Sir, I am writing in reply to the case reported by Stagnell and Burrows1 regarding a 69-year-old lady who had an unusual cementoma removed in their department. In their letter, the authors state, 'Given her lack of capacity to consent, she was consented for by her daughters and the senior members of the team'. The current law in England and Wales is that no-one may consent to treatment on the behalf of a non-competent adult; instead it is their best interests that govern whether treatment is carried out.2 Whilst I am sure that the authors acted in the best interests of the patient, it is a mistake to state that consent was gained from her family or team members. Unless the patient has executed a lasting power of attorney (LPA) whereby a patient nominates a chosen donee (or donees) to make decisions on his or her behalf then nobody but that patient may consent to medical treatment. The authors make no reference to an LPA existing. When consent cannot be gained, it is for the clinicians involved to act in that patient's best interests; acting in a non-competent patient's best interests is not a tautology for gaining consent. This might been seen by many to be focusing too much on minutiae, but as the law is heavily dependent upon the words, terms and phrases used, it becomes increasingly important to ensure these are correct.

Drs Stagnell and Burrows respond: We wish to acknowledge the response to our original publication: we would like to make clear, that all guidelines are followed routinely whilst engaging in clinical activity with particular reference to the Mental Capacity Act and matters of consent. In this case, the patient's daughters did carry LPA, and we appreciate it was an oversight to have not made reference to this in our initial article and we apologise for any confusion or concern caused.