Consent to treatment
All adults are presumed to have sufficient capacity to decide on their own medical treatment, unless there's significant evidence to suggest otherwise.
"Capacity" means the ability to use and understand information to make a decision, and communicate any decision made.
A person lacks capacity if their mind is impaired or disturbed in some way, and this means the person is unable to make a decision at that time.
Examples of how a person's brain or mind may be impaired include:
Someone with such an impairment is thought to be unable to make a decision if they can't:
As capacity can sometimes change over time, it should be assessed at the time that consent is required.
This will usually be done by an appropriately trained and experienced health professional who is either:
If the health professional feels you have the capacity to give your consent, your decision will be accepted and your wishes will continue to be respected, even if you lose capacity at a later stage.
If the health professional feels you don't currently have the capacity to give consent, and you haven't made an advance decision or formally appointed anyone to make decisions for you, they'll need to carefully consider what's in your best interests before making a decision.
If someone makes a decision about treatment that other people would consider to be irrational, it doesn't necessarily mean they have a lack of capacity, as long as they understand the reality of their situation.
For example, a person who refuses to have a blood transfusion because it's against their religious beliefs wouldn't be thought to lack capacity. They still understand the reality of their situation and the consequences of their actions.
However, someone with anorexia who is severely malnourished and rejects treatment because they refuse to accept there's anything wrong with them would be considered incapable. This is because they're regarded as not fully understanding the reality of their situation,or their consequences.
If an adult lacks the capacity to give consent, a decision on whether to go ahead with the treatment will need to be made by the health professionals treating them. To make a decision, the person's "best interests" must be considered.
There are many important elements involved in trying to determine what a person's best interests are, including:
If a person is felt to lack capacity, and there's no one suitable to help make decisions about medical treatment, such as family members or friends, an independent mental capacity advocate (IMCA) must be consulted.
In situations where there's serious doubt or dispute about what's in an incapacitated person's best interests, healthcare professionals can refer the case to the Court of Protection for a ruling. This is the legal body that oversees the operation of the Mental Capacity Act (2005).
Situations that must always be referred to the courts include:
A person's capacity to consent can change. For example, they may have the capacity to make some decisions but not others, or their capacity may come and go.
In some cases, people can be considered capable of deciding some aspects of their treatment but not others. For example, a person with severe learning difficulties may be capable of deciding on their day-to-day treatment, but incapable of understanding the complexities of their long-term treatment.
Some people with certain health conditions may have periods when they're capable and periods when they're incapable. For example, a person with schizophrenia may have psychotic episodes (when they can't distinguish between reality and fantasy), during which they may not be capable of making certain decisions.
A person's capacity can also be temporarily affected by:
If a person knows their capacity to consent may be affected in the future, they can choose to draw up a legally binding advance decision (also known as a living will). This sets out the procedures and treatments that a person refuses to undergo.
You can also choose to formally arrange for someone, often a close family member, to have lasting power of attorney (LPA) if you wish to anticipate your loss of capacity to make important decisions at a later stage. Someone with LPA can make decisions about your health on your behalf, although you can choose to specify in advance certain treatments that you would like them to refuse.
Consent to treatment is the principle that a person must give permission before they receive any type of medical treatment, test or examination. This must be done on the basis of an explanation by a clinician.
All adults are presumed to have sufficient capacity to decide on their own medical treatment, unless there is significant evidence to suggest otherwise.
People aged 16 or over are entitled to consent to their own treatment, and this can only be overruled in exceptional circumstances.