Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Jonathan Hooker is, I believe, quite right that the consent of
relatives is neither necessary nor sufficient for treating an incompetent
adult. Despite this, the practice of seeking relatives' consent is
widespread; many practitioners even get relatives to sign consent forms.
This seems to be not only legally ill-founded, but also ethically
questionable. The main worries are, first, that it diverts the
clinician's attention away from what should be their main focus, the
patient's best interest. Second, we cannot always be sure that relatives
do have the best interest of the patient at heart. In practice problems
are rare, but, as Morris (1) shows, they do occur.
1Morris E. Consent may be hard to obtain for incompetent patients
when relatives object. BMJ 1998; 316: 1608(23 May.)