MJDF Law, Ethics, and Professionalism 3 — Questions and Answers

Question 1: Under the Mental Capacity Act 2005 (England and Wales), which of the following is a core principle that dentists must apply when treating a patient who may lack capacity?

Decisions should always be made by the patient's next of kin
A patient must be assumed to have capacity unless it is established that they lack it, and treatment must be in their best interests (Correct answer)
Patients who have previously had capacity issues can never consent to dental treatment
Emergency treatment must always be deferred until the patient regains capacity

Correct answer: A patient must be assumed to have capacity unless it is established that they lack it, and treatment must be in their best interests

The MCA 2005 presumes capacity in all adults, requires that capacity be assessed for each specific decision, and mandates that treatment for those lacking capacity must be in their best interests — it cannot be delegated to relatives as a right.

The Mental Capacity Act 2005 (MCA) is the primary legislation governing decision-making for adults (16+) in England and Wales who may lack the capacity to make specific decisions for themselves. It establishes five key principles that must guide all actions and decisions: 1. A person must be assumed to have mental capacity unless it is established that they lack it. 2. A person must be supported to make their own decision before anyone concludes they lack capacity. 3. A person has the right to make an unwise decision — making an unusual or seemingly unwise choice does not in itself indicate lack of capacity. 4. Any action taken for a person who lacks capacity must be in their best interests. 5. Any action taken for someone who lacks capacity must be the least restrictive option available. Capacity assessment is decision-specific and time-specific — a person may lack capacity to consent to a complex surgical procedure but have capacity to accept or refuse a dental examination. The two-stage test for capacity: (1) Is there an impairment or disturbance of the mind or brain? (2) Does this impairment mean the person cannot understand, retain, use/weigh, or communicate information relevant to the decision? For dental treatment of patients lacking capacity: 'best interests' decisions are made by the clinician in consultation with those involved in the patient's care (family, carers — but note they do NOT consent on behalf of the adult; consent is the clinician's responsibility). A Lasting Power of Attorney (LPA) with a health and welfare designation can make health decisions for someone who lacks capacity. For significant treatment, a Court of Protection application may be needed. MJDF candidates must thoroughly understand MCA 2005 principles for ethics and law questions.

Question 2: Which of the following BEST describes the concept of 'Gillick competence' in the context of dental treatment?

A legal standard requiring parental consent for all under-18 dental treatment
The principle that a child under 16 can consent to dental treatment if they have sufficient understanding and intelligence to fully understand the proposed treatment (Correct answer)
A requirement that children aged 16-17 have both their own consent and parental consent
The right of a child to refuse any treatment even in an emergency

Correct answer: The principle that a child under 16 can consent to dental treatment if they have sufficient understanding and intelligence to fully understand the proposed treatment

Gillick competence (confirmed in Fraser guidelines) means a child under 16 can give valid consent if they have sufficient maturity and understanding to comprehend the nature, purpose, and risks of the treatment proposed.

The concept of 'Gillick competence' arises from the House of Lords judgment in Gillick v West Norfolk and Wisbech Area Health Authority (1985). The court held that a person under 16 can give valid consent to medical (and dental) treatment if they have sufficient maturity and intelligence to fully understand the nature, purpose, risks, and implications of what is proposed. Assessing Gillick competence involves evaluating whether the child: understands the nature of the treatment and why it is proposed; understands the risks and likely consequences of having or refusing treatment; understands the likely consequences of refusing treatment; has sufficient recall and communication to engage with the consent process; and is making the decision free from undue influence. Key points for dental practice: Gillick competence is assessed for each individual decision and patient — it is not an all-or-nothing status; 16-17 year olds are presumed to have capacity (Family Law Reform Act 1969), though parental consent remains valid alongside; parental consent is valid for children under 16 who lack Gillick competence; a competent child's refusal of treatment is more complex — courts have upheld clinicians overriding a competent child's refusal when it was in their best interests (this area differs from adults' absolute right to refuse). In dental practice, a Gillick-competent child can, for example, consent to their own orthodontic treatment, tooth extraction, or other procedures without parental consent. Dental records should document the assessment of Gillick competence. Understanding this principle is important for MJDF ethics and law questions.

