Appendix: Consent to Treatment

What does 'consent to treatment ' mean?

Consent to treatment is a patient's agreement for a health professional to provide a particular form of treatment. For consent to be valid, the patient must:

  • Have received sufficient information to make that decision;
  • Have the mental capacity to make it;
  • Not be acting under duress.

What does 'mental capacity' mean? Mental capacity relates to an individual's ability to make a particular decision. In England and Wales there is a statutory Mental Capacity Law that does not apply in Northern Ireland, but is guiding good practice.

What factors should be considered when assessing a person's decision-making capacity? The assessment of decision-making capacity is a matter of clinical judgment guided by current professional practice and subject to legal requirements. To demonstrate capacity the patient should be able to:

  • Understand in simple language what the proposed treatment is, its purpose and why it is being proposed;
  • Understand the main benefits, risks and possible alternatives, and the consequences of not receiving the proposed treatment;
  • Retain the information for a sufficient period of time in order to consider it and arrive at a decision;
  • Communicate the decision.

When seeking a person's consent to treatment , what information should that person receive? There is an obligation on the treating healthcare professional to ensure that the person fully understands the nature, purpose and likely effects of the proposed treatment. Any misrepresentation of these elements will invalidate consent. Information should be presented in a way that is easiest for the person to understand, for example, by using simple language or visual aids. A support worker, interpreter, speech and language therapist, family member, or advocate may help with communication.

In considering what information to provide, the healthcare professional should try to ensure that the person is able to make a balanced judgement on whether to give or withhold consent. It must be tailored to an individual's needs and abilities. It is advisable to inform the person of any 'material' or 'significant' risks in the proposed treatment, any alternatives to it and the risks incurred by doing nothing. If the patient asks specific questions about the treatment and associated risks, these should be answered truthfully.

Some individuals may wish to know very little about the treatment or care that is being proposed. If information is offered and declined, it is good practice to record this fact in the notes. However, it is possible that individuals' wishes may change over time and it is important to provide opportunities for them to express this.

In the very rare event that the health or social care professional believes that to follow this guidance in full would have a deleterious effect on the person's health or well being, this view, and the reasons for it, should be recorded in the patient's notes. When such concerns arise it is advisable to discuss the issue within the team caring for the individual. The mere fact that the person might become upset by hearing the information, or might refuse treatment or care, is not sufficient to act as a justification.

How can you ensure consent is given voluntarily ? To be valid, consent must be given voluntarily and freely, without pressure or undue influence being exerted on the person either to accept or refuse treatment or care. Such pressure can come from partners or family members as well as health or social care professionals. Professionals should be alert to this possibility and where appropriate should arrange to see the person on their own to establish that the decision is truly theirs.

When individuals are seen and treated in a setting such as a prison or psychiatric hospital where involuntary detention may be an issue, there is a potential for offers of treatment or care to be perceived as coercive, whether or not this is the case. Coercion invalidates consent and care must be taken to ensure that the individual makes a decision freely.

Coercion should be distinguished from providing the individual with appropriate reassurance concerning their treatment or care, or pointing out the potential benefits of treatment or care for the person's health or well-being. However, threats such as withdrawal of any privileges or loss of remission of sentence for refusing consent, or using such matters to induce consent are not acceptable.

Acquiescence, where the person appears to agree but does not fully understand what the treatment entails, is not valid consent. This may be a particular issue for people with a learning disability which staff should be alert to and take measures to avoid.

Is good practice guidance available for Northern Ireland? Good practice guidance is available for Northern Ireland: Guide to Consent for Examination, Treatment or Care (2003). Department of Health, Social Services and Public Safety. LINK TO Guide to Consent for Examination,Treatment or Care (2003)

Further detailed guidance for children, older people, people with learning disabilities, prisoners and other detainees, is available in different languages at

These Consent Guides for Healthcare Professionals include:

  • HSS (MD) 7/2003 Circular: Good Practice in Consent (PDF 172 KB)
  • Reference Guide to Consent for Examination, Treatment or Care (PDF 155 KB)
  • Good practice in consent: Implementation guide for health care professionals (PDF 194 KB)
  • Good practice in consent : Desk Aid 12 Key Points on Consent (PDF 55 KB)
  • Seeking Consent: Working with children (PDF 111 KB)
  • Seeking Consent: Working with older people (PDF 97 KB_
  • Seeking Consent: Working with people with learning disabilities (PDF 97 KB)
  • Seeking Consent: Working with prisoners and other detainees (PDF 109 KB)

Consent Guides for Social Workers, Social Care Staff and Students:

  • Consent in Social Care (72.6KB)
  • Good Practice in Consent - Social Work Students(60.1KB)

Patient Information Leaflet

  • Consent - it's up to you (PDF 106 KB)
  • Consent - it's up to you - Cantonese Translation (PDF 181KB)
  • Consent - it's up to you - Mandarin Translation (PDF 171 KB)
  • Consent - it's up to you - Irish Translation (PDF 131 KB)

Consent - What you have a right to expect - Guides for

  • Adults (PDF 66 KB)
  • Parents (PDF 67 KB)
  • Children and young people (PDF 101 KB)
  • People with learning disabilities (PDF 127 KB)
  • Relatives and Carers (PDF 62 KB)