Circumstances that affect the decision-making process continued

No one else can make a decision on behalf of an adult who has capacity. If a patient who has capacity asks you or someone else to make a decision on their behalf, you should tell them this. You should explain that it’s important they understand some basic information so that you can proceed with treatment or care. This would usually include what the options are and what they aim to achieve.

If a patient has chosen an option but doesn’t want to discuss the details, you should explain they will need to have some information about what it would involve before you can proceed, such as:

1. whether the procedure is invasive
2. what level of pain or discomfort they might experience and what can be done to minimise this
3. anything they should do to prepare for the intervention
4. if it involves any risk of serious harm.

You should try to find out why they don’t want to be involved in decision making and explore whether you can do anything to reassure and support them. They might be anxious about the decision or overwhelmed by the information and need time or support to process it.

If, after trying to discuss options with them along the lines set out above, your patient insists that they don’t want even this basic information, you will need to judge whether their consent is valid so that you can proceed. This is more likely to be the case if the proposed option is a well-established intervention commonly used for treating the condition they have, and there’s reason to believe the patient wants to be treated or cared for rather than take no action. You should consider seeking advice from your medical defence body or professional association in these circumstances.

Many factors influence patients’ decision making, but it’s important that nothing influences a patient to such an extent that they can’t exercise free will. If a patient can’t make a decision freely, they won’t be able to consent.

Patients may feel pressure to have particular treatment or care. Pressure can come from others – partners, relatives or carers, employers or insurers – or from patients’ beliefs about themselves and society’s expectations.

You should be aware of this possibility and of other situations in which patients may be particularly vulnerable or susceptible to pressure, for example, if they are:

1. experiencing domestic or other forms of abuse
2. resident in a care home
3. cared for or supported by others because of a disability
4. detained by the police or immigration services, or in prison
5. subject to compulsory treatment or assessment orders, or at risk of becoming so.*

If you suspect a patient’s rights have been abused or denied, you must follow local safeguarding procedures and consider raising a concern.

You should do your best to make sure patients reach their own decision, having considered relevant information (see paragraph 10) about the available options, including the option to take no action. You should support them to make a decision, following the steps in paragraphs 27–30 as well as:

1. giving them more time and a safe, quiet space to consider the options
2. making sure you have an opportunity to talk to them on their own
3. signposting them to specialist support services.

You must make sure your patient is aware that they have the right to choose whether or not to have treatment. You should not proceed with treatment or care if you don’t think it will serve the patient’s needs.*

If, after following the guidance in paragraphs 72–74, you still believe a patient is under such extreme pressure to agree to or refuse a particular intervention that they can’t exercise free will, you should seek advice through local procedures, consult your medical defence body or professional association or seek independent legal advice. The Court may be able to make declarations and orders to protect adults where they are not able to freely make a decision.