Patients 'unable to give consent'

One in three acute care patients are incapable of consenting to treatment, a study says

One in three patients in acute medical wards are mentally incapable of consenting to treatment, a study shows.

Fifty out of 159 patients interviewed by the Institute of Psychiatry in London were deemed mentally incapable - mainly because of dementia or delirium.

But medical staff only recognised this in only 12 of the 50 cases, The Lancet medical journal reported.

Report co-author Professor Matthew Hotopf said this was "worrying" because people could be coerced into treatment.

"It is quite obvious people struggle to fully understand the information they are given when they are receiving acute care.

"It does not mean they are mentally incapable altogether, just unable to fully understand and make informed decisions about their immediate care.

"It is a reflection of how the need for acute care affects the mental capacity of patients.

'Difficult'

"Their thought process has been interfered with. "

Prof Hotopf said under current laws it was difficult for doctors to diagnose someone as mentally incapable of agreeing to treatment.

"The natural inclination is to avoid the issue. But that is not good for the patient.

Without getting consent there is the potential to harm Paul Corry, of Rethink

"People can be coerced into treatment and it is not very transparent, that does not help the patient."

Of the 159 interviewed for the study, 50 (31%) were found to be mentally incapable, according to the findings published in The Lancet journal.

The patients who were deemed mentally incapable tended to be older.

Of the 50 patients identified by the researchers, the medical staff treating them only recognised 12 (24%) of them were mentally incapable.

Harm

Paul Corry, of mental health charity Rethink, said the findings were "not surprising".

"The founding principals of medicine is that you should not harm the patient. Without getting consent there is the potential to harm.

"There is also evidence to suggest that patients involved in deciding about their treatment are much more likely to make a full recovery."

He said the problem doctors face is that there is a "legal black hole" in the UK as the Mental Health Act does not cover the issue.

But he said the Mental Capacity Bill, which is currently going through parliament, would go some way to remedying the situation by allowing patients to nominate someone else to act in their best interests.

A spokeswoman for the British Medical Association said: "Doctors must be aware how mental capacity impacts on patients' ability to make informed and valid consent and the BMA would be concerned if this is not happening.

"Capacity is often discussed as though it is something patients either definitively have or lack but the boundary is often less certain.

"It is important that doctors are sensitive to this and that patients are given any practical assistance they need to maximise their decision-making capacity."