FFICM Professional Ethics and Standards 3 — Questions and Answers
Question 1: A Lasting Power of Attorney (LPA) for health and welfare has been registered for an incapacitated ICU patient. What authority does the attorney hold?
- The attorney can demand any treatment the patient desires
- The attorney can make decisions about life-sustaining treatment only if the LPA explicitly grants this power (Correct answer)
- The attorney's views are advisory only and carry no legal weight
- The attorney automatically has full medical decision-making power
Correct answer: The attorney can make decisions about life-sustaining treatment only if the LPA explicitly grants this power
An LPA for health and welfare only extends to life-sustaining treatment decisions if the document explicitly includes this authority.
Question 2: In research involving incapacitated ICU patients, what mechanism most commonly authorises participation when the patient cannot consent?
- Waiver of consent granted by the hospital administrator
- Consultee agreement from a personal or nominated consultee (Correct answer)
- Verbal assent from the next of kin
- Approval by the lead researcher alone
Correct answer: Consultee agreement from a personal or nominated consultee
Under the Mental Capacity Act 2005, a personal or nominated consultee must be identified to advise on the incapacitated patient's likely wishes regarding research participation.
Question 3: Which of the following best describes 'therapeutic privilege' in the ICU context?
- The right of doctors to perform any intervention they believe is beneficial
- Withholding information from a patient when disclosure would cause serious harm to them (Correct answer)
- Administering treatment without consent in an emergency
- Prescribing outside licensed indications in intensive care
Correct answer: Withholding information from a patient when disclosure would cause serious harm to them
Therapeutic privilege refers to withholding information when the clinician believes disclosure would cause serious psychological harm, though it is controversial and rarely justified.
Question 4: A family requests that a dying patient not be told their prognosis. What is the ethical framework for responding to this request?
- Always comply with family requests to maintain trust
- Assess whether the patient has expressed a wish to know, and generally respect the patient's own preferences (Correct answer)
- Withhold all information to reduce patient distress
- Disclose everything immediately regardless of family concerns
Correct answer: Assess whether the patient has expressed a wish to know, and generally respect the patient's own preferences
The patient's own wishes about receiving information take priority; family preferences are considered but cannot override a competent patient's right to know.
Question 5: What is the ethical status of 'double effect' as applied to opioid analgesia in dying ICU patients?
- It is illegal in the UK and should never be used
- It permits intentional hastening of death to relieve suffering
- It justifies titrating analgesia to relieve symptoms even if there is a foreseeable risk of hastening death, provided intent is symptom relief (Correct answer)
- It applies only to palliative care outside the ICU
Correct answer: It justifies titrating analgesia to relieve symptoms even if there is a foreseeable risk of hastening death, provided intent is symptom relief
The doctrine of double effect permits actions with two effects — intended good (symptom relief) and foreseen but unintended harm (possible earlier death) — provided the intent is the good effect.
Question 6: Which body provides the primary professional standards framework for intensivists practising in the UK?
- The Care Quality Commission (CQC)
- The General Medical Council (GMC) (Correct answer)
- The Faculty of Intensive Care Medicine (FICM)
- NHS England
Correct answer: The General Medical Council (GMC)
The GMC sets the overarching professional standards for all registered doctors in the UK, including those practising intensive care medicine.
Question 7: In the context of organ donation after circulatory death (DCD), which ethical principle is most critical to maintaining public trust?
- Maximising the number of organs retrieved
- Strict separation between the treating team and the donation team (Correct answer)
- Minimising cold ischaemia time
- Ensuring donor family financial compensation
Correct answer: Strict separation between the treating team and the donation team
The dead donor rule and separation of treating and donation teams ensures that end-of-life care decisions are not influenced by transplantation interests, preserving ethical integrity.
FFICM Professional Ethics and Standards 3
A Lasting Power of Attorney (LPA) for health and welfare has been registered for an incapacitated ICU patient.
What authority does the attorney hold?