Refusal to consent: can it be ignored?

The common law has long recognised the right of competent adults to autonomy and self determination and this has been held to apply to the right to refuse medical and surgical treatment even when refusal could lead to severe detriment to the individual's life and health. Those who work with patients in a health profession can be faced with a refusal to consent to treatment when the best clinical opinion is that the treatment is appropriate and necessary, and considered to be in the patient's best interests. There have been no clear guidelines which health professionals can follow in deciding to treat or not treat in the presence of a patient's refusal. Where the patient continues to be competent there is an opportunity to take the matter up again with him or her as circumstances change. However, when the patient loses competence, a clinical dilemma arises. There are documented legal cases in which courts have authorized treatment of competent adults even when they have refused or are refusing treatment. Some of these cases involve saving the life of an unborn child. The question which arises is whether different principles apply when an unborn child is involved. To date most of the cases have been heard in North American courts. However, there have been two recent cases in England where courts have authorized treatment without consent when the subjects have apparently had the capacity to make a decision to refuse treatment.(ABSTRACT TRUNCATED AT 250 WORDS)