We are accustomed to the situation where it may be better to prioritise the quality rather than the quantity of a patient’s remaining life. This shift in emphasis is made only in conjunction with the patient, or her family; but for the management of physical illness, this is rarely controversial.

The same cannot be said of mental illness.

A 64 year old lady was lying in the resuscitation room of an emergency department in London whilst an SHO was proposing to insert a cannula into her left arm.

Vets do this all the time. Faced with the stark prognosis of a beloved family friend with Cushing’s who will die unless he gets his daily bromocriptine, the vet recommends without qualms that the horse’s owner conceals the foul-tasting tablet by burial deep within a carrot.

It is not uncommon to hear of the patient with capacity who resists hospital discharge; but who has no medical cause to remain.

Compulsion may be needed for amputation. Hospitals sometimes seek judicial authorisation for amputations in incapacitated adults.

Patients do not often disagree with the clinician who is treating them. When disagreement occurs, under some circumstances, this may lead to the patient’s capacity to make decisions being questioned.

Can the Mental Health Act enforce blood transfusion?

Consent For Surgery by CLAWS

Hospitals have a duty to prevent incapacitated patients from hurting themselves.

The foreseeable risks associated with clinical practice seem innumerable, and when seeking a patient’s consent for treatment, we are faced daily with the prospect of trying to identify what we will and will not disclose.