent for reduction mammoplasty." British Journal of Plastic Surgery 53.2 (2000): 121-125.

A brief exploration of the framing effect with updated references would strengthen the paper and enlighten readers. See for example: Heisig, S. R., Shedden-Mora, M. C., Hidalgo, P., & Nestoriuc, Y. (2015). Framing and personalizing informed consent to prevent negative expectations: An experimental pilot study. Health Psychology, 34(10), 1033-1037. https://doi.org/10.1037/hea0000217

The information is presented in an orderly fashion which is well signposted using clear section headings. Doing so enhances a reader’s ability to locate pertinent information.

Montgomery v Lanarkshire Health Board radically shifted the requirements for informed consent which had been in place for nearly 4 decades. It would have been informative but not sufficient to present the rulings in subsequent consent cases where the Montgomery test was applied. Unsurprisingly some within the medical profession regarded the shift to a more patient centered approach a threat to traditional medical paternalism while others recognized the move as an advancement of patient autonomy and better decision making.

To their credit, the authors have presented both the opposing (medical paternalists) and supporting (proponents of patient autonomy) arguments.

They convincingly quashed the arguments brought by the paternalists by presenting the arguments made by the patient autonomists. As the author’s correctly point out, Montgomery v Lanarkshire decision is a confirmation the GMC guidance on consent. It may have been helpful to also point out that both the decision and the GMC guidance reflect the shift from the biomedical model of disease to the biopsychosocial model and reflects this.

Similarly, there was an expectation that the Montgomery v Lanarkshire ruling would open the floodgates to medical negligence claims. The authors demonstrate this to be a misapprehension by referring to appropriate subsequent court rulings.

The paper’s conclusions provide a succinct overview of the arguments presented. It closes with a particularly strong statement advising readers “The Montgomery ruling has not radically changed the process of consent; it has simply given appropriate recognition to patients as decision makers.”