Question 3: A dental patient discloses information suggesting they are being domestically abused. What is the dentist's primary obligation?

Immediately contact the police without informing the patient
Ensure the patient is safe in the immediate consultation, offer information about support services, document carefully, and consider safeguarding referral in line with local policy (Correct answer)
Refuse to provide treatment until the abuse is reported to authorities
Maintain complete confidentiality and take no action as it is a personal matter

Correct answer: Ensure the patient is safe in the immediate consultation, offer information about support services, document carefully, and consider safeguarding referral in line with local policy

Domestic abuse is a safeguarding concern. The primary obligation is patient safety — not automatic reporting (which could increase danger), but careful documentation, offering support resources, and following local safeguarding protocols.

Domestic abuse (including physical, emotional, financial, and sexual abuse) is recognised as a public health and safeguarding issue. When a patient discloses or shows signs of domestic abuse, the dental team has important responsibilities under safeguarding frameworks and professional duty of care. Primary actions: ensure the patient's immediate safety during the consultation (private setting, no partner present); take the disclosure seriously, respond with empathy without judgment; if appropriate and safe to do so, ask direct questions (trained DASH risk assessment); provide information about support services (National Domestic Abuse Helpline: 0808 2000 247; local services); document carefully using the patient's own words and noting clinical signs. Key principles: most adults experiencing domestic abuse have capacity and can make their own decisions. Automatic reporting to police without consent could increase danger (the perpetrator may become more violent if they discover the disclosure). Confidentiality can only be breached without consent if: there is an immediate risk to life (life-threatening danger); there is a public interest justification (e.g., children at risk in the same household — child safeguarding referral may be mandatory regardless of adult's wishes); or other legal obligation. Multi-agency safeguarding processes (MARAC — Multi-Agency Risk Assessment Conference) may be appropriate for high-risk cases. Every dental practice should have a safeguarding lead and follow the NHS/CQC safeguarding protocols. Dental teams receive training to identify and respond to abuse indicators. MJDF candidates must understand the complex balance between confidentiality, patient autonomy, and safeguarding obligations in cases of domestic abuse and other safeguarding scenarios.

Question 4: What does the principle of 'veracity' mean in the context of dental ethics?

Treating all patients with equal respect regardless of background
The duty of the dentist to tell the truth and be honest with patients in all communications (Correct answer)
Ensuring that dental records accurately reflect treatments completed
The principle that dentists should avoid excessive charges

Correct answer: The duty of the dentist to tell the truth and be honest with patients in all communications

Veracity is the ethical principle of truthfulness and honesty — requiring dentists to provide patients with accurate information about their diagnosis, treatment options, risks, and prognosis, and to be honest in all professional communications.

Veracity (from the Latin 'veritas' meaning truth) is one of the core principles of biomedical and dental ethics. It refers to the duty to be truthful, honest, and non-deceptive in all communications with patients, colleagues, and other stakeholders. In dental practice, veracity requires: providing patients with accurate information about their dental condition and diagnosis; honestly describing treatment options, including the limitations and risks of each option; disclosing mistakes and adverse events to patients (the 'duty of candour' — a statutory and professional obligation under the Health and Social Care Act 2008 and GDC Standards); not misrepresenting qualifications, capabilities, or the nature of treatments; providing honest prognostic information even when unfavourable; being truthful in all records, claims, and professional communications. Veracity is closely linked to respect for patient autonomy — patients can only make genuinely informed decisions if they are given truthful information. Deception, even if paternalistic and well-intentioned (telling a patient something false to 'protect' them from distressing information), undermines autonomy and trust. The GDC's Standards for the Dental Team (Standard 4: 'Maintain and protect patients' information') and the broader ethical framework both emphasise honesty. The duty of candour means that if something goes wrong, dentists must tell the patient, apologise, explain what happened, and offer appropriate remediation. For MJDF candidates, familiarity with the four principles of biomedical ethics (autonomy, beneficence, non-maleficence, justice — Beauchamp and Childress) and additional principles including veracity, fidelity, and compassion is essential for ethics questions.

