Consent forms, refusing treatment and asking for a second opinion

Key rules

• Written consent: Consent is verbal as a rule, but it must be in writing for surgery, invasive tests or treatments, and procedures with notable risks.
• Refusal: You can refuse treatment, and your refusal should be in writing and recorded in your clinical record.
• Withdrawal: You can withdraw consent at any time, in writing, with no reason needed and no penalty.
• Second opinion: A second opinion is not a national right; it exists only in some regions and under their conditions.

Consent comes first, and you can say no

Doctors in Spain need your informed consent before treating you. You have the right to refuse treatment, and you can change your mind later. This applies in public and private care. The exceptions are narrow and are listed below.

When consent must be in writing

Consent is usually verbal. For surgery, invasive tests or treatments, and procedures with notable risks, you sign a consent form. The form is added to your clinical record.

Before you sign, the doctor must explain in enough time for you to think:

• what the procedure is and what it is for
• the likely risks, and any risks linked to your personal situation or job
• the consequences, contraindications and alternatives

Do not sign a form you do not understand. Ask for the explanation again, in simpler words if needed, and take the time you need.

Refusing treatment

You can refuse any treatment. Ask the doctor what happens if you refuse, and whether an alternative exists. The centre must offer an alternative where one exists.

Your refusal must be in writing and recorded in your clinical record. If you refuse the recommended treatment, you may be asked to sign a voluntary discharge (alta voluntaria). If you refuse to sign it, the centre's management can decide on a forced discharge (alta forzosa) after a doctor's report. That does not happen if you accept an alternative treatment the doctor prescribes.

Withdrawing consent

You can withdraw consent at any time, without giving a reason and without penalty. Do it in writing. A verbal change of mind alone may not be recorded.

When doctors can act without your consent

There are two cases:

• There is a risk to public health under the law.
• There is an immediate serious risk to your physical or mental health and consent cannot be obtained. Where possible, doctors consult your relatives or people close to you.

If you cannot decide, or are a minor who cannot understand the treatment, a legal representative, relatives or people close to you decide, in your favour and respecting your dignity. Minors aged 16 or over, or emancipated, give consent themselves, except in serious-risk cases, where parents are informed and their opinion is taken into account. Any living will you have made is taken into account.

Second opinion: it depends on your region

Spain has no national right to a second medical opinion. Some regions have created one in their own rules, usually for serious or life-threatening conditions, rare diseases, or conditions with a high risk of disability. Conditions differ by region. Typically you need a diagnosed serious condition, a referral from your treating doctor, and a specialist at a designated reference centre. Several regions have regulated it, including Madrid, Cataluña, Andalucía, Valencia and Galicia. Check your own region's rules with your regional health service.

Where your region has a procedure, you ask your treating doctor or the hospital's patient-service office (atención al paciente). You submit a written request with your ID and health card. Your records and imaging go to the reference specialist, and the region's health authority usually approves the request. The time to get an answer varies by region.

Where there is no procedure, ask your treating doctor to refer you to another specialist or hospital. You can also see a private doctor. Take copies of your clinical history, test results and imaging.

The checklist, warnings and questions below cover the practical steps.

Checklist

• Ask the doctor to explain the risks, alternatives and consequences of the treatment before you decide.

• If you refuse treatment, say so in writing and check that it is added to your clinical record.

• Ask whether an alternative treatment exists if you refuse the recommended one.

• Check with your regional health service whether your region recognises a right to a second opinion for your condition.

• Ask your treating specialist or the hospital's patient-service office (atención al paciente) for a second opinion, with a written request, your ID and your health card.

• Ask your treating doctor for a referral to another specialist or hospital if your region has no second-opinion procedure.

Second-opinion conditions and timing differ by region; confirm them with your regional health service.

What to watch out for

• Signing a form you do not understand: For surgery, invasive tests or treatments, and procedures with notable risks, you must give written consent. A form signed without understanding the risks may not reflect your real choice. Ask for the nature, purpose, risks, contraindications and alternatives to be explained first, with enough time to decide, and keep a copy.

• Refusing treatment can lead to discharge: If you refuse treatment, you will be asked to sign a voluntary discharge (alta voluntaria). If you refuse to sign, the centre can ask management to order a forced discharge (alta forzosa), confirmed by a doctor. Ask whether an alternative treatment exists; accepting one prescribed by the doctor means the forced discharge does not apply. You can reverse your decision later.

• Exceptions to your right to refuse: Doctors can treat without consent when there is a public-health risk covered by law, or an immediate serious risk to you and consent is impossible. Special rules apply to minors and incapacitated patients. If you want your wishes respected in advance, make a living will (prior instructions) that doctors must consider.

• Withdrawing consent only verbally: You can withdraw consent at any time, but it must be in writing. Put your withdrawal in writing and ask that it is added to your record.

• Assuming a second opinion is a right everywhere: Spain has no general national right to a second opinion. Some regions grant it, usually for serious or life-threatening conditions or rare diseases, with a referral from your doctor. Ask your regional health service whether it applies to you; if not, ask for a referral to another specialist or see a private doctor.

Frequently asked questions

Can I change my mind after I have signed a consent form?

Yes, you can withdraw consent you have already given, at any time, in writing. You do not need to give a reason, and withdrawing has no penalty.

Can doctors treat me without my consent in an emergency?

Yes, doctors can carry out essential treatment without your consent if there is an immediate serious risk to your physical or mental health and you cannot give consent. They should consult your relatives or people close to you where circumstances allow. The same applies when a public-health risk is covered by law.

Who gives consent if I cannot decide for myself or my child is a minor?

Your legal representative, or relatives or people close to you, give consent when a doctor judges you unable to decide or a court has found you incapacitated. Decisions must favour the patient.

How do I ask for a second opinion in the public system?

Ask your treating specialist or family doctor, or the patient-service office (atención al paciente) of your hospital, and submit a written request with your ID and health card. Your records and test results are then sent to the reference specialist.