The Court of Appeal has issued guidelines following a spate of cases in which women were forced to undergo Caesarean sections against their will. Most of the women were mentally competent and therefore legally entitled to say no to the treatment - a subtlety of medical law apparently not grasped by every High Court family division judge.

The guidelines supersede draft guidelines outlined at the time. They apply not only to childbirth cases but to any patient and any proposed treatment.

The guidance closes the door on court applications to override the refusal of competent patients. These would be 'pointless', the judges say. Doctors must explain the nature and reasons for the treatment and the risks and consequences of refusing it. For their own protection, hospital authorities should seek unequivocal assurances from the patient in writing that the refusal represents an informed decision.

Even if a patient is thought to be incompetent, the scope for last-minute court applications will be limited. Virtually all the declarations made by the High Court have been at emergency ex parte - one-sided - hearings, where the woman had no opportunity to put her side. In future, any declarations obtained in those circumstances will be useless.

The patient will have to be represented by solicitors or, if incapable of instructing them, by the official solicitor, and the judge will want evidence of the patient's incompetence.

In these cases, trusts will have to get their act together well in advance. But in an emergency, an incompetent patient can be treated in what doctors judge to be the patient's best interests.