Consent to treatment - When consent isn't needed 

When consent isn't needed 

There are a few exceptions when treatment may be able to go ahead without the person's consent, even if they are capable of giving their permission.

These circumstances are outlined below.

Additional procedures

There may be some circumstances when, during an operation, it becomes obvious that the person immediately requires an additional emergency procedure that was not included in their original consent.

For example, they may be having abdominal surgery, when the surgeon notices that their appendix is dangerously close to bursting and needs to be removed.

If it's felt that it would be too dangerous to delay the additional procedure to get consent, this procedure can go ahead if it is considered to be in the person's best interests.

However, extra procedures cannot be done just because it would be convenient for the healthcare professionals. There has to be a clear medical reason why it would be unsafe to wait to obtain the person's consent.

Emergency treatment

If a person requires emergency treatment to save their life, and they are unable to give consent as a result of being incapacitated (for example, they are unconscious), treatment will be carried out.

In these cases, the reasons why treatment was necessary will be fully explained once they have recovered.

Mental health conditions

Under the Mental Health Act (1983), people with certain mental health conditions  such as schizophrenia, bipolar disorder or dementia  can be compulsorily detained and treated at a hospital or psychiatric clinic without their consent, if deemed necessary.

If the person lacks capacity (the ability to understand information and use it to make a decision) and has not previously expressed their wishes, their mental health condition may be treated without consent, as may any related conditions, such as those resulting from self-harm. However, unrelated physical conditions cannot be treated without consent.

An advance decision prohibiting certain types of treatment can be overruled if a person is being held under the 1983 Act, even if they made the original decision when they were capable.

Self-harm and attempted suicide

In cases of self-harm or attempted suicide where the person refuses treatment and was competent when they harmed themselves, it may be necessary to see if they can be treated without consent under the 1983 act. This can happen if a person has a serious mental health condition that requires hospital treatment.

The person's nearest relative or an approved social worker must make an application for the person to be forcibly kept in hospital and treated. Two doctors must assess the person's condition.

Risk to public health

Under the Public Health (Control of Disease) Act (1984), a magistrate can order that a person is detained in hospital if they have an infectious disease that presents a risk to public health, such as rabies, cholera or tuberculosis (TB).

Severely ill and living in unhygienic conditions

Under the National Assistance Act (1948), a person who is severely ill or infirm and is living in unsanitary conditions can be taken to a place of care without their consent.

Page last reviewed: 03/06/2014

Next review due: 03/06/2016

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

User740855 said on 17 January 2013

I would like to point out the lack of justification afforded by the above principles to circumcision of male infants. Circumcision is done without the patient's consent. In the absence of overwhelming justification, such as a life threatening emergency, surgeries must not be performed on patients who cannot provide informed consent.

In the UK, everyone has the same legal rights, regardless of their age, sex, or religion, etc. If babies have the exact same legal rights as adults, then they must be treated with the same respect for their autonomy as we would treat adults. Therefore, in a medical setting, they should be treated not as objects, but more like adults who are temporarily incompetent or unconscious.

If we were to do so, and then apply to them the standards we use for incompetent adults, routine infant circumcision would be clearly seen as unethical. It would consequently also be illegal.

A parent may not elect totally unnecessary surgeries for their child. Parental consent alone cannot justify an unnecessary surgery which violates the patient's autonomy; there must be an overwhelming justification provided. The "consent by proxy" of a parent, for their infant child, is no more authoritative than consent by a parent for surgery on their adult children. No one would accept the idea of performing a circumcision on an incapacitated, grown man simply because his parents requested it. There must always be an overwhelming justification whenever performing surgery on a patient without their consent. In the absence of a proper justification for abrogating patient consent, medical intervention becomes unethical.

The human rights and legal protections that adults enjoy apply equally to children. Physicians have an obligation to protect the rights of children under their care. Routine infant circumcision violates those rights.

I suggest reading a thorough legal analysis of the issue here: http://www.ncbi.nlm.nih.gov/pubmed/11216345

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Complaints

If you believe that you have received treatment that you did not consent to, you can make an official complaint.

Read more about how to make a complaint.