Skip to main content Accessibility help
  • Print publication year: 2007
  • Online publication date: December 2009

3 - Legal and ethical issues in liaison psychiatry

from Part I - Basic skills


Liaison psychiatrists are frequently asked to advise when patients refuse consent to medical intervention. This chapter aims to give practising clinicians a framework for understanding legal issues surrounding refusal of treatment in the general hospital context. Non-psychiatrists in general hospitals are unaware of the limitations of the mental health act (MHA) with respect to issues of non-consent, and may erroneously expect that it normally has a role where there is refusal of treatment for physical health in persons with mental disorder. Every adult who has reached the age of majority (18 years) has, a priori, the right and capacity to decide whether or not he/she will accept medical treatment, even if a refusal may risk permanent damage to his/her physical or mental health, or even lead to premature death. The chapter provides a series of case vignettes and commentaries with regard to law applied to clinical situations.

Related content

Powered by UNSILO
B v. Croydon Health Authority 1994 22 BMLR 13
Bannink, M., Gool, A. R., Heide, A, et al. (2000). Psychiatric consultation and quality of decision making in euthanasia. Lancet, 356, 2067–8.
Bolam v. Friern Hospital Management Committee. [1957] 2 All ER 118–28 at 122
Bolitho v. City and Hackney HA [1997] 4 All ER 771
British Medical Association. (1995). Advance Statements About Medical Treatment. Code of Practice with Explanatory Notes. Report of the British Medical Association. London: BMJ Publishing Group.
British Medical Association and Law Society. (1995). Assessment of Mental Capacity: Guidance for Doctors and Lawyers. London: British Medical Association.
Department of Health and Welsh Office. (1999). Code of Practice Mental Health Act 1983. London: HMSO.
Department of Health. (2001). Reference Guide to Consent to Examination or Treatment (
Dyer, C. (2001). High Court throws out ‘suicide aid’ case. British Medical Journal, 323, 953.
General Medical Council. (1999). Seeking Patient's Consent: the Ethical Considerations.London: GMC.
General Medical Council. (2002). Withholding or Withdrawing Life-prolonging Treatments: Good Practice in Decision-making. London: GMC.
Kennedy, I. and Grubb, A. (2000). Medical Law, 3rd edn. London: Butterworths.
Mental Health Act Commission Guidance Note 3. (1999). Guidance on the treatment of Anorexia Nervosa under the Mental Health Act 1983 (issued August 1997 and updated March 1999). Available on the Mental Health Act Commission website:
Mental Health Act Commission Guidance note GN1/2001. (2001). Use of the Mental Health Act 1983 in General Hospitals without a Psychiatric Unit. Available on the Mental Health Act Commission website:
Mental Capacity Act. (2005). HMSO.
Mental Health Act. (1983). HMSO.
R (on the application of B) v. Ashworth Hospital Authority 2003 EWCA Civ 547; Court of Appeal, 15 April 2003.
Re B (consent to treatment: capacity) 2002 1FLR 1090
Re C (adult: refusal of medical treatment) [1994] 1 All ER 891 (Fam Div)
Re KB 1993 19 BMLR 144 (Fam Div)
Re MB (an adult: medical treatment) 1997 38 BMLR 175 (CA)
Re S (adult patient's best interests) 2000 2FLR 389 at 400
Re T (adult: refusal of medical treatment) 1992 9 BMLR 46
St George's Healthcare NHS Trust v. S [1998] 3 All ER 673 CA at 702