CONSENT, COMPETENCE AND REFUSAL OF TREATMENT452 Administrative and Legal Issues
(i) Thus competence incorporates the elements of comprehension,
appreciation, reasoning and choice.
4 Therefore, explain the details of any proposed procedure, and warn of pos-
sible complications. The patient must understand the implications and
nature of the treatment proposed, or of not accepting the treatment.
5 Pat ient s w ho a re not d e eme d c omp e t ent , t h at i s w it h c ond it ion s t h at pre c lud e
comprehension of the nature and implications of the treatment proposed,
may be given emergency treatment without consent to save life or to prevent
serious damage to health.
6 The doctor should also proceed in cases of emergency to save life, even if
consent was not obtained in a competent patient.
7 Patients under the age of 16 years may be able to consent for minor treatment
provided they have the ability to understand what is proposed, although for
major treatment it is more appropriate to seek consent from the parent or
guardian (or teacher in an emergency).
(i) Importantly, medical information should not then be supplied to
others, including parents, without permission.
(ii) It is appropriate to proceed to life-saving treatment of a minor
even if the parent or guardian refuses, including a blood
transfusion in a Jehovah’s Witness minor.
(iii) Contact the hospital administration, the paediatric team and at
least commence application for a court order as necessary.Refusal of treatment and discharge against medical advice
1 Patients who refuse admission to hospital and/or a recommended treatment
plan may be permitted to discharge themselves against advice, provided they
are competent and well informed – that is, they understand fully the con-
sequences of their actions.
2 Make meticulous notes of exactly what was said to the patient, and his or her
response, demonstrating that they clearly understood the issues.
(i) The patient may sign the appropriate form, accepting
responsibility for their own action.
(ii) However, it is much more important to document in long-hand
in the medical notes exactly what was said and what the patient
understood and decided.
3 Record if the patient refuses to sign any form, or disappears before a form is
signed, and have this countersigned by a witness, such as a senior nurse or a
second doctor.
4 A patient suffering from a mental illness may be involuntarily detained
against his or her will under the relevant Mental Health Act, if he or she is a
danger to t hemselves or ot hers (see p. 443).