Intended for healthcare professionals


“Wrongful conception” ruling against UK general practitioner

BMJ 2022; 376 doi: (Published 14 January 2022) Cite this as: BMJ 2022;376:o79
  1. Andrew Papanikitas, honorary tutor in general practice1,
  2. John Spicer, general practitioner2,
  3. Benedict Hayhoe, clinical lecturer in primary care3
  1. 1Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
  2. 2Country Park Practice, London, UK
  3. 3Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  1. Correspondence to: A Papanikitas andrew.papanikitas{at}

A challenging ruling with implications for all health professionals offering periconceptual advice

In December 2021, Evie Toombes successfully sued Philip Mitchell, her mother’s general practitioner, arguing that she would never have been conceived had he given her mother clearer advice about the role of folic acid supplements before and during pregnancy. Despite surgical interventions, she still experiences neuromuscular, bladder, and bowel problems. These disabilities notwithstanding, she has become a successful athlete.12

Mitchell had made the following note of the relevant consultation in 2001: “Preconception counselling. Folate if desired discussed.” Judge Rosalind Coe, QC, described this as, “completely inadequate”2 and held that his advice was negligent. Had he given the correct advice, she said, Toombes’s mother, Caroline Toombes, would have delayed conceiving and taken folic acid. The court held that had she done so, she would, on the balance of probabilities, have subsequently conceived a baby unaffected by neural tube defect.12

Recommendations at the time supported periconceptual folate supplementation, and Mitchell described this in his evidence as …

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