Consent, refusal and capacity concerns

Medicines are part of care and treatment. People should be involved in decisions about their medicines, given clear information, and asked respectfully. A medicines round is not a command.

A person with mental capacity can refuse a medicine, even if staff or family consider the decision unwise. Staff should record the refusal, try to find the reason, offer the medicine again later when appropriate, and escalate according to the care plan and the level of risk.

When someone refuses

• Pause: do not force, trick or rush the person.
• Explain: use simple language, check hearing and vision aids, and allow time to respond.
• Explore: ask whether pain, nausea, taste, timing, swallowing difficulty, fear, belief, side effects or misunderstanding is involved.
• Try again if appropriate: a short wait or a different approach may help if this is safe and policy allows.
• Record: document the refusal and any reason given or observed.
• Escalate: inform the senior, nurse, prescriber or pharmacist as required, especially for repeated refusals or high-risk medicines.

If the person has fluctuating capacity or may lack capacity to make the medicines decision, staff must follow the Mental Capacity Act 2005 process in England and Wales, the Adults with Incapacity (Scotland) Act 2000 framework in Scotland, or the current local legal framework and service policy in Northern Ireland. This is a senior or manager-led process and is not a shortcut to override a refusal.

Refusal is information, not defiance to defeat. Respect it, record it, explore it and escalate when safety or capacity is uncertain.