We may advise and persuade, but never coerce

The lay and medical press have recently hosted a vigorous debate over enforced caesarean sections. At least six cases have been reported in the past six months, of which one, albeit an unusual one, is discussed in this week's BMJ (p 1183).1 A landmark judgment from the court of appeal this March has clarified the legal position: a mentally competent patient has an absolute right to refuse medical treatment even where that decision might lead to her death or the death of her baby, for any rational or irrational reason or for no reason at all. What this means is that unless capacity to consent is at issue, the courts are unlikely to consider future applications of this kind. The capacity to consent is assumed to be present until it is shown not to be, and is quite distinct from mental health or rationality.2 This still leaves some obstetricians feeling uncomfortable.

In this week's BMJ four sets of commentators …