Ethics

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4. Emergency treatment

Does consent need to be sought for emergency treatment?

Yes, if the patient is competent.

 

Can treatment be provided in an emergency situation where the patient is unable to give consent?

In an emergency, where consent cannot be obtained, doctors should provide medical treatment that is in the patient’s best interests and is immediately necessary to save life or avoid significant deterioration in the patient’s health.

If, however, the patient is an adult and there is clear evidence of a valid advance refusal of a particular treatment (such as a refusal of blood by a Jehovah’s Witness) that treatment should not be given.

If a patient has appointed a welfare attorney, or there is a court-appointed deputy or guardian this person where practicable must be consulted about treatment decisions. (See also Cards 6 adults who lack capacity, 8 on assessing best interests and 9 on advance decisions and Card 1 list: ‘0-18 years’, ‘Scotland’, ‘MCA’, ‘Advance decisions’, ‘Consent’ ‘DoH’, ‘MET’, ‘MDU’, ‘MPS’.)

 

Can treatment be provided to a child in an emergency situation where there is nobody available to give consent?

Where the patient is under 18 years old in England, Wales and Northern Ireland and under 16 in Scotland and is unable to consent, either because of lack of capacity or because of illness, anyone with parental responsibility can provide consent (see Card 7 on children and young people and Card 1 list: ‘Children’). If, however, treatment is required urgently and nobody with parental responsibility is available, doctors can proceed with treatment that is in the young person’s best interests (see also Card 8 on determining ‘best interests’ and Card 1 list: ‘0-18 years’, ‘Children’).

 

What action can be taken where a patient is unconscious and an unexpected finding is made during the course of a procedure that requires urgent attention?

When obtaining consent for any procedure, doctors should advise the patient of any foreseeable problems that could come to light while the patient is unconscious. This enables the doctor to obtain the patient’s consent in advance for necessary treatment should the situation arise. The GMC warns doctors that where they treat outside patient consent their actions may be challenged. Where treatment which has not been discussed with the patient is required as a matter of urgency and it is not possible to wait until the patient has regained consciousness, the guidance contained above will apply. (See also Card 1 list: ‘Consent’.)

 

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Card 4: Emergency treatment