Even when his or her life depends on receiving medical treatment, an adult of sound mind is entitled to refuse it. This reflects the autonomy of each individual and the right of self-determination. Lest reiteration may diminish the impact of this principle, it is valuable to recognise the force of the language used when the right of self determination was most recently considered in the House of Lords (1).
It is well established English law that it is unlawful, so as to constitute both a tort (a civil wrong) and the crime of battery, to administer medical treatment to an adult who is conscious and of sound mind without his consent. such a person is completely at liberty to decline to undergo treatment even if the result of his doing so will be that he will die (2).
The principle of self-determination requires that respect must be given to the wishes of the patient, so that if an adult patient of sound mind refuses, however unreasonably, to consent to treatment or to care by which his life would or might be prolonged, the doctors responsible for his care must give effect to his wishes, even though they do not consider it to be in his best interests to do so...To this extent, the principle of the sanctity of human life must yield to the principle of self-determination ..and, for present purposes perhaps more important, the doctor's duty to act in the best interests of his patient must likewise be qualified (3).
Any treatment given by a doctor to a patient which involves any interference with the physical integrity of the patient is unlawful unless done with the consent of the patient: it constitutes the crime of battery and the tort of trespass to the person (4).
A doctor has no right to proceed in the face of objection, even if it is plain to all, including the patient, that adverse consequences and even death will or may ensue (5).
The author can do no better than to open a discussion of the topic of consent by quoting the powerful and unambiguous language of the law lords in a leading case. The underlying reason for this position:
...is that English law goes to great lengths to protect a person of full age and capacity from interference with his personal liberty. We have too often seen freedom disappear in other countries not only by coups d'etat but by gradual erosion; and often it is the first step that counts. So it would be unwise to make even minor concessions (6).
The foregoing applies to all adults who are mentally competent; when a patient lacks the capacity to make decisions about whether to consent to treatment (e.g., when he or she is unconscious or suffering from mental disability), the medical practitioners who are responsible for his or her treatment must act in the patient's best interests and, if appropriate, may conduct major invasive treatments without expressed consent (7).
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