ABSTRACT
Proper medical treatment is routinely defined, in law and in practice, as requiring the consent of the patient. Patients with disorders of consciousness (long-term ‘coma’) are unable to give or withhold consent because they are completely unconscious (‘vegetative’) or have only fleeting and occasional moments of consciousness (‘minimally conscious’). They are completely (or largely) unaware of themselves and their environment. 1 They cannot understand the situation they are in or the treatments on offer; they cannot retain information relevant to a decision to accept or to refuse a particular medical treatment, nor can they weigh up the pros and cons of any treatment. 2 In England and Wales these patients, like others who lack the capacity to make some or all decisions because of learning disabilities or dementia, fall under the remit of section 5 of the Mental Capacity Act 2005, which is designed to ensure that proper medical treatment can be provided to people who lack the capacity to consent to it without putting doctors at risk of criminal prosecution.
