Ethics and Consent Flashcards

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?

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.

According to the Mental Capacity Act 2005, what are the five key principles?

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.

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?

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.

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?

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.

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?

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.

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)?

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.