Consent, Risk and Safeguarding: When Respecting Choice Becomes Unsafe
Safeguarding practice frequently involves uncomfortable decisions about when to respect an individual’s choices and when intervention is required to prevent harm. Consent alone does not automatically remove safeguarding responsibilities, particularly where capacity is unclear or risks are escalating.
This article builds on the Mental Capacity, Consent & Safeguarding Decision-Making framework and intersects closely with risks associated with Understanding Types of Abuse. It focuses on how providers manage risk where individuals appear to consent to harmful situations.
The Difference Between Unwise Decisions and Unsafe Practice
The Mental Capacity Act explicitly protects the right to make unwise decisions. However, safeguarding requires providers to ensure those decisions are genuinely informed and free from undue influence. Confusing unwise decisions with unsafe practice can lead either to unlawful restriction or to neglectful inaction.
Providers must demonstrate that they have explored understanding, weighed risks, and considered alternatives before stepping back from safeguarding involvement.
Operational Example 1: Risky Lifestyle Choices
Context: An individual repeatedly declined support despite serious self-neglect and health risks.
Support approach: Capacity assessments focused on understanding consequences and ability to weigh long-term impact.
Day-to-day delivery: Staff used motivational approaches, repeated conversations and accessible materials rather than one-off assessments.
Evidence of effectiveness: The provider evidenced respectful engagement while escalating safeguarding appropriately as risks increased.
Consent Under Pressure
Consent given under pressure, fear or dependency is not valid consent. Safeguarding frameworks require providers to consider relational dynamics, power imbalances and cultural factors that may influence decision-making.
Operational Example 2: Financial Dependency and Consent
Context: An adult consented to financial arrangements that left them without access to funds.
Support approach: Capacity assessment explored alternatives and consequences, alongside safeguarding enquiries.
Day-to-day delivery: Independent advocacy was introduced to support decision-making free from influence.
Evidence of effectiveness: Records demonstrated proportionate intervention and eventual reduction in financial harm.
Balancing Proportionality and Protection
Safeguarding interventions must be proportionate to risk. Over-intervention can be as damaging as under-intervention. Providers must evidence why particular actions were taken and why less restrictive options were insufficient.
Operational Example 3: Escalating Risk Despite Capacity
Context: A person assessed as having capacity continued to make choices leading to repeated safeguarding alerts.
Support approach: Safeguarding planning focused on harm reduction rather than elimination of risk.
Day-to-day delivery: Multi-agency involvement ensured risks were monitored and responses coordinated.
Evidence of effectiveness: The provider demonstrated defensible practice and avoided regulatory criticism.
Commissioner Expectation: Risk Management, Not Risk Avoidance
Commissioners expect providers to manage risk intelligently rather than eliminate it. Evidence of structured decision-making, review and escalation is critical.
Regulator Expectation: Evidence of Balanced Judgement
The CQC expects providers to show that consent and capacity are considered alongside safeguarding duties, with clear evidence of proportional and lawful responses.
Embedding Consent and Risk into Safeguarding Systems
Effective providers integrate consent and risk discussions into supervision, safeguarding audits and quality reviews, ensuring consistent practice across teams.