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: 15/09/2014

Next review due: 15/09/2016

Relevant legal terms

  • The Mental Health Act (1983, amended 2007) sets out various legal rights that apply to people with severe mental health problems. The Act also contains the powers that enable some patients to be 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 in 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 (see above).
  • 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 is refusing to have.

Consent to treatment is the principle that a person must give their permission before they receive any type of medical treatment or examination. This must be done on the basis of a preliminary explanation by a clinician.

Consent is required from a patient regardless of the intervention  from a physical examination to organ donation.

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

It can be given:

  • Verbally  for example, by saying they are happy to have an X-ray.
  • In writing  for example, by signing a consent form for surgery.

Patients may passively allow treatment to take place  for example, by holding out an arm to show they are happy to have a blood test. However, since the capacity to consent has not been tested, and the benefits and risks have not been explained, this is not the same as consent (see below).

"Capacity" means the ability to use and understand information to make a decision, and communicate any decision made.

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 either consent or not to consent to treatment must be made by the person themselves, and must not be influenced by pressure from medical staff, friends or family.
  • Informed  the person must be given all of the information in terms of 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.
  • 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.

If an adult has the capacity to make a voluntary and informed decision to consent to or refuse a particular treatment, their decision must be respected. This still stands even if refusing treatment would result in their death, or the death of their unborn child.

If a person does not have the capacity to make a decision about their treatment, the healthcare professionals treating them can go ahead and give treatment if they believe it is in the person’s best interests. However, the clinicians must take reasonable steps to seek advice from the patient’s friends or relatives before making these decisions.

Read more about assessing the capacity to consent.

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.

If someone is going to have a major medical procedure, such as an operation, their consent should ideally be obtained well in advance, so they have plenty of time to examine any information about the procedure and ask questions. If they change their mind at any point before the procedure, the person is entitled to withdraw their previous consent.

If they are able to, consent is usually given by patients themselves. However, someone with parental responsibility may need to give consent for a child to have treatment. Read more about the rules of consent applying to children and young people

If someone with little or no chance of recovery requires treatment for the sole purpose of keeping them alive, and the person is unable to make a decision themselves, an agreement about continuing or stopping treatment will need to be reached between the healthcare professionals responsible for their care and the person's relatives and friends. Read more about consent and end of life issues.

When consent is not necessary

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

For example, it may not be necessary to obtain consent if:

  • Treatment is needed in an emergency, and the person is unable to give consent because they lack the capacity to do so.
  • When, during an operation, it becomes obvious that the person immediately requires an additional procedure to treat a life-threatening problem that was not included in their original consent.
  • A person with a severe mental health condition – such as schizophrenia, bipolar disorder or dementia – lacks the capacity to consent to the treatment of their mental health. However, in these cases, treatment for unrelated physical conditions still requires consent, which the patient may be able to provide, despite their mental illness.

Read more about when consent isn't needed.

Page last reviewed: 03/06/2014

Next review due: 03/06/2016

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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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