1. Montgomery v Lanarkshire Health Board (2015 UKSC 11) (UK Supreme Court)

Facts:

A diabetic pregnant woman was not informed of the risk that vaginal delivery could cause shoulder dystocia (baby’s shoulder getting stuck), a known complication due to her condition. The doctor followed a “clinical judgment” standard and did not disclose the risk.

Legal Issue:

Whether doctors must disclose material risks and relevant contraindications to treatment.

Judgment:

The UK Supreme Court rejected the old paternalistic “doctor knows best” approach.

Key Holding:

• Doctors must disclose any material risk a reasonable patient would consider important.
• Also includes drug and treatment contraindications, not just surgical risks.
• Patient autonomy is central.

Importance for Drug Contraindication:

If a drug has a known risk for a condition (e.g., anticoagulants in bleeding disorders), failure to disclose it may violate this principle.

2. Sidaway v Board of Governors of the Bethlem Royal Hospital (1985 UKHL 1) (UK House of Lords)

Facts:

A patient underwent spinal surgery and was not warned about a less than 1% risk of paralysis.

Legal Issue:

Whether failure to disclose rare but serious risks constitutes negligence.

Judgment:

The court applied the Bolam test, holding that doctors are not negligent if their conduct aligns with a responsible medical body.

Key Holding:

• Disclosure depends on accepted medical practice.
• Courts should defer to medical opinion.

Relevance to Drug Contraindications:

Under this older approach, if most doctors did not disclose certain drug contraindications, failure to warn might not be negligence.

Modern Position:

This case has been largely overruled/limited by Montgomery, but it remains important historically.

3. Canterbury v Spence (1972 US Court of Appeals) (United States)

Facts:

A patient underwent spinal surgery without being informed of the risk of paralysis. He became partially paralyzed and sued.

Legal Issue:

Whether doctors must disclose risks even if medical custom does not require it.

Judgment:

Court ruled in favor of the patient.

Key Holding:

• Established the “reasonable patient standard”.
• Doctors must disclose information that a reasonable patient would find significant in deciding treatment.

Drug Contraindication Link:

This case is widely applied to situations where:

• Drug interactions are not disclosed
• Allergy risks are ignored
• Contraindicated prescriptions are given without warning

If a reasonable patient would refuse a drug if they knew the contraindication, non-disclosure is negligence.

4. Samira Kohli v Dr. Prabha Manchanda (2008) (Supreme Court of India)

Facts:

A woman consented to diagnostic laparoscopy. During surgery, doctors performed a hysterectomy and removed ovaries without prior explicit consent.

Legal Issue:

Whether additional procedures without informed consent are lawful.

Judgment:

The Supreme Court of India held:

• Consent must be real, valid, and informed.
• Unauthorized procedures are unlawful unless life-saving.

Key Principles:

• Consent must include risks, alternatives, and consequences.
• Blanket or implied consent is insufficient.

Drug Contraindication Application:

In India, this case is used to argue that:

• Prescribing a drug without disclosing serious contraindications (e.g., teratogenic drugs in pregnancy)
• can violate informed consent principles and amount to negligence.

5. Jacob Mathew v State of Punjab (2005) (Supreme Court of India)

Facts:

A patient died allegedly due to medical negligence involving delayed oxygen supply.

Legal Issue:

What constitutes criminal medical negligence?

Judgment:

Court clarified standards for negligence:

• Mere error of judgment is not negligence.
• There must be gross negligence or recklessness.

Key Principle:

• Medical professionals are protected from frivolous criminal prosecution.
• But gross failure in duty (including ignoring contraindications) can be criminal negligence.

Drug Contraindication Relevance:

If a doctor:

• knowingly prescribes a contraindicated drug
• or ignores clear warnings (e.g., allergy, kidney failure, drug interaction)

it may rise to gross negligence depending on harm caused.

Synthesis: Legal Rule on Drug Contraindication Non-Disclosure

Across these cases, a consistent legal standard emerges:

A doctor must disclose:

• Material risks of drugs
• Known contraindications (disease-based, allergy-based, pregnancy-based)
• Serious drug interactions
• Safer alternatives

Failure to do so may lead to:

• Civil liability (negligence compensation)
• Professional misconduct (medical council action)
• In rare cases, criminal liability (gross negligence)