Medical Contracts: Doctor-Patient Agreements

• Diagnosis is considered the first central skill in medicine.
• Doctors view the diagnostic interaction with patients as a contractual relationship.
• The three elements of a contract are offer, acceptance, consideration, and the intention to be legally bound.
• Dissatisfaction with a contract's outcome can lead to legal action if terms are breached.
• Teff suggests that medical interactions can be viewed as breach of contract, battery, or negligence.
• Picard outlines that a patient asking for treatment is the offer, the doctor treating them is the acceptance, and the promise of payment is the consideration.
• A medical contract can exist without a specific agreement on treatment fee or duration.
• In Sidaway v Board of Governors of the Bethlem Royal Hospital [1985] AC 871, the relationship between doctor and patient is contractual.
• Doctors perform services for fees, and patient consideration involves payment or promising to pay.
• A contract can exist even if the patient does not pay because the patient's submission to treatment is seen as giving up their right not to be touched, which is valid consideration.
• Coggs v Bernard (1703) 92 ER 107 supports the idea that a contract can arise even in publicly funded healthcare.

Terms of the Contract

• Doctors and patients can agree to express terms, which do not necessarily have to be in writing, but there are rarely express terms.
• Courts will look at implied terms to understand the nature of a contract and determine if there was a breach.

Eyre v Measday [1986] 1 All ER 488

• A woman sought a sterilisation and the doctor said it was irreversible but did not explain the 1% failure rate.
• The patient became pregnant and sued, claiming the doctor breached the contract to render her infertile.
• The court rejected the claim, stating the Moorcock test must be applied to imply a term.
• The requirements for implication are that it is needed to give business efficacy to the contract, and that the parties would have implied the term at the time of formation if asked.
• The court will imply a term that the doctor will operate with reasonable care and skill.
• In the absence of any express agreement to the contrary, the court will be slow to imply the promise of a cure, therefore the claim failed.

Thake and Another v Maurice [1986] 1 QB 644

• Facts were similar to Eyre, sterilisation performed on a man.
• Patient was not warned about recanalisation, that occurred, and the man's wife gave birth.
• Applying the Moorcock principle, the court rejected the implied term to an effective cure.
• The court drew on Lord Denning's statements stating the law does not usually imply a warranty that a sick man will be cured, but only that the doctor will use reasonable care and skill.
• Doctors do not guarantee the success of any operation unless they say so explicitly.
• Implying such a term would conflict with the implied term to use reasonable care, as medicine is an inexact science.
• Contract law in the medical context has largely fallen out of vogue.
• Contract law presents an advantage when the statute of limitations for breaches of contract is lengthier than for a tort.