Consent to treatment 

Introduction 

What does patient choice mean to you?

People talk about choices they have made for their health, in their lifestyle, their NHS treatment and of NHS services.

Media last reviewed: 21/09/2012

Next review due: 21/09/2014

Relevant legal terms

  • The Mental Health Act (1983) sets out various legal rights that apply to people with severe mental health problems. The Act also contains the powers which enable some patients to be compulsorily detained in hospital.
  • The Mental Capacity Act (2005) is designed to protect people who cannot make decisions for themselves. The Act explains when a person is considered to be lacking capacity, and how decisions should be made in their best interests. 
  • The Court of Protection is the legal body that oversees the operation of the Mental Capacity Act (2005).
  • An advance decision (previously called advance directive or "living will") is a legally binding document that sets out in advance the treatments and procedures that someone does not consent to.

Consent to treatment is the principle that a person must give their permission before they receive any type of medical treatment.

Consent is required from a patient regardless of the treatment, from blood test to organ donation.

The principle of consent is an important part of medical ethics and the international human rights law.

Defining consent

For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision. These terms are explained below.

  • Voluntary: the decision to consent or not consent to treatment must be made alone, and must not be due to pressure by medical staff, friends or family.
  • Informed: the person must be given full information about what the treatment involves, including the benefits and risks, whether there are reasonable alternative treatments, and what will happen if treatment does not go ahead. Healthcare professionals should not withhold information just because it may upset or unnerve the person (see below).
  • Capacity: the person must be capable of giving consent, which means they understand the information given to them and they can use it to make an informed decision. Read about assessing the capacity to consent.

If the person has enough capacity and makes a voluntary and informed decision to refuse a particular treatment, their decision must be respected. This is still true even if their decision would result in their death, or the death of their unborn child.

How to give consent

Consent should be given to the healthcare professional directly responsible for the person's current treatment, such as the nurse arranging a blood test, the GP prescribing new medication or the surgeon planning an operation.

It can be given:

  • verbally
  • non-verbally, for example, raising a hand to indicate they are happy for a nurse to take a blood sample
  • in writing, by signing a consent form

If someone is going to have major medical intervention, such as an operation, their consent should be obtained well in advance so they have plenty of time to study any information about the procedure and ask questions.

Withholding information

To consent to a treatment or procedure, the person needs to be fully informed about the treatment and understand why it is considered necessary. 

Healthcare professionals should not withhold information just because it may upset or unnerve the person. Even if the person specifically requests not to be told about the extent or likely outcome of their condition, the healthcare professional has a moral and legal responsibility to provide them with at least:

  • a basic overview of their condition
  • the likely outcome of their condition
  • their treatment options

Involving the Court of Protection

There are some circumstances where a decision should always be referred to the Court of Protection if the person cannot give their consent. Situations that should always be referred to the courts include:

  • sterilisation for contraceptive purposes
  • donation of regenerative tissue, such as bone marrow
  • withdrawal of nutrition and hydration from a person who is in a persistent vegetative state 
  • where there is serious concern about the person's capacity or best interests

When consent is not necessary

There are a few exceptions when treatment can go ahead without consent.

One main exception is if a person does not have the mental capacity (the ability to understand and use information) to make a decision about their treatment. In this case, the healthcare professionals can go ahead and give treatment if they believe it is in the person’s best interests.

Read more about when consent is not needed




Page last reviewed: 11/06/2012

Next review due: 11/06/2014

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The 2 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Rueda said on 03 January 2014

I agree with yasasii1. In theory consent is required however in practice Nurses and Doctors presume consent for all treatment. If you dare refuse or ask for more information you are simply ignored or otherwise cajoled and coerced to agree with no other options offered. For a simple example, take a look at MRSA screening guidance issued by hospitals. There is never any mention of consent to this screening. In fact most imply the screening is a requirement ahead of any treatment when this is simple not true and a patient has every right to refuse any screening.

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yasasii1 said on 05 January 2011

One has the right to refuse treatment but how does one enforce it.I have been subjected to medications,clothes stripped off me,x rays,ct scan and an invasive procedure that caused me harm recently at a nhs hospital by staff who did not understand the words no consent, this has left me severly traumatised and fearful of medical staff.

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