In Singapore, a doctor’s duty to advise is governed by section 37 of the Civil Law Act 1909, in force since 1 July 2022. A doctor must give the information a reasonable patient in your circumstances would need, plus information the doctor knows or ought to know matters to you personally, unless there is a reasonable justification for withholding it. The outcome depends on your specific facts, so please consult a qualified lawyer.
You agreed to a procedure. Afterwards, a complication occurred that nobody had mentioned. Was that negligence? The answer may turn on informed consent: what your doctor had to tell you before you decided. Singapore’s law on this changed significantly in 2017 and was written into statute in 2022.
How the Law on Informed Consent Developed in Singapore
For many years, the courts judged doctors’ advice by the Bolam test: a doctor was not negligent if a responsible body of medical opinion would have acted the same way, provided that opinion was logical (Bolitho). The focus was on what doctors considered acceptable.
In Hii Chii Kok v Ooi Peng Jin London Lucien [2017] SGCA 38, the Court of Appeal moved to a more patient-centred approach for medical advice, drawing on the UK decision in Montgomery. The question became what information would be relevant and material to the patient, not only what doctors usually disclose. The court kept the Bolam and Bolitho test for diagnosis and treatment.
Parliament then codified the standard for medical advice in section 37 of the Civil Law Act 1909, inserted by the Civil Law (Amendment) Act 2020 and in force from 1 July 2022.
What Section 37 Requires Your Doctor to Tell You
Under section 37, a doctor meets the standard of care for medical advice if a respectable body of medical opinion accepts their conduct as reasonable, and that opinion is logical. But that medical opinion can only be relied on if it requires the doctor to have given the patient:
- information that a person in the patient’s circumstances would reasonably require to make an informed decision about the treatment or advice, and
- information the doctor knows or ought reasonably to know is material to that particular patient, even if most patients would not need it.
Whether information is material to you personally depends on concerns you expressly raise with the doctor, or concerns that ought to be apparent from your medical records that the doctor can access and should review.
The Act gives examples. A patient who asks about paralysis after a flu vaccination should be told about a very rare nerve complication that doctors would not normally mention, because the patient raised the concern. Similarly, if a patient’s earlier records show repeated concerns about a particular side effect of knee surgery, a later surgeon at the same hospital ought to address it, even if the patient does not raise it again.
Under section 37(4), the fact that other respected doctors hold different views does not, by itself, stop a doctor from relying on the peer professional opinion.
When Can a Doctor Hold Back Information?
A doctor can withhold information only where there is reasonable justification. The Act’s illustrations make the line clear:
| Situation | Reasonable justification? |
|---|---|
| Emergency life-saving surgery on an unconscious patient, with no one available to decide for them | Yes |
| A patient has already been advised by other specialists and clearly says they do not want the information again | Yes |
| The doctor believes the patient needs the procedure and fears that explaining the risks would put them off | No, not by itself |
Is a Signed Consent Form Enough?
A signed consent form is evidence that a discussion took place, but it does not settle the question on its own. The law looks at what information was actually given and whether it met the section 37 standard. A form listing general risks may not cover a risk that was material to you because of a concern you raised.
From Missing Information to a Claim
Showing that you were not told something is only part of a claim. You would generally also need to show that, if you had been properly informed, you would have made a different decision, for example declining the procedure or choosing another option, and that you suffered loss as a result.
For the steps in bringing a claim, time limits and compensation, see filing a medical negligence claim in Singapore and how to identify and respond to medical negligence.
Practical Steps for Patients
- Raise your specific concerns. Under section 37(3), concerns you expressly communicate become material to you. Write them down before the consultation.
- Ask about alternatives, including the option of not having the treatment at all.
- Keep notes of what you were told, by whom and when.
- Request your medical records if you later have concerns about what happened.
If you believe you were not given information you needed before treatment, our medical negligence team can review your situation. See our medical negligence services.
Frequently Asked Questions
Does section 37 apply to dentists?
Yes. Section 37 applies to healthcare professionals who provide medical advice, and expressly includes registered medical practitioners, dentists and oral health therapists.
What if the patient is a child or lacks capacity?
Section 37 treats the person responsible for making the decision for the patient, such as a parent, as the patient for the purposes of the duty to advise.
Does informed consent apply to diagnosis mistakes?
No. Informed consent concerns the advice given before a decision. Claims about diagnosis or treatment are generally assessed under the Bolam and Bolitho test.
This article is for general information only and does not constitute legal advice. Please consult a qualified lawyer for advice on your specific situation.