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How a snail in a bottle came to define GPs’ duty of care

thomas correct


It is fascinating to recall that the modern law of negligence evolved following a trivial incident of consuming a fizzy drink in 1928 in Paisley, near Glasgow. I recently made a pilgrimage to the site of origin.

Donoghue v Stevenson [1932] AC 562, also known as the ‘Snail in the Bottle case’ is one of the most celebrated and landmark cases in the British legal history.

In 1928, Ms Amy Donoghue was invited by a friend to Well Meadow Café, Paisley. The friend bought her a ginger beer. Halfway through, Ms Donoghue felt something drastically wrong – a decomposed snail was in the beer. She later developed gastroenteritis.

Donoghue sued the manufacturer David Stevenson in the Court of Sessions, Scotland. The court dismissed the case due to lack of precedent, and said there was no case to answer. She was granted leave to appeal. She went to House of Lords, who passed the judgement in Donoghue’s favour.

The judgement established several legal principles:

  • The Neighbourhood Principle – Donoghue had received the drink as a gift – she was a ‘neighbour’, rather than a party to the contract.

’The rule that you are to love your neighbour becomes in law, you must not injure your neighbour….You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour.’ – Lord Atkin

  • Duty of care – The case proved that the manufacturer has a duty of care to the consumers who use the products. Lord Atkin made it clear in ratio decendi: ’a manufacturer of products which he sells…to reach the ultimate consumer in the form in which they left him… owes a duty to the consumer, to take reasonable care’. This principle has later been applied in many laws, including Trade Practice Act (Commonwealth, 1974). This is paramount importance in medical practice, where thousands of drugs, equipments and vaccines are used on a daily basis.
  • Negligence – The House of Lords ruling confirmed that negligence is a tort. A plaintiff can take legal action against a respondent if the respondent’s negligence causes injury or loss or damage to property.

The duty of care is a standard in the law of negligence

Duty of care is a legal obligation imposed on an individual requiring that they adhere to a standard of reasonable care while performing any acts that could foreseeably harm others. 

Translating these into medical practice, all health professionals have duty of care to themselves, patients, colleagues and ‘neighbours’ (those who are likely to come into contact during daily practice). This is applicable to every aspect of the work.

In practice, always act in the best interest of patients, avoid act or omission which are likely to cause harm. Always put safety first – act within your own competence. In reality, this composes of many issues – keeping knowledge and skills up to date; providing service at the standard of the reasonable person; using discretion to ensure that the service can be delivered safely; delegating work only when it is safe to do so; accurately keeping records; protecting confidentiality.

The duty of care is a standard in the law of negligence. It is a duty to act in the way a responsible person should act in the given circumstance, and deviation from this could result in negligence. The duty of care can be owed by the individual or the establishment. The failure to use reasonable care can result in negligence.

In a nutshell, a young Scottish lady confronted the establishment and challenged the legal system with courage, conviction and confidence, achieving victory for herself and thereby establishing one of the key fundamental legal principles. This has been followed not only in the UK, but across most of the Commonwealth, so almost two thirds of the world. The statute of Amy Donoghue is placed across the road opposite Lord Atkin’s judgement, in Paisley. Let us pay tribute to the brave lady Ms Amy Donoghue for being the catalyst to establish the norms of duty of care globally.

Dr Thomas Abraham is a GP in Hull with an interest in medical ethics