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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.
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