Refusal of treatment in a patient with fluctuating capacity - theory and practice

In clinical practice there is an increasing emphasis on the need for informed consent and, correspondingly, whether individual patients are capable of giving informed consent. The wealth of recent law on this issue can be bewildering for clinicians for whom the formal assessment of capacity is still a rare clinical event. This paper reports the case of a man with both serious mental illness and a life threatening physical illness. It describes the role and limitations of different theoretical approaches to the assessment of capacity when applied to real life assessments. It places this in the context of recent governmental and legal advice on when, in such cases, doctors need to seek the help of the courts.

Keywords:

• Autonomy
• capacity
• competence
• consent
• paternalism
• treatment