1. The patient has the right to consent well informed, freely and in advance to any service provided by a health professional. The consent of the patient is only valid for the medical intervention consented to. Sometimes during an operation a new ailment may be discovered which requires an immediate intervention. Such a so-called extended operation creates no problem when this discovery was foreseeable and the extension has been discussed previously with the patient. However, not all events are foreseeable. Van Quickenborne makes a distinction as to whether the ‘extended operation’ of the unforseeable ailment has important disadvantageous consequences for the patient or not. In the latter case, consent to the ‘extended operation’ may be presumed. In the former case, however, consent has to be asked for except for an emergency in which case the duty to help prevails.
2. Consent must be given expressly except when the health professional, after having informed the patient adequately, can reasonably infer consent from the patient’s behaviour. Consent not given expressly is also referred to as implicit, tacit or non-verbal consent. The consent shall be recorded and added to the patient’s medical record at the patient’s or health professional’s request and with the health professional’s or patient’s approval.
3. When, in an emergency case, there is uncertainty as to the will of the patient or his representative, health professionals shall immediately deliver all necessary services in the interest of the patient’s health. The health professional shall record this in the patient’s medical record and shall act as soon as possible in accordance with the provisions of the preceding paragraphs.
4. Patients have the right to refuse or withdraw their consent for any service. Article 8, 4°, third paragraph provides explicitly that neither refusal nor withdrawal of consent shall end the right to high-quality care. In other words, refusal by itself does not terminate the legal relations between the patient and physician.
5. If the patient has made a written statement refusing a given medical service at the time when he or she was still capable of asserting the rights covered in the law on the rights of patients, this refusal shall be respected as long as the patient does not revoke it in a period when he is competent to exercise his rights himself. This provision, which establishes the binding character of a so-called advance refusal, is perhaps the most controversial part of the patient rights law. According to the explanatory report, an advance refusal has in principle the same legal effect as a currently expressed refusal: the health professional is not authorized to act, and must respect the refusal. In order for an advance refusal to be binding, two conditions must be met. Firstly, it must apply to a ‘well-defined medical service’. A refusal that uses vague terms is not binding. Secondly, there may be no lingering doubt that the refusal comes from the person involved. In an emergency situation a physician will often not have enough time to verify this and his the duty to provide assistance will take precedence.

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