ABSTRACT
For competent adults, the right to refuse consent follows from the existence of a right to consent. If medical treatment is only lawful – as it is for competent adults (excluding public health and mental health (see 9.3 below) justifications) – when it is done with consent, then a refusal to give consent will make medical treatment unlawful (see Chapter 2). The right to refuse treatment is thus based on the principle of autonomy and the right to bodily integrity. Respecting the individual’s right to refuse treatment also respects his dignity and this is important both ethically and legally (Article 3 of the European Convention on Human Rights prohibits inhuman or degrading treatment). However, the right to give or refuse consent is not absolute. Ethically, a number of liberty-limiting constraints operate when an individual’s actions threaten to adversely affect other individuals. The most widely accepted of these is the ‘harm theory’ (Mill, 1991), which states that the only justification for restricting an individual’s liberty is to prevent harm to others. Some commentators extend this to also prevent self-harm (Raz, 1989). The question for the law is whether and how these ethical constraints should be legally enforced.
