Consent to Treatment

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.

If the person has enough capacity and makes a voluntary and informed decision to refuse a particular treatment, their decision must be respected.

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 or the GP prescribing new medication.

 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

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

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. 

Capacity to give consent needs to be assessed at the time that consent is required. 

All adults are presumed to have sufficient capacity to decide on their own medical treatment unless there is significant evidence to suggest otherwise.

Any evidence that a person does not have this capacity has to show both of the following:

• a person's mind or brain is impaired or disturbed

• the impairment or disturbance means the person is unable to make a decision at the current time

Examples of these conditions include:

• mental health conditions, such as schizophrenia or bipolar disorder (manic depression)

• dementia

• serious learning disabilities

• long-term effects of brain damage

• physical or mental conditions that cause confusion, drowsiness or a loss of consciousness

• delirium (mental confusion)

• intoxication caused by drug or alcohol misuse

Someone is thought to be unable to make a decision if they are unable to:

• understand information about the decision

• remember that information

• use that information as part of their decision-making process 

• communicate their decision by talking, using sign language or by any other means

Advance decisions
If a person knows their capacity to consent may be affected in the future, they can pre-arrange a legally binding advance decision (previously known as an advance directive).

An advance decision sets out the procedures and treatments that a person does not consent to. This means the healthcare professionals treating the person cannot perform certain procedures or treatments against their wishes.

For an advance decision to be valid, it must be specific about what the person does not want done and under what circumstances. For example, if they want to refuse a certain treatment, even if by doing so their life is at risk, they must clearly state this.

The healthcare professionals must follow the advance decision, providing it is valid and applicable.  If there is any doubt about the advance decision, the case can be referred to the Court of Protection.

Text adapted from NHS Choices where links to further information can be found.