When and how to treat patients who refuse treatment

BMJ 2014; 348 doi: (Published 02 June 2014) Cite this as: BMJ 2014;348:g3501

This Practice article by Rosemary A Humphreys and colleagues (BMJ 2014;348:g2043, doi:10.1136/bmj.g2043) contains some errors in the following sections. A more detailed discussion of these issues can be viewed in the authors’ rapid response to the online article (

In table 1, the “Criteria” for “Common law” should have read “Action is needed to prevent harm; in emergencies only,” rather than “Action is needed to prevent harm; in emergencies only until there is time to assess capacity or undertake an MHA assessment” as was published. Also, under “MHA” the “Criteria” should have read: “The patient’s mental disorder is of a nature (type) or [not “and” as published] degree (severity) that requires compulsory assessment or treatment in hospital.”

In the third row of figure 1 (algorithm), “Use common law” should have read “Use MCA (or common law).” In the fourth row, “Use frameworks of MHA or MCA (following step 2) once there is opportunity for assessment” should have read “Following step 2 use frameworks of MCA (if not already using) or MHA once there is opportunity for assessment.” For clarity, both table 1 and figure 1 have been reproduced at the bottom of this page with their correct wording.

Finally, in the section “Step 1: how urgent is treatment? Is common law applicable?” the second sentence should be replaced with: “In such situations, despite there being insufficient time for a fuller capacity assessment, the MCA should be used. In emergencies the MCA Code of Practice acknowledges that there is a reduction in the time available, and subsequent expected level of capacity assessment required, to arrive at a ‘reasonable belief’ that capacity is lacking and to decide on what treatment, if any, is in the patient’s best interests. However, there are a few important exceptions to this when common law is used, such as when the patient is under the age of 16 or when the intervention is for the protection of others; in such cases the MCA is not applicable (see Table).”

Summary of key differences between common law, the Mental Capacity Act (MCA), Mental Health Act (MHA)*

View this table:


Cite this as: BMJ 2014;348:g3501

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