human rights and legislation who resource book on mental health

10.1 Major medical <strong>and</strong> surgical procedures
MI Principles: Major medical or surgical procedures
A major medical or surgical procedure may be carried out on a person with mental illness only
where it is permitted by domestic law, where it is considered that it would best serve the health
needs of the patient <strong>and</strong> where the patient gives informed consent, except that, where the
patient is unable to give informed consent, the procedure shall be authorized only after
independent review.
(Principle 11(13), MI Principles)
Major medical or surgical procedures on patients with mental disorders should generally only be
performed after obtaining free <strong>and</strong> informed consent. The ethical st<strong>and</strong>ards governing these
treatments should apply both to non-mental-health patients <strong>and</strong> mental health patients alike. If
a patient lacks the capacity to give informed consent, <strong>legislation</strong> may permit such procedures
only under exceptional circumstances <strong>and</strong> with adequate safeguards.
Medical <strong>and</strong> surgical procedures without consent may be permitted if they are deemed to be life
saving, <strong>and</strong> if delay due to waiting for restoration of the patient’s capacity to consent would put
that patient’s life at risk. In rare cases of mental illness or profound mental retardation, where the
patient’s lack of capacity to consent is likely to be permanent, medical <strong>and</strong> surgical interventions
may also be necessary without consent. In these situations, the proposed medical or surgical
treatment may be authorized either by an independent review body or, in countries where the
law permits, a proxy consent by a guardian, relative or personal representative. In other
instances, medical <strong>and</strong> surgical treatment must be delayed until the patient’s mental state
improves to a point where he/she has the capacity to make a treatment decision.
Where emergency medical <strong>and</strong> surgical treatment is necessary to save a patient’s life or prevent
irreparable deterioration in his/her physical health, a person with a mental disorder should be
entitled to the same treatment available to other persons without mental disorders <strong>who</strong> are not
able to consent (e.g. unconscious patients). Legislation governing emergency medical <strong>and</strong>
surgical treatment given without consent to all persons should thus also cover persons with
mental disorders. Medical services carry the responsibility of providing <strong>and</strong> justifying the
appropriateness of such emergency medical <strong>and</strong> surgical treatment.
10.2 Psychosurgery <strong>and</strong> other irreversible treatments
MI Principles: Psychosurgery <strong>and</strong> other intrusive <strong>and</strong> irreversible treatments
Psychosurgery <strong>and</strong> other intrusive <strong>and</strong> irreversible treatments for mental illness shall never be
carried out on a patient <strong>who</strong> is an involuntary patient in a mental health facility <strong>and</strong>, to the
extent that domestic law permits them to be carried out, they may be carried out on any other
patient only where the patient has given informed consent <strong>and</strong> an independent external body
has satisfied itself that there is genuine informed consent <strong>and</strong> that the treatment best serves the
health needs of the patient.
(Principle 11(14), MI Principles)
Psychosurgery <strong>and</strong> other irreversible mental health treatments generally should not be permitted
to be performed on people unable to give informed consent. In view of the irreversible nature of
certain treatments, <strong>legislation</strong> may provide an additional level of protection to consenting
patients by making it m<strong>and</strong>atory that an independent review body, or similar safeguard, sanction
the treatment. The review body (or other safeguarding structure) should interview the patient,
ensure that the patient has the capacity to give, <strong>and</strong> has in fact given, informed consent, <strong>and</strong>
review the patient’s medical/psychiatric history <strong>and</strong> records. The review body/safeguard must be
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