Question 5: Under the GDC Standards for the Dental Team, what does the principle of 'patient confidentiality' require a dentist to do?

Share all patient information with other treating dental professionals without restriction
Keep patient information secure, only share it with relevant parties for direct care purposes, and seek consent for other uses (Correct answer)
Automatically disclose patient information to the NHS when requested
Store all patient records in unlocked, easily accessible locations for efficiency

Correct answer: Keep patient information secure, only share it with relevant parties for direct care purposes, and seek consent for other uses

The GDC requires dentists to protect patient information, share it only on a need-to-know basis for care purposes, and comply with data protection law (UK GDPR). Patient consent or legal justification is required for other uses.

Patient confidentiality is a fundamental ethical and legal obligation in dental practice, governed by: the GDC Standards for the Dental Team (Standard 4: Maintain and protect patients' information); UK GDPR and the Data Protection Act 2018; common law duty of confidence; NHS contractual obligations. The duty of confidentiality requires: keeping all information patients share in the context of the dental relationship private; only sharing information with those who need it for the patient's direct care (and within the care team this is usually implied consent — the patient understands their dentist may share information with a hygienist, specialist, or hospital if needed); not sharing information with third parties (including family members) without the patient's explicit consent, unless a specific legal exception applies; maintaining secure storage and disposal of records. Exceptions to confidentiality where disclosure without consent may be justified: preventing serious harm to the patient or others (e.g., immediate threat to life); legal obligation (court orders, statutory reporting — notifiable diseases, terrorism-related disclosures under the Terrorism Act); safeguarding children or vulnerable adults (child protection referrals — even without parental consent where the child's welfare requires it); public interest (disclosure to prevent crime or protect public safety — must be proportionate and the interest must outweigh the confidentiality harm). When considering whether to breach confidentiality: seek consent if possible; if not, consider whether the public interest genuinely justifies the disclosure; disclose minimum necessary information; document the decision and rationale. In complex cases, seek advice from professional bodies (GDC, MDO/dental defence organisations).

Question 6: The 'duty of candour' in UK dental practice means that a dentist MUST:

Only disclose treatment errors if the patient asks directly
Inform patients when something has gone wrong with their care that has caused harm, apologise, and offer appropriate remedy (Correct answer)
Report all minor incidents to the CQC immediately regardless of patient impact
Maintain written records of all patient complaints in a public register

Correct answer: Inform patients when something has gone wrong with their care that has caused harm, apologise, and offer appropriate remedy

The duty of candour requires dental professionals to be open and honest with patients when treatment has caused harm — this includes timely notification, a sincere apology, explanation, and support/remedy. It is both an ethical and statutory obligation.

The duty of candour is the professional, ethical, and legal obligation of healthcare providers (including dentists) to be open and honest with patients when things go wrong that cause harm or distress. In the UK, this was formalised following the Francis Report (Mid Staffordshire NHS Foundation Trust Public Inquiry) which highlighted systematic failures of openness in healthcare. For dental professionals, the duty of candour has two components: (1) Professional duty (GDC Standards for the Dental Team, Principle 6: 'Work with colleagues in a way that is in patients' best interests' and Principle 4 on patient information) — this requires honesty about mistakes affecting patients; (2) Statutory duty under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 — this applies to registered providers (dental practices) and requires notification and support when patient safety incidents occur. When something goes wrong, the dentist must: tell the patient (or their representative) as soon as reasonably practicable after becoming aware of the incident; provide an honest explanation of what happened; apologise (an apology is not an admission of legal liability); explain what can be done to help; document the discussion; follow up as appropriate. A sincere apology is encouraged and does not constitute an admission of negligence. Patients who have been harmed deserve to know what happened — this rebuilds trust and allows them to seek further treatment if needed. MJDF candidates must know the duty of candour as part of professionalism and ethics.

MJDF Law, Ethics, and Professionalism 3

Under the Mental Capacity Act 2005 (England and Wales), which of the following is a core principle that dentists must apply when treating a patient who may lack capacity?