Consent to treatment

The patient's consent is a prerequisite for treatment, The physician fulfil s an important role in determining whether the patient should be regarded a s competent or incompetent, due to the legal consequences, competency being a legal concept. The matter is even more complicated in psychiatric practi ce. The present article addresses the medico-legal issues raised and discus ses possible perspectives such as Advance Directives, The patient's psychol ogical status and competency are currently determined with the help of vari ous psychological tests. These are currently used in combination, because a lone none provides a useful standard. If the patient is deemed incompetent, treatment of the psychological disorders can be administered without his c onsent, However, authors are not unanimous regarding the treatment of the p ossible somatic complications such as self-mutilations. Furthermore, ethica l justifications of involuntary hospitalisation are discussed. Advance Dire ctives are used in some countries, and might represent a useful aid in solv ing some difficult situations, provided that they are used in conjunction w ith a thorough clinical examination of the patient. Curr Opin Psychiatry 13 :549-552. (C) 2000 Lippincott Williams & Wilkins.