Capacity, necessity and chemical restraint

Valid consent: capacity + informed disclosure + voluntary; procedure-specific; may be withdrawn.^[1]

Capacity four-stage test: after plain-language disclosure — understand, retain, weigh/use, communicate. Presumed; decision- and time-specific; unwise ≠ incapacity; support reversible causes first.^[1]

Capacitous refusal: honour even life-saving treatment; document assessment, advice, refusal, risks.^[1]

^[1]Necessity: if capacity absent and treatment is immediately necessary to save life/prevent serious harm, treat under common-law necessity; document.

Agitation ladder: de-escalation first → oral meds if possible → IM droperidol 5–10 mg (common first-line) or olanzapine; benzo alternative with monitoring; avoid IM olanzapine + IM benzo; monitor SpO2/RR/BP/consciousness/ECG (QT).^[2][3] Restraint proportionate, least restrictive, time-limited, documented.