PLAB 2 Ethics and Consent 2 — Questions and Answers
Question 1: A junior doctor makes a prescribing error that causes harm to a patient. According to GMC Duty of Candour, what must happen?
- The error should be hidden to avoid litigation
- The patient must be told honestly about the error, given an apology, and offered a remedy. The incident must be reported through the organisation's incident reporting system (Correct answer)
- The error should only be disclosed if the patient specifically asks
- The junior doctor should handle it alone without informing seniors
Correct answer: The patient must be told honestly about the error, given an apology, and offered a remedy. The incident must be reported through the organisation's incident reporting system
The professional duty of candour (GMC) and statutory duty of candour (CQC) require that patients are told when things go wrong, given an honest explanation, an apology, and offered a remedy. The incident must be reported through Datix or equivalent system, investigated, and lessons learned shared.
Question 2: A patient in A&E is unconscious after a road traffic collision and requires emergency surgery. There is no time to obtain consent and no family is contactable. What is the legal basis for proceeding with treatment?
- Treatment cannot proceed without consent under any circumstances
- Treatment can proceed under the doctrine of necessity and the Mental Capacity Act 2005 Section 5 — emergency treatment in the patient's best interests when they lack capacity and there is no time to consult (Correct answer)
- A court order must be obtained first
- Two doctors must agree before treatment can proceed
Correct answer: Treatment can proceed under the doctrine of necessity and the Mental Capacity Act 2005 Section 5 — emergency treatment in the patient's best interests when they lack capacity and there is no time to consult
In a genuine emergency where the patient lacks capacity and delay would cause serious harm, treatment can proceed without consent under the common law doctrine of necessity and Section 5 of the Mental Capacity Act 2005. Treatment must be limited to what is immediately necessary and in the patient's best interests.
Question 3: A competent adult patient with terminal cancer has decided to stop all active treatment. They understand the consequences. Their family disagrees and asks you to continue treatment. What should you do?
- Follow the family's wishes as they know the patient best
- Respect the patient's autonomous decision — a competent adult has the right to refuse treatment even if it leads to death. Support the family with information and emotional care, but do not override the patient's wishes (Correct answer)
- Seek a court order to continue treatment
- Secretly continue treatment without the patient's knowledge
Correct answer: Respect the patient's autonomous decision — a competent adult has the right to refuse treatment even if it leads to death. Support the family with information and emotional care, but do not override the patient's wishes
A competent adult's right to refuse treatment is absolute in UK law, even if the refusal leads to death. The family has no legal authority to override this decision. You should support the family emotionally, explain the patient's right to autonomy, and ensure the patient receives appropriate palliative care.
Question 4: You are a foundation year doctor and witness a senior colleague performing a procedure without proper consent. According to GMC guidance, what should you do?
- Do nothing as they are more senior than you
- Raise the concern — GMC guidance states that all doctors have a duty to raise concerns about patient safety regardless of the seniority of the person involved, through appropriate channels (Correct answer)
- Discuss it only with your peers
- Wait to see if it happens again before acting
Correct answer: Raise the concern — GMC guidance states that all doctors have a duty to raise concerns about patient safety regardless of the seniority of the person involved, through appropriate channels
GMC guidance (Raising and Acting on Concerns) requires all doctors to raise concerns about patient safety, regardless of the seniority of the person involved. You should raise it with the colleague first if safe to do so, then escalate through clinical governance, patient safety teams, or external whistleblowing channels if necessary.
Question 5: A Lasting Power of Attorney (LPA) for Health and Welfare is activated. When does this LPA take effect?
- Immediately upon registration, even if the person has capacity
- Only when the person (donor) loses capacity to make the specific decision in question (Correct answer)
- When the attorney decides it should take effect
- When the person is admitted to hospital
Correct answer: Only when the person (donor) loses capacity to make the specific decision in question
An LPA for Health and Welfare only takes effect when the donor lacks capacity to make the specific decision. While the person retains capacity, they make their own decisions. An LPA for Property and Finance can take effect while the person has capacity if they choose. All LPAs must be registered with the Office of the Public Guardian.
Question 6: A researcher approaches you about recruiting your patients for a clinical trial. What ethical principles must be followed according to the Declaration of Helsinki and UK research governance?
- Patients can be enrolled without their knowledge for the greater good
- Voluntary informed consent is essential, participants must understand the risks and benefits, they can withdraw at any time, the research must have ethical approval (REC), and patient welfare must always take precedence over the interests of science (Correct answer)
- Only written consent from the hospital is needed, not from patients
- Research ethics approval is optional for observational studies
Correct answer: Voluntary informed consent is essential, participants must understand the risks and benefits, they can withdraw at any time, the research must have ethical approval (REC), and patient welfare must always take precedence over the interests of science
The Declaration of Helsinki and UK Research Governance Framework require: voluntary informed consent, ethical approval from a Research Ethics Committee (REC), the right to withdraw at any time, that patient welfare takes precedence over research interests, and that vulnerable groups receive additional protection.
PLAB 2 Ethics and Consent 2
A junior doctor makes a prescribing error that causes harm to a patient.
According to GMC Duty of Candour, what must happen?