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No is a complete sentence

02 February 2022
Volume 30 · Issue 2


Anna-Marie Madeley discusses exercising the right to decline elements of maternity care and the importance of respecting women who choose to do so

The right to decline all or some elements of recommended or routine care, interventions or processes in any healthcare setting sits within the context of the universal right to protection of the security of the person (United Nations, 1948) and respect for a private family life, as well as residing within a framework for respectful and dignified maternity care (Human Rights Act, 1988; Council of Europe, 1990) and is legally protected within the UK.

Anyone accessing healthcare, including competent pregnant women, have the unalienable right to make decisions about their care, including declining such, even if that decision might lead to the death of her or the fetus, or if the decision appears to onlookers to be unwise or without reason (St George's Health Care NHS Trust v SR v Collins and others ex parte S, 1997). Guidance supports an automatic presumption of capacity to make decisions (General Medical Council, 2020) without any assumption being made that age, medical condition (including mental ill health) (High Court of Justice, Family Division, 1994), beliefs or a decision being made that clinicians might consider unwise or morally challenging, none of which would automatically imply lack of capacity (Birthrights, 2017; General Medical Council, 2020). Therefore, the right to decline is intrinsically linked to informed consent and autonomy. For consent to be considered informed and valid, it must be voluntary, freely given and, importantly, is not a static and once only event; it can be withdrawn at any time. Therefore, declining recommended or routine care is synonymous with withholding or refusing consent.

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