MRCPsych Professional Ethics and Standards 3 — Questions and Answers
Question 1: Which of the following BEST describes 'therapeutic privilege' and its current standing in UK medical ethics?
- A legal right for clinicians to withhold information to prevent patient distress, widely accepted in UK law
- A largely discredited concept — withholding information to prevent distress generally violates patient autonomy (Correct answer)
- A formal GMC-approved exception to informed consent requirements
- A concept applicable only in surgical specialties
Correct answer: A largely discredited concept — withholding information to prevent distress generally violates patient autonomy
Therapeutic privilege — withholding information to spare distress — is largely rejected in contemporary UK ethics as it undermines patient autonomy and informed consent.
Question 2: A psychiatrist in private practice develops romantic feelings for a former patient discharged 6 months ago. According to GMC guidance, this relationship:
- Is permissible after a 6-month waiting period
- Remains inappropriate indefinitely due to the power imbalance inherent in the therapeutic relationship (Correct answer)
- Is acceptable provided the patient initiates the relationship
- Is permissible if the contact is purely social
Correct answer: Remains inappropriate indefinitely due to the power imbalance inherent in the therapeutic relationship
GMC guidance prohibits sexual and romantic relationships with former patients indefinitely, as the power dynamics of the therapeutic relationship do not simply dissolve at discharge.
Question 3: Under the Equality Act 2010, which of the following is a 'protected characteristic' directly relevant to psychiatric practice?
- Occupation
- Mental and physical disability (Correct answer)
- Marital wealth
- Political affiliation
Correct answer: Mental and physical disability
Disability, including mental illness, is a protected characteristic under the Equality Act 2010, requiring reasonable adjustments in healthcare settings.
Question 4: A patient with anorexia nervosa has capacity and refuses nasogastric feeding. She is not detained. What is the ethical and legal position?
- She must be fed as anorexia impairs decision-making by definition
- Her capacitous refusal must be respected, even if this results in death (Correct answer)
- A best-interests decision can override her refusal without detention
- The family can consent to treatment on her behalf
Correct answer: Her capacitous refusal must be respected, even if this results in death
A capacitous adult's refusal of treatment is legally and ethically binding in England and Wales, even if that decision may lead to death.
Question 5: The concept of 'moral distress' in psychiatry refers to:
- A patient's distress caused by guilt about past behaviour
- A clinician's distress when prevented from acting according to their ethical judgement (Correct answer)
- Conflict arising from differing cultural moral frameworks between clinician and patient
- Distress caused by participating in involuntary treatment
Correct answer: A clinician's distress when prevented from acting according to their ethical judgement
Moral distress occurs when clinicians know the ethically right action but are constrained by institutional or systemic factors from carrying it out.
Question 6: An NHS psychiatrist is offered a paid speaking engagement by a pharmaceutical company whose drug they regularly prescribe. Which response reflects best ethical practice?
- Accept if the fee is modest and the topic is educational
- Disclose the relationship to their employer and consider declining or declaring conflict of interest (Correct answer)
- Accept only if the engagement takes place outside working hours
- This is always prohibited under GMC rules
Correct answer: Disclose the relationship to their employer and consider declining or declaring conflict of interest
GMC guidance requires declaring and managing conflicts of interest; clinicians must be transparent with their employer and consider whether the relationship compromises their objectivity.
Question 7: Gillick competence in the psychiatric assessment of a 15-year-old patient refers to:
- The automatic right of all children under 16 to refuse treatment
- The capacity of a young person to consent to treatment if they sufficiently understand its nature and implications (Correct answer)
- A legal framework that requires parental consent for all psychiatric treatments under 18
- A framework applicable only to contraceptive advice
Correct answer: The capacity of a young person to consent to treatment if they sufficiently understand its nature and implications
Gillick competence allows a young person under 16 to consent to treatment if they demonstrate sufficient understanding, regardless of parental consent.
MRCPsych Professional Ethics and Standards 3
Which of the following BEST describes 'therapeutic privilege' and its current standing in UK medical ethics?