for Health, but whose day-to-day involvement is monitored by the Mental Health
Act Commission). To verify the consent, they will have certified in writing that the patient is capable of understanding [the] nature, purpose and likely effect [of the treatment] and has consented to it' #section 58 #3)#a)). Alternatively, if the patient cannot, or will not, consent, the medication may continue, but only if a SOAD hascertified in writing that the patient is not capable
of understanding the nature, purpose and likely effects of that treatment or has not
consented to it but that, having regard to the likelihood of its alleviating or pre-
venting a deterioration of [the patient's] condition, the treatment should be given'
#section 58 #3)#b)). The simplest means of ensuring that one of these alternatives
exists is for the nurse to check which form, if any, is in the patient's file. If the
patient is consenting to treatment, it must be covered by a Form 38; if the patient is
not consenting, a Form 3 9must be present. The question for the nurse, initially, is
not whether the patient is consenting, but whether there is a form apparently
proper on its face which entitles the nurse to be involved in the treatment of the
detained patient.
In most hospitals, where thought has been given to the issue, a copy of the
relevant form is kept with the medicine card, so that the legal authorisation for the
treatment of the patient may be checked every time a drug is administered. This is
asimple procedure which enables an easy check to be made. It is surprising,
however, how frequently the relevant form is not kept with the treatment card and
how frequently the nurse does not realise the significance of the form, and the
importance of checking that it covers the treatment in question.
In addition to the issue of checking the lawfulness of treatment, the nurse may
be involved in other matters relating to treatment of the detained patient. Treat-
ment covered by Form 38, where the patient consents, does not give rise to a
statutory review of the need for treatment [16]. The MHA Code of Practice, how-
ever, at paragraph 16.35 requires that, as a matter of good practice, `all treatments
...should be regularly reviewed and the patient's treatment plan should include
details of when this will take place'. The Code of Practice, while not specifying
intervals for review, suggests that a new Form 38 should be completed when:
#1) there is a change in the treatment plan from that recorded;
#2) consent is re-established after being withdrawn;
#3) there is a break in the patient's detention;
#4) there is a permanent change of rmo;
#5) the patient's detention is renewed #or annually, whichever is earlier);
#6) there is change in the hospital where the patient is detained. [17]
As well as being good practice, reviewing treatment regimes will enable regular
consideration to be given to the question of the patient's continued consent. A
patient retains the right to withdraw consent to treatment at any time #section 61),
and nurses should be aware of the need to assess continuing consent whenever
delivering medication. In the event that consent is withdrawn the nurse should
request the attendance of the rmo who may be able to encourage the patient to
accept the treatment. By so doing, the nurse will ensure compliance with their own
professional code of practice, and will also act in accordance with the MHA Code
of Practice which states:
164 Nursing Law and Ethics