Many patients who are admitted to hospital, or treated in the community, lack capacity. In the vast majority of cases, these patients do not refuse treatment that is given that is deemed to be in their best interest. The problem arises when patients who lack (or are suspected of lacking) capacity refuse treatment.

There are 3 main frameworks that are used in this scenario:

• common law: used to treat patients in emergency scenarios
• Mental Capacity Act: (MCA) used in patients who require treatment for physical disorders that affect brain function. Remember this may be delirium secondary to sepsis or a primary brain disorder such as dementia
• Mental Health Act (MHA): used in patients who require treatment for mental disorders. For patients already admitted to hospital, a section 5(2) is used if there is not the time for a more formal section 2 or 3. A typical scenario would be a patient who has a mental health disorder attempting to discharge themselves, when it is thought this may result in harm