Duty of candour: a statutory obligation or just the right thing to do?

In 1990 the case of Robbie Powell catalogued a story of medical errors and neglect that ultimately lead to his untimely death from Addison's disease at 10 years of age. In this high-profile case, the child's father felt that events were made even more unbearable by failures of health care providers to offer credible explanations for what had occurred and subsequently by the detrimental actions of investigatory bodies.¹ Despite tireless and tenacious legal challenges, Robbie Powell's father was denied the truth for nearly 2 decades. It is now established that forgery and falsification of patient medical records occurred and investigations were plagued by conflict of interest and dishonesty, including cabinet ministers providing false parliamentary answers.² Indeed, two Police Complaints Authority investigations into the handling of the case named the Dyfed-Powys police force as 'institutionally incompetent' and identified 35 separate potential criminal offences including falsification of documents and perverting the course of justice.³ No criminal prosecutions were brought and in May 2000 the European Court of Human Rights stated in a judgement on the case that:As the law stands now … doctors have no duty to give parents of a child who died as a result of their negligence a truthful account of the circumstances of the death, nor even refrain from deliberately falsifying records.⁴Although this case must be considered rare and indeed extreme, it is important to take a moment to reflect on a purely human level how one would feel if a loved one suffered serious harm or death as the result of a medical incident. Add to that emotional turmoil the distress of not being told what had happened or the insult of being deceived by those with whom care and support had been entrusted. In the 27 years since this tragic case, the National Health Service (NHS) has slowly moved towards a culture of transparency and openness. This article discusses the UK statutory Duty of Candour (DoC) and the implications for enacting the legislation with respect to perioperative and intensive care medicine.

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