When and how to treat patients who refuse treatment

摘要

Knowing when and how to treat patients who refuse treatment is challenging. About 30% of acute medical inpa-tients lack capacity to make key decisions about their treatment,1 and this rises to above 40% for psychiatric inpatients.2 Clinicians tend to overestimate patients' capacity and miss cases where capacity is lacking.3 Navigating the relevant legal frameworks (common law, the Mental Capacity Act (MCA), and the Mental Health Act (MHA)) can seem daunting. This article explains the basics of this complex area and provides advice for clinicians on which framework to use and when it should be used, focusing on the needs of doctors working in "general" hospitals in England and Wales who treat patients over 16 years. Scotland and Northern Ireland have separate legal frameworks and the law for those under the age of 16 is a specialist area beyond the scope of this article. However, despite these differences, the principles of how to manage patients who refuse treatment are the same.