He is independent in most activities of daily living. He is admitted to hospital with acute myocardial infarction complicated by mild congestive heart failure. During the discussion, the clinician emphasizes that CPR causes broken ribs and, even when successful, leaves the patient with severe neurologic impairment. Mr. M declines CPR and is consequently admitted to a ward bed without continuous cardiac monitoring. A patient's freedom to decide can be impinged upon by internal factors arising from the patient or the patient's condition or by external factors.
Force involves the use of physical restraint or sedation to enable a treatment to be given.
The requirement for voluntariness does not imply that clinicians should refrain from persuading patients to accept advice. In attempting to persuade the patient to follow a particular course of action, the clinician still leaves the patient free to accept or reject this advice. Ethics Voluntariness is an ethical requirement of valid consent. Practically, it requires the physician to ensure that situations do not arise in which the patient's actions are substantially controlled by others. Law Voluntariness is a legal requirement of valid consent.