MSRA MSRA Ethics and Law 2 — Questions and Answers
Question 1: A patient discloses during consultation that they are HIV-positive but refuses to inform their regular sexual partner. What is the doctor's responsibility?
- Immediately disclose the diagnosis to the partner
- Respect confidentiality absolutely and take no further action
- Counsel the patient, encourage disclosure, and consider informing the PHSA if the partner is at serious risk (Correct answer)
- Refuse to continue treating the patient
Correct answer: Counsel the patient, encourage disclosure, and consider informing the PHSA if the partner is at serious risk
Doctors should strongly encourage patients to disclose, and if a serious identifiable risk persists after counselling, disclosure to a third party may be justified to prevent serious harm.
Question 2: A 17-year-old is brought in unconscious following a drug overdose. His parents demand full disclosure of his medical history and current treatment. What is the correct approach?
- Provide full disclosure to the parents as he is a minor
- Treat the patient, and share only information necessary for immediate care, respecting prior expressed confidentiality preferences where known (Correct answer)
- Refuse to speak to parents at all
- Discharge to parental care without treatment
Correct answer: Treat the patient, and share only information necessary for immediate care, respecting prior expressed confidentiality preferences where known
Even for minors, confidentiality obligations apply; share information necessary for treatment and safety, but full historical disclosure requires either patient consent or a clear public interest justification.
Question 3: A patient lacks mental capacity and has no advance directive. What framework governs treatment decisions in England and Wales?
- The Mental Health Act 1983
- The Mental Capacity Act 2005 (Correct answer)
- Common law best interests standard only
- The Human Rights Act 1998
Correct answer: The Mental Capacity Act 2005
The Mental Capacity Act 2005 governs decision-making for incapacitated adults, requiring clinicians to act in the patient's best interests after consulting those close to them.
Question 4: During a ward round, a consultant makes a clinical error and asks the junior doctor not to document it. What should the junior doctor do?
- Comply with the consultant's request to avoid conflict
- Document the clinical facts accurately and escalate the error via incident reporting (Correct answer)
- Document the error but do not tell the patient
- Ask the patient if they want to know
Correct answer: Document the clinical facts accurately and escalate the error via incident reporting
The duty of candour requires honest documentation of errors and transparent reporting through incident systems; concealment is professionally and legally indefensible.
Question 5: A pharmaceutical company offers a doctor a paid speaking engagement with flights and accommodation to promote their new drug. What should the doctor do?
- Accept as it is a legitimate educational opportunity
- Decline if the arrangement could reasonably be seen as influencing prescribing behaviour (Correct answer)
- Accept and declare the interest only if asked
- Accept provided the drug is on formulary
Correct answer: Decline if the arrangement could reasonably be seen as influencing prescribing behaviour
GMC guidance prohibits accepting gifts or hospitality that could influence, or appear to influence, clinical decisions; sponsored engagements tied to product promotion fall into this category.
Question 6: A patient is found to have capacity but requests a treatment that the doctor believes is not clinically indicated. What is the most appropriate response?
- Prescribe the treatment to maintain the therapeutic relationship
- Explain the clinical rationale, explore the patient's concerns, and offer appropriate alternatