Consent to treatment

Somewhat paradoxically, many detained patients consent to have treatment once they are 'sectioned', but others do not. Section 58 (treatment requiring consent or a second opinion) covers the use of ECT in detained patients, and administration of drugs when a particular medication is being continued longer than 3 months. Administration of such treatment requires that either the patient consented and this has been certified as 'informed' by the responsible medical officer or an independent doctor; or an independent doctor has certified that the patient has not given consent or is not capable of understanding the nature, purpose, and likely effects of the treatment, but that, having regard to the likelihood of its alleviating or preventing deterioration of his/her condition, the treatment should be given. The independent doctor must consult two other staff members, one a nurse and the other neither a doctor nor a nurse.

Section 57 (treatment requiring consent and a second opinion) covers the special conditions regulating two treatments that have often given rise to ethical concern: psychosurgery and surgical implantation of hormones to reduce male sexual drive. Here, the patient's informed consent is not sufficient on its own (whether the patient is detained or voluntary). It must be supported by an independent doctor appointed by the Mental Health Act Commission, and two other non-medical appointed persons who have certified in writing that the patient is capable of understanding the nature, purpose, and likely effects of the proposed treatment and has consented to it. This occasionally gives rise to situations where a patient consents to, or even requests, a particular treatment (for example, hormone treatment of a sex offender), but the commission refuses.

Section 62 (urgent treatment), a treatment normally restricted under Sections 57 or 58, may be given to a detained patient without obtaining formal consent or a second opinion in an emergency, such as ECT to save the life of a seriously dehydrated depressed patient. In practice, such treatment would often be given under common law.

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