A patient with full capacity refuses a blood transfusion on religious grounds, understanding it may cost their life. What should the nurse do?

Respect the refusal, ensure they understand the risks, and document the discussion

Give the transfusion because it is life-saving

Wait until the patient is unconscious, then transfuse

Ask the family to overrule the patient

A patient signed a consent form last week but now says they have changed their mind and do not want the operation. What is the position?

They can withdraw consent at any time; the form does not bind them

The signed form means the operation must go ahead

Only the surgeon can cancel now

They must give a valid reason to withdraw

A doctor asks you to obtain consent for a procedure you do not fully understand and cannot explain. What should you do?

Decline, because valid consent needs someone who can explain the procedure and answer questions

Get the signature and let the doctor explain later

Explain it as best you can from memory

Ask another patient who has had it to explain

A 40-year-old with capacity consents to surgery but says they do not want to hear about the risks. How should the nurse respond?

Note their choice, but ensure they know enough to make a valid decision and can ask later

Proceed without any risk discussion at all

Refuse to let them have the surgery

Tell the risks anyway, over their objection

Part B1 of 8 The Accountable Professional Chapter 17 of 75

Consent Questions: Adults, Capacity and Refusal

NMC CBT consent practice: what makes consent valid, a capacitous adult's right to refuse, implied consent, and worked scenario answers.

Start reading ← Bank contents ~5 min read

By JobLabs Editorial · UK healthcare reference editorial team

· July 16, 2026 · Updated Jul 17, 2026 · 2 min read

Consent runs through the whole of nursing practice, and the CBT tests it hard because it is where good intentions and the law can pull in different directions.

Consent is valid when three things are true at once:

The person has capacity to make the decision.
They have enough information to make it.
They give it voluntarily, without pressure.

Take away any one of the three and the consent is not valid, however firmly it was given or however neat the signed form looks.

Refusal is the hard part

The single most tested idea in this chapter is that a capacitous adult can refuse treatment, for any reason or none, even when refusal will harm or kill them. It feels wrong to a new nurse to stand back while someone declines care that would save them. But treating a capacitous adult against a valid refusal is unlawful. Your job is to make sure the decision is informed, then respect it and record it.

Family cannot overrule that refusal. Next-of-kin status carries no power to consent for, or against, a capacitous adult. Questions that offer “ask the family to decide” are almost always offering you the wrong answer.

A signed form proves a conversation happened. It does not create valid consent, and it does not lock the patient in. Consent can be withdrawn at any time, including in the anaesthetic room, as long as the person has capacity. A stem where someone changes their mind after signing is testing whether you know the signature does not bind them.

Consent is only informed if the person taking it can explain the procedure and answer questions about it. Being handed a form to get signed for something you cannot describe is a trap: the right action is to decline and let a competent colleague do it.

When an adult lacks capacity, the framework changes entirely, and that is the next chapter: the Mental Capacity Act. Five consent scenarios first.

Sources & further reading

Key takeaway from Consent Questions: Adults, Capacity and Refusal

Frequently asked questions

Can a patient refuse treatment that will save their life?

Yes. An adult with capacity can refuse any treatment, for any reason or none, even if the decision leads to their death. The refusal must be informed and voluntary. You cannot treat them against that decision, but you can make sure they understand the consequences.

Does consent have to be written?

No. Consent can be verbal, written or implied by behaviour, such as rolling up a sleeve for a blood pressure check. Written consent is a record that a discussion happened; it is not what makes consent valid. Capacity, information and voluntariness are.

Who can consent for an adult who lacks capacity?

No other adult can simply consent on their behalf unless they hold the legal authority to, such as a health and welfare lasting power of attorney or a court deputy. Otherwise care is given in the person's best interests under the Mental Capacity Act.

Check your understanding

5questions. Click an answer to see the explanation. Your score is saved on this device only.

1
A patient with full capacity refuses a blood transfusion on religious grounds, understanding it may cost their life. What should the nurse do?
A capacitous adult may refuse any treatment, even to the point of death. Treating them against a valid, informed refusal is unlawful. The nurse's role is to check understanding, respect the decision, and record it clearly. Family cannot override a capacitous adult.
2
A patient rolls up their sleeve when you approach with a blood pressure cuff. What type of consent is this?
Cooperating with a routine, low-risk procedure implies consent. It is valid for something like a blood pressure check, but you would still explain what you are doing. Implied consent is not enough for significant or invasive procedures, which need an explicit discussion.
3
A patient signed a consent form last week but now says they have changed their mind and do not want the operation. What is the position?
Consent can be withdrawn at any point, including after a form is signed, as long as the person has capacity. A signature records a past agreement; it does not remove the ongoing right to change your mind. No reason is required.
4
A doctor asks you to obtain consent for a procedure you do not fully understand and cannot explain. What should you do?
Consent is only informed if the person taking it can describe the procedure, benefits, risks and alternatives, and answer questions. Collecting a signature without that discussion produces an invalid consent. The task should be done by someone competent to do it.
5
A 40-year-old with capacity consents to surgery but says they do not want to hear about the risks. How should the nurse respond?
People can decline detailed information, and that choice is respected, but consent still has to be informed enough to be valid. You offer the essential information, record their preference, and keep the door open. You do not force a full risk list on them, and you do not skip consent entirely.

Consent Questions: Adults, Capacity and Refusal

Refusal is the hard part

Sources & further reading

Frequently asked questions

Keep reading

Mental Capacity Act Scenario Questions

Confidentiality and Disclosure Questions

Diabetes and Insulin Management Questions

Consent Questions: Adults, Capacity and Refusal

Refusal is the hard part

Forms are records, not consent

Who can take consent

Sources & further reading

Frequently asked questions

Keep reading

Mental Capacity Act Scenario Questions

Confidentiality and Disclosure Questions

Diabetes and Insulin Management Questions