MRCPsych Professional Ethics and Standards 2 — Questions and Answers
Question 1: A psychiatrist discovers that a colleague is regularly seeing patients while impaired by alcohol. What is the FIRST appropriate action?
- Report immediately to the General Medical Council
- Discuss concerns directly with the colleague first
- Inform the clinical director or responsible officer (Correct answer)
- Document concerns and monitor the situation
Correct answer: Inform the clinical director or responsible officer
The first step is typically to raise concerns with the responsible officer or clinical director, who has formal authority to investigate and act.
Question 2: Under the Mental Capacity Act 2005, when assessing decision-making capacity, which principle is paramount?
- Capacity is presumed absent until proven otherwise
- Capacity is presumed present unless evidence indicates otherwise (Correct answer)
- A consultant psychiatrist must always assess capacity
- Past decisions indicate future capacity
Correct answer: Capacity is presumed present unless evidence indicates otherwise
The MCA 2005 establishes that capacity must be presumed unless there is evidence to the contrary — the presumption of capacity is the foundational principle.
Question 3: A patient with schizophrenia discloses that they have been driving regularly despite being told not to by their GP. What is the psychiatrist's ethical obligation?
- Maintain strict confidentiality as the GP has already addressed this
- Advise the patient to inform the DVLA and breach confidentiality if they refuse (Correct answer)
- Immediately report to police without informing the patient
- Document the disclosure but take no further action
Correct answer: Advise the patient to inform the DVLA and breach confidentiality if they refuse
GMC guidance requires advising the patient to inform the DVLA, and if they refuse, the psychiatrist should breach confidentiality to protect public safety.
Question 4: Which ethical framework best describes the approach of treating patients according to their own values and goals rather than imposing the clinician's values?
- Beneficence
- Autonomy (Correct answer)
- Justice
- Non-maleficence
Correct answer: Autonomy
Autonomy refers to respecting a patient's right to make decisions consistent with their own values, free from undue clinician influence.
Question 5: A patient detained under Section 3 of the Mental Health Act refuses electroconvulsive therapy (ECT). Under what circumstance can ECT be given without consent?
- If two responsible clinicians agree it is necessary
- If the patient lacks capacity and it is immediately necessary to save life or prevent serious deterioration (Correct answer)
- Never — ECT requires explicit consent even in detained patients
- If the patient's family consents on their behalf
Correct answer: If the patient lacks capacity and it is immediately necessary to save life or prevent serious deterioration
Under the MHA, ECT can be given without consent only when the patient lacks capacity and it is immediately necessary to save life or prevent serious deterioration.
Question 6: In Tarasoff-style duty-to-warn scenarios in the UK context, what does GMC guidance advise when a patient threatens serious harm to an identifiable person?
- Confidentiality is absolute and no disclosure is permitted
- Disclosure to protect a third party may be justified if the risk is serious and credible (Correct answer)
- The psychiatrist must always report to police regardless of risk assessment
- Only the patient's family should be informed
Correct answer: Disclosure to protect a third party may be justified if the risk is serious and credible
GMC guidance allows breach of confidentiality to protect a third party when there is a serious and credible risk of harm, balancing public protection against patient confidentiality.
Question 7: A trainee psychiatrist is asked by a senior colleague to falsify a patient's clinical record to avoid a complaint. The trainee should:
- Comply as the senior colleague takes responsibility
- Refuse and escalate the request to a clinical supervisor or governance lead (Correct answer)
- Seek advice from a medical defence organisation before deciding
- Comply only if the falsification seems minor
Correct answer: Refuse and escalate the request to a clinical supervisor or governance lead
Falsifying medical records is serious professional misconduct; the trainee must refuse and report the request through appropriate governance channels.
MRCPsych Professional Ethics and Standards 2
A psychiatrist discovers that a colleague is regularly seeing patients while impaired by alcohol.
What is the FIRST appropriate action?