PLAB 2 Ethics and Consent — Questions and Answers
Question 1: A 78-year-old man with advanced dementia is admitted with pneumonia. He lacks capacity to make treatment decisions. He has no advance directive or lasting power of attorney. According to the Mental Capacity Act 2005, how should treatment decisions be made?
- The most senior doctor decides alone based on their clinical judgement
- Decisions should be made in the patient's best interests, considering their past wishes, beliefs, values, and consulting relevant people (family, carers, IMCA if no one else) (Correct answer)
- The family must make all decisions on the patient's behalf
- Treatment cannot be given without the patient's consent under any circumstances
Correct answer: Decisions should be made in the patient's best interests, considering their past wishes, beliefs, values, and consulting relevant people (family, carers, IMCA if no one else)
The Mental Capacity Act 2005 requires best interests decision-making for patients who lack capacity. This involves considering the patient's past and present wishes, beliefs, values, and consulting anyone named by the patient, carers, family, or an Independent Mental Capacity Advocate (IMCA). The least restrictive option must be chosen.
Question 2: According to the Mental Capacity Act 2005, what are the five key principles?
- Beneficence, non-maleficence, autonomy, justice, and fidelity
- Presumption of capacity; support to make decisions; right to make unwise decisions; best interests; least restrictive option (Correct answer)
- Confidentiality, honesty, safety, dignity, and respect
- Diagnosis, prognosis, treatment, consent, and discharge
Correct answer: Presumption of capacity; support to make decisions; right to make unwise decisions; best interests; least restrictive option
The five principles of the Mental Capacity Act 2005 are: (1) A person is presumed to have capacity unless proven otherwise; (2) All practicable steps to help them decide must be taken first; (3) An unwise decision does not mean lack of capacity; (4) Decisions for those lacking capacity must be in their best interests; (5) The least restrictive option must be chosen.
Question 3: A 16-year-old patient wants to refuse a life-saving blood transfusion. Their parents consent to the treatment. According to UK law, can the young person's refusal be overridden?
- No — a 16-year-old has the same rights as an adult and their refusal is absolute
- Yes — while a 16-17 year old can consent to treatment, their refusal of life-saving treatment can be overridden by someone with parental responsibility or by a court order (Correct answer)
- No — if the patient is Gillick competent, their decision is final regardless of age
- Yes — anyone under 18 has no say in their medical treatment
Correct answer: Yes — while a 16-17 year old can consent to treatment, their refusal of life-saving treatment can be overridden by someone with parental responsibility or by a court order
Under UK law, while 16-17 year olds can consent to treatment (Family Law Reform Act 1969), their refusal of treatment can be overridden by a parent or court order, particularly for life-saving treatment. This is different from adult patients whose competent refusal is absolute. A court order provides the safest legal route.
Question 4: A patient writes an Advance Decision to Refuse Treatment (ADRT) stating they do not want CPR. For this ADRT to be legally valid and applicable to life-sustaining treatment, which conditions must be met?
- It can be verbal and does not need to be written
- It must be in writing, signed, witnessed, and include a specific statement that it applies even if life is at risk (Correct answer)
- It only needs to be discussed with a family member
- It must be registered with the GMC
Correct answer: It must be in writing, signed, witnessed, and include a specific statement that it applies even if life is at risk
Under the Mental Capacity Act 2005, an ADRT refusing life-sustaining treatment must be: (1) in writing, (2) signed by the person (or someone on their behalf in their presence), (3) witnessed, and (4) must include a clear statement that the decision applies 'even if life is at risk.' Without these requirements, it is not legally binding for life-sustaining treatment.
Question 5: A doctor discovers that a patient is HIV positive while treating them for an unrelated condition. Under what circumstances can this information be disclosed without the patient's consent?
- It can never be disclosed without consent under any circumstances
- Disclosure without consent may be justified if there is a serious and identifiable risk to a specific individual (e.g., a sexual partner), and the patient has refused to disclose despite counselling — as per GMC guidance on confidentiality (Correct answer)
- It can be freely shared with all healthcare staff regardless of need
- It must be disclosed to the patient's employer immediately
Correct answer: Disclosure without consent may be justified if there is a serious and identifiable risk to a specific individual (e.g., a sexual partner), and the patient has refused to disclose despite counselling — as per GMC guidance on confidentiality
GMC guidance allows disclosure without consent in exceptional circumstances where failure to disclose poses a serious risk of death or serious harm to an identifiable individual. The doctor should first encourage voluntary disclosure, offer support, and seek advice from a senior colleague or Caldicott Guardian before disclosing.
Question 6: A patient is admitted to hospital under Section 2 of the Mental Health Act for assessment. Can this section be used to treat their physical health conditions (e.g., diabetes)?
- Yes — Section 2 allows treatment for any medical condition
- No — the Mental Health Act only authorises treatment for mental disorder. Physical health conditions require separate consent or, if the patient lacks capacity for that decision, the Mental Capacity Act 2005 applies (Correct answer)
- Yes — detained patients lose all rights to refuse treatment
- No — physical health conditions cannot be treated at all while a patient is sectioned
Correct answer: No — the Mental Health Act only authorises treatment for mental disorder. Physical health conditions require separate consent or, if the patient lacks capacity for that decision, the Mental Capacity Act 2005 applies
The Mental Health Act only authorises treatment for the mental disorder for which the patient is detained (with some exceptions for conditions directly causing or contributing to the mental disorder). Physical health treatment requires the usual consent process, or if the patient lacks capacity, the Mental Capacity Act 2005 applies.
PLAB 2 Ethics and Consent
A 78-year-old man with advanced dementia is admitted with pneumonia.
He lacks capacity to make treatment decisions.
He has no advance directive or lasting power of attorney.
According to the Mental Capacity Act 2005, how should treatment decisions be made?