Voluntariness

Patients may find it very difficult to say “No” to the proposed treatment, or to challenge the doctor’s assumption that they would have no objections

Patients overtly coerced into undergoing treatment they plainly do not want can rightly claim that their “consent” was not given freely and is therefore not valid. Cases of overt coercion are rare, but there are many circumstances in which patients may feel that they have been covertly pushed into accepting treatment they would prefer not to have had.

For example, in some circumstances patients may find it very difficult to say “No” to the proposed treatment, or to challenge the doctor’s assumption that they would have no objections to going ahead, so it is best to check that they have no misgivings before proceeding. Relatives, friends and caregivers (and sometimes employers) can also exercise considerable influence in a patient’s decision-making, and this might sometimes develop into undue pressure. If there is a likelihood that this is the case, check that the patient has truly considered all the options and is aware that they have a right to refuse the proposed procedure.8

Patients who are detained by the Police, Immigration Services, Prison Authorities or under mental health legislation may be particularly vulnerable, and under these circumstances you should try to ensure that they are aware that they can refuse treatment if they so wish. Patients detained under the Mental Health Act may be treated for their mental disorder without their consent (depending on the section of the Act that applies), but not for physical ailments unless these arise from the mental disorder.

Scenario 4

Mr H is doubtful about having an injection straight into the joint, but Dr J brushes aside his doubts

Mr H is a plasterer in his late forties. He has been experiencing pain in his left knee, on and off, for several years, but this has been adequately managed with a combination of physiotherapy and NSAIDs.

One day, he comes to see his GP, Dr J, complaining of intense pain and limited movement in his knee. Dr J, noting Mr H’s history and finding, on examination, that the knee is slightly swollen, recommends an intra-articular injection of steroid. As he is aware that Mr H is self-employed and needs to be able to return to work as soon as possible, he suggests that he administer the injection there and then.

Mr H is doubtful about having an injection straight into the joint, but Dr J brushes aside his doubts, saying that it will get him “up and running in no time”. He points out that it is unlikely he will get another appointment at the practice until the following week, which will only delay his recovery. Mr H reluctantly acquiesces, and allows Dr J to administer the injection.

Unfortunately, he subsequently develops septic arthritis in the joint. Although this is successfully treated with antibiotics, he loses several more weeks’ work and decides to sue Dr J. His claim alleges invalid consent, not only because he had not been warned about the small risk of infection, but because he had felt coerced into making a hasty decision.

  

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