Section 14 amends section 58 of the 1983 Act to shorten the ‘three-month time-period’, after which certification must be provided, to two months. This new time period applies where the patient has capacity or competence in respect of the treatment and consents; or where the patient lacks capacity/competence in respect of the treatment (and there is no conflict with any valid and applicable advance decision, or a decision made by a done or deputy or by the Court of Protection). By bringing forward the second opinion appointed doctor’s assessment to two months, the use of compulsory medication where the patient lacks capacity/competence to consent, receives independent scrutiny at an earlier point in the patient’s treatment course. This helps to ensure that the patient’s right to self-determination is being upheld and that the treatment is delivering a therapeutic benefit.
	Where a patient lacks capacity or competence to consent and the compelling reasons test applies within the first two months of medical treatment, to avoid the second opinion appointed doctor’s providing two separate certificates (i.e. one to certify the absence of capacity or competence at two months and one to certify treatment under section 57A), the second opinion appointed doctor is able to provide a single combined certificate covering both issues. This may help to streamline responsibilities on the second opinion appointed doctor’s service and minimise administrative burden.
	Table 1: Summary of how sections 13 and 14 will amend section 58 of the 1983 Act.
	Category
Patient presentation
Conditions for administering treatment
1
Consenting with capacity/competence at the time
The effect of section 14 is that, if the patient is consenting to treatment, after a period of two months an approved clinician or second opinion appointed doctor must certify that:
· The patient is validly consenting and
· the treatment is appropriate (within the new meaning)
2
Refusing treatment with capacity/competence at the time, or the patient lacks capacity and treatment is in conflict with any valid and applicable advance decision or a decision made by a donee or deputy or by the Court of Protection.
The effect of section 13 is that treatment can be given only if there is ‘compelling reason’ to do so (i.e. there is no alternative medication available or none that the patient accepts) and certification has been provided by a second opinion appointed doctor, which must provide that:
· the treatment in question is appropriate;
· the decision to give treatment was made by the approved clinician in line with the duties under section 56A; and
· in respect of any available alternative treatment/s either the patient has not given valid consent, or they appear to conflict with a valid and applicable advance decision, or a decision made by a donee or deputy or the Court of Protection.
3
Lacks capacity/competence and cannot validly consent to treatment
The effect of section 14 is that treatment can be given but, after a period of two months, a second opinion appointed doctor must certify that:
· the patient lacks the relevant capacity/competence to consent;
· the treatment is appropriate.
Treatment Section 14: Medicine etc.: treatment in other circumstances