recording dissent may be the only step left that the nurse feels able to take. This
dissent would be identified by the Mental Health Act Commission and potentially
investigated. A more recently introduced alternative may be to utilise the Public
Interest Disclosure Act 1998 [23], although how willing a nurse may be to take this
route is uncertain.
Treatment under section 57
The treatments covered by section 57 are psychosurgery and the surgical
implantation of hormones to reduce male sexual drive #the two procedures are
deemed neurosurgery by the Mental Health Act Commission). In order for them to
be performed, the patient must consent and this must be verified by a SOAD and
two members of the Mental Health Act Commission #from an internal panel
appointed for this purpose). These three must have certified in writing that the patient is capable of understanding the nature, purpose and likely effects of the treatment in question and has consented to it' #section 57#2)#a)). Also, the SOAD must certify that,having regard to the likelihood of the treatment alleviating or
preventing a deterioration of the patient's condition, the treatment should be
given' #section 57#2)#b)). These requirements are certified as being satisfied by the
completion of a Form 37. If there is no Form 37, the treatment cannot go ahead.
The presence of a Form 37 will also be required if the treatment is planned for an
informal patient, being a patient who is not detained under the MHA by virtue of a
section. These two forms of treatment, which raise considerable ethical and legal
issues, are carried out relatively rarely on detained patients [24]. Owing to this
limited use, more attention has been spent on the preceding treatments authorised
by sections 58 and 63.
Emergency treatment under section 62
Before moving on to consider treatment outside the MHA, it is worth noting that
the requirements in the Act relating to sections 57 and 58 may be sidestepped in an
emergency by virtue of section 62. In these cases it is important for nurses to
ensure that they are satisfied that the criteria of section 62 are met, since reliance
upon another person's view #i.e. the doctor's) may not be sufficient to protect the
nurse from action where the treatment turns out to be unlawful. At the very least, it
is necessary for the nurse to ensure that there is documentation that the section has
been satisfied. This may be done via a local form #as suggested by the Code of
Practice in paragraph 16.41) or some other recording system.
It may be necessary for the nurse to assess whether the treatment actually
satisfies section 62, as part of the nurse's duty to account to the patient. The section
provides:
`#1)Sections 57 and 58 above shall not apply to any treatment ±
#a) which is immediately necessary to save the patient's life, or
#b) which #not being irreversible) is immediately necessary to prevent a
serious deterioration of his condition; or
#c) which #not being irreversible or hazardous) is immediately necessary and166 Nursing Law and Ethics