That patients exercise 'rights' to autonomy when providing consent only makes sense if there is a corresponding right to refuse, and so this module considers the nature and scope of the right to refuse or withdraw consent to medical treatment.
We will explore whether the right is subject to limitations, and specific criteria that apply. Mirroring the module on positive consent, a thorough understanding of refusal encompasses many of the same 'categories' of patient encountered in the previous session.
A key question to consider during this module is whether consent and refusal are two sides of the same coin? If so, does it mean that the criteria and principles applied to the former must be applied with equal weight and effect to the latter? In logic, there is no difference in the 'ability' to either consent or refuse. In law, however, we find that the two aspects are often treated distinctly, with higher thresholds being required by the courts in relation to refusals.
Aims and objectives
- Understand how the presumption of capacity operates in the context of refusals, and what thresholds must be satisfied before treatment can lawfully proceed;
- Consider the problems that arise when there are disputes over the nature or substance of a refusal, and the potential for uncertainty in both law and practice in determining whether to override a patient's expressed wishes - particularly when the dispute involves parental refusals;
- Survey the different approaches and rules that attach to different 'categories' of minor, and how the concept of concurrent consent manifests itself in refusal situations; and
- Look at categories of 'vulnerable' patient, including those with conditions like anorexia, those who are incarcerated, and those in late-term pregnancies.