Basildon EM Handbook 2018

Consent is required for every examination, treatment, or intervention performed on a patient. Consent may be explicit or implied. The key principles for valid consent are:

1.The patient must be competent.

2.The patient must be sufficiently informed to make a choice.

3.Consent must be given voluntarily.

Who can give consent?

The only person who can consent for a competent adult is the patient themselves.  A young person of any age can consent to treatment provided they are considered to be competent (Gillick competent) to make the decision.  At the age of 16 there is a presumption that the patient is able to give valid consent. However, up to the age of 18 in England, Wales, and Northern Ireland, and age 16 in Scotland, if the person is felt to lack capacity, a person with parental responsibility can give consent on behalf of the patient.  A Lasting Power of Attorney can consent on behalf of an adult patient once capacity is lost.

Refusal of consent

Competent adult patients are entitled to refuse consent to treatment, even if doing so may result in permanent physical injury or death. The exception to this is where compulsory treatment is authorized by mental health legislation. Where the consequences of refusal are grave, it is important that the patient understands this. Doctors must respect a refusal of treatment if the patient is a competent adult, who is properly informed, and not being coerced.

In England, Wales, and Northern Ireland, refusal of treatment by competent under-18s is not necessarily binding upon the doctors. The courts have ruled that patients under 18 have a right to consent to treatment, but not to refuse it if this would put their health in serious jeopardy. In such circumstances consent may be gained from an adult with parental responsibility or a court. In Scotland, it is likely that neither parents nor the courts are entitled to override a competent young patient's decision, although this has not been tested in the courts.  Cases of refused consent are best discussed with senior medical staff, the hospital legal department, and/or medical defence societies.

Consent for emergency treatment

Consent should be sought for emergency treatment if the patient is competent.  If consent cannot be obtained, medical treatment that is in the patient’s best interest, and is immediately necessary to save life or avoid significant deterioration in the patient’s health, should be provided.

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