Changes in legislation and case law have brought about several changes in the way that doctors in England and Wales have to deal with consent and capacity issues. These changes affect dermatology in many ways regarding the way we gain consent and the information we have to share with the patient. This article will provide an update and overview on these changes and how they affect dermatology in particular. Legislation changes have opened up avenues to discuss difficult advance decisions with patients. It is hoped that these will reduce the number of ethical dilemmas arising from questions about the treatment of incapacitated patients. It is also necessary, following recent case law, to document and discuss any significant, unavoidable or frequently occurring side-effects of any proposed medication with patients. This means that the recent changes in legislation and case law bring opportunities to dermatologists, but also require improved documentation.