FFICM Professional Ethics and Standards 2 — Questions and Answers
Question 1: A patient in the ICU lacks capacity and has no advance directive. Their adult children disagree about withdrawing life-sustaining treatment. What is the most appropriate next step?
- Proceed with the majority family vote
- Seek a court order immediately
- Convene a formal family meeting facilitated by the clinical team and consider ethics consultation (Correct answer)
- Continue full treatment indefinitely until consensus is reached
Correct answer: Convene a formal family meeting facilitated by the clinical team and consider ethics consultation
When families disagree, a structured family meeting with potential ethics consultation is the recommended approach before escalating to legal proceedings.
Question 2: Which ethical principle underpins the concept of informed consent in intensive care?
- Beneficence
- Justice
- Non-maleficence
- Autonomy (Correct answer)
Correct answer: Autonomy
Autonomy — the right of competent individuals to make their own decisions — is the core ethical principle underlying informed consent.
Question 3: Under the Mental Capacity Act 2005, what is the presumption regarding adult patients in the ICU?
- Capacity is absent unless proven otherwise in ICU patients
- Capacity must be formally tested before any intervention
- Every adult is presumed to have capacity unless demonstrated otherwise (Correct answer)
- A diagnosis of delirium automatically removes capacity
Correct answer: Every adult is presumed to have capacity unless demonstrated otherwise
The Mental Capacity Act 2005 presumes all adults have capacity unless there is evidence to the contrary.
Question 4: A competent patient refuses a blood transfusion on religious grounds despite a life-threatening haemorrhage. What should the intensivist do?
- Administer blood because saving life overrides religious beliefs
- Accept the refusal and manage without blood products (Correct answer)
- Seek an emergency court order to override the refusal
- Sedate the patient to remove the barrier to consent
Correct answer: Accept the refusal and manage without blood products
A competent adult's informed refusal of treatment must be respected regardless of the clinician's view of the decision's wisdom.
Question 5: Which document most clearly represents a patient's prospective autonomous wishes about future critical care treatment?
- A GP referral letter
- An advance decision to refuse treatment (ADRT) (Correct answer)
- A next-of-kin contact form
- A DNACPR order signed by the consultant
Correct answer: An advance decision to refuse treatment (ADRT)
An ADRT is a legally binding document in which a competent adult specifies treatments they wish to refuse if they later lose capacity.
Question 6: What is the primary ethical justification for withdrawing futile life-sustaining treatment in the ICU?
- It reduces healthcare costs
- It frees up ICU beds for other patients
- Continued treatment offers no reasonable prospect of benefit and burdens the patient (Correct answer)
- It aligns with institutional performance metrics
Correct answer: Continued treatment offers no reasonable prospect of benefit and burdens the patient
Treatment is considered futile when it cannot achieve any reasonable clinical benefit and its continuation causes disproportionate burden.
Question 7: An intensivist learns that a colleague is practising while impaired by alcohol. What is the ethical obligation?
- Speak to the colleague privately and monitor the situation
- Report concerns to the appropriate regulatory body or employer (Correct answer)
- Ignore the situation unless a patient is directly harmed
- Discuss it with nursing staff only
Correct answer: Report concerns to the appropriate regulatory body or employer
Clinicians have a professional duty to report a colleague whose impairment puts patients at risk, in line with GMC Good Medical Practice.
FFICM Professional Ethics and Standards 2
A patient in the ICU lacks capacity and has no advance directive.
Their adult children disagree about withdrawing life-sustaining treatment.
What is the most appropriate next step?