Consent, capacity and patient wishes in OET letters: how to word them
When OET case notes mention consent, mental capacity, a refusal or the patient's wishes, report them as facts from the notes, in neutral language, and only where they affect what the reader must do. Use phrases such as 'She has consented to...', 'He has declined...', 'She has expressed a wish to...' or 'His capacity to make this decision was assessed...', and do not add legal judgements or conclusions that the notes do not state.
When consent and wishes belong in the letter
OET-style case notes sometimes include lines such as "pt agrees to referral", "declined home help", "wishes to die at home", "capacity assessed — able to decide re discharge" or "daughter has power of attorney". These are not decoration. They can change what the reader is allowed or expected to do.
Include them when they affect the reader's actions, for example:
- the patient has agreed to (or declined) the service you are referring to;
- the patient has a clear wish about where they live, their treatment or end-of-life care;
- someone else is legally involved in decisions, as stated in the notes;
- the patient has asked that certain information not be shared with family.
Leave them out when they are routine and change nothing for this reader. For selection in general, see how to select case notes.
Accuracy note: this is a language guide, not legal or professional advice. Consent and capacity rules differ between countries and services. In a letter, report only what the case notes state, and never draw your own legal conclusion.
Neutral phrases you can use
| Situation | Neutral phrase |
|---|---|
| Agreement | "Mrs Hale has consented to this referral." / "He has agreed to daily visits." |
| Refusal | "She has declined a care package at this stage." / "He chose not to have the vaccination." |
| Reason given | "...as she prefers to manage with her son's help." |
| Wish | "She has expressed a wish to remain at home." / "His wish is to be cared for at home." |
| Assessed capacity (if in notes) | "His capacity to make decisions about his discharge was assessed, and he was found able to make this decision." |
| Someone else involved (if in notes) | "His daughter holds lasting power of attorney for health decisions." |
| Information sharing | "She has asked that her diagnosis not be discussed with her neighbours." |
| Changing mind | "He initially declined physiotherapy but has since agreed to attend." |
Words to avoid
| Avoid | Why | Use instead |
|---|---|---|
| "refused to comply" | Sounds like blame | "declined" |
| "is non-compliant with the plan" | Judgemental label | "has chosen not to..." or describe what happens |
| "is incompetent" | Offensive and not a clinical statement | Report the assessment the notes give |
| "insists on going home" | Implies the wish is unreasonable | "has expressed a strong wish to go home" |
| "lacks capacity" (when notes only say "confused") | Draws a conclusion not in the notes | "She was confused on admission." |
| "family forced her" | Accusation | Report facts from the notes neutrally |
For tone in general, see formal tone and the Genre & Style criterion. For wording other difficult topics, see non-adherence and sensitive information.
Where these sentences go
- Opening paragraph: if consent is the condition for the referral ("...with her consent, I am referring her to...").
- Middle paragraph: wishes and decisions, grouped with the social situation they relate to.
- Closing paragraph: if the request depends on the wish ("Given her wish to remain at home, I would be grateful if...").
Worked example 1: declined service (invented case)
Notes (invented): Mr Arnav Mehta, 81, lives alone. Discharged after chest infection. Offered daily carers — declined, "wants to stay independent". Agreed to weekly community nurse visit. Agrees to info being shared with GP and community nurse. Son lives interstate.
Mr Mehta was offered daily carer visits but declined, as he wishes to remain independent. He has, however, agreed to a weekly visit from a community nurse and has consented to this information being shared with you.
Two sentences give the reader what they need: what was offered, the decision, the reason, and what was accepted.
Worked example 2: end-of-life wish (invented case)
Notes (invented): Mrs Rosa Ferraro, 88, advanced heart failure. Discussed with palliative team. Expressed wish to die at home. Daughter (lives with her) supports this. Advance care plan completed, copy enclosed.
Mrs Ferraro has expressed a wish to be cared for at home for the rest of her life, and her daughter, who lives with her, supports this decision. A copy of her advance care plan is enclosed.
The letter does not interpret the plan. It points to the document. See palliative care letters.
Worked example 3: capacity stated in the notes (invented case)
Notes (invented): Mr Liam O'Brien, 79, mild dementia. Wants to return home rather than residential care. Capacity assessment re discharge destination: able to make this decision. Daughter worried about his safety at home.
Mr O'Brien has expressed a wish to return home rather than move to residential care. His capacity to make this decision was assessed, and he was found able to make it. His daughter has raised concerns about his safety at home.
The sentence about capacity is only included because the notes record an assessment. Without that note, the letter would say nothing about capacity. For dementia letters, see dementia and delirium.
Common mistakes
- Inventing consent. Adding "the patient consents" when the notes say nothing.
- Judging capacity. Writing "lacks capacity" because the patient is confused.
- Hiding the patient's wish. Putting a key wish at the end when the whole request depends on it.
- Taking sides. Presenting a relative's view as the decision.
- Over-explaining law. The reader does not need a legal explanation; they need the facts.
Practise and check
Practise a timed letter at /writing/, or check a letter you have written to get an estimated grade, a mark for each criterion and line-by-line corrections. medEmu is an independent practice tool for OET Writing for Nursing; its grades are estimates, and it is not affiliated with OET.
Sources
This guide is medEmu's writing advice, not official OET guidance and not legal, clinical or professional advice; consent and capacity rules vary by country, so check your regulator's and employer's guidance. All patients and decisions are invented for practice, and a real letter must follow the case notes. The network used for this run could not reach oet.com or regulator websites, so no OET test facts or regulator requirements are stated. For OET's official Writing information, see oet.com.