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# Standards of disclosure: what must the patient be told?

- Topic

Three standards decide how much to disclose; today what counts is what a reasonable patient, or this patient, would find important.

Updated Nov 13, 2026

## Key points

- Professional standard: what doctors usually say; it has lost ground in the courts.
- Reasonable patient: what a reasonable person in the patient's position would want to know in order to decide.
- Subjective: what this patient, given their life and values, would consider important.
- A rare but serious risk can be material; frequency alone does not decide.
- Montgomery (United Kingdom, 2015): material risks and reasonable alternatives are disclosed.
- Colombia: Ley 23 de 1981, art. 16 (warn of the foreseen risk) and Ley 1751 de 2015, art. 10 d) (information sufficient to decide).

## What it is

The informed consent page lists the three standards; this page explains how they are applied. The professional standard asks what doctors usually say; the reasonable-patient standard asks what a reasonable person in the patient's position would want to know; the subjective standard asks what this patient needs to know given their life and values. Courts have moved from the first towards the other two: in the United States with the Canterbury case (1972) and in the United Kingdom with Montgomery (2015), which requires disclosure of material risks and reasonable alternatives. A risk is material because of its severity, its probability and what it means for that person. In Colombia, Ley 23 de 1981 speaks of warning of the «foreseen risk», and Ley 1751 de 2015 requires information sufficient to decide.

## Key facts

- What is disclosed: diagnosis and prognosis; nature and purpose of the intervention; expected benefits; material risks; reasonable alternatives, including no treatment; the recommendation and its reasons; uncertainties.
- What is sometimes forgotten: that the technique is new or the team's experience is limited, conflicts of interest, and the costs or paperwork the patient will face.
- Montgomery test: a risk is material if a reasonable person in the patient's position would attach significance to it, or if the doctor knows or should know that this patient would.
- If the patient asks something specific, it is answered truthfully, even if another patient would not have asked.
- Disclosing is not overwhelming: information is prioritized, tailored, and more is offered.
- The therapeutic exception is narrow and does not allow withholding a risk just because it would frighten the patient.

## One case, three standards: a pianist facing hand surgery with a rare risk of nerve injury

| Standard | Is the risk disclosed? | Why |
| --- | --- | --- |
| Professional | Depends on custom | If surgeons do not usually mention it, it would not be required |
| Reasonable patient | Probably yes | It is serious and affects hand function |
| Subjective | Yes | For a pianist it is decisive |

## In clinical practice

- Before explaining, ask what worries the patient and what they do for a living: that tells you which risks are material for them.
- Give absolute figures with the same base («1 in 100»), not just adjectives such as «rare».
- Record in the medical record the main risks and alternatives discussed (Decreto 3380 de 1981, art. 12).
- If a rare, serious risk is omitted and then occurs, the ethical and legal problem is the omission, even if the technique was correct.

## Legal framework in Colombia

- Ley 23 de 1981, art. 15: do not expose the patient to unjustified risks, ask for consent and explain the consequences beforehand.
- Ley 23 de 1981, art. 16: liability for adverse reactions does not go beyond the foreseen risk, of which the doctor warns the patient or their relatives and close persons.
- Decreto 3380 de 1981, art. 10: the warning is fulfilled with a prudent notice of the adverse effects that, in the doctor's judgement, may occur; art. 13: the doctor is not liable for what could not reasonably be foreseen.
- Ley 1751 de 2015, art. 10 d): clear, appropriate and sufficient information for free, conscious and informed decisions about procedures and their risks.
- Decreto 3380 de 1981 is compiled in Decreto 780 de 2016 (arts. 2.7.2.2.1.1.9 to 2.7.2.2.1.1.13). Official texts checked on 2026-11-13 at minsalud.gov.co and normograma.supersalud.gov.co.

## Test yourself

Think of the answer, then tap the question to see it.

## What question does the reasonable-patient standard answer?

What a reasonable person in the patient's position would want to know in order to decide whether to accept or refuse the intervention.

## Can a very rare risk be material?

Yes. Materiality depends on severity, probability and what the risk means for that patient; a rare, serious risk can be material.

## What did the UK Supreme Court require in Montgomery (2015)?

That the doctor disclose material risks and reasonable alternatives, using a patient-centred test rather than doctors' usual practice.

## Which article of Ley 23 de 1981 requires warning of the foreseen risk?

Article 16; Decreto 3380 de 1981 (art. 10) specifies that it is fulfilled with a prudent notice of the possible adverse effects.

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## Connections

## Related 5

- [Informed consent: elements and how to obtain it](https://durgical.com/en/medical-ethics/informed-consent-elements-and-how-to-obtain-it/)
- [Therapeutic privilege and the right not to know](https://durgical.com/en/medical-ethics/therapeutic-privilege-and-the-right-not-to-know/)
- [Understanding in consent: framing, false beliefs and how to check](https://durgical.com/en/medical-ethics/understanding-in-consent-framing-false-beliefs-and-how-to-check/)
- [Ley 23 de 1981: the Colombian medical ethics law](https://durgical.com/en/medical-ethics/ley-23-de-1981-the-colombian-medical-ethics-law/)
- [Medical liability: obligation of means and lex artis](https://durgical.com/en/medical-ethics/medical-liability-obligation-of-means-and-lex-artis/)

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Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.

Sources: [Informed Consent](https://plato.stanford.edu/entries/informed-consent/) (Stanford Encyclopedia of Philosophy, 2025); [Montgomery v Lanarkshire Health Board [2015] UKSC 11](https://www.supremecourt.uk/cases/uksc-2013-0136.html) (The Supreme Court of the United Kingdom, 2015); [Ley 23 de 1981, por la cual se dictan normas en materia de ética médica](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IGUB/ley-23-de-1981.pdf) (Ministerio de Salud y Protección Social, 1981); [Decreto 3380 de 1981, por el cual se reglamenta la Ley 23 de 1981](https://normograma.supersalud.gov.co/compilacion/docs/decreto_3380_1981.htm) (Superintendencia Nacional de Salud, Normograma, 1981); [Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud](https://normograma.supersalud.gov.co/compilacion/docs/ley_1751_2015.htm) (Superintendencia Nacional de Salud, Normograma, 2015).

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/medical-ethics/standards-of-disclosure-what-must-the-patient-be-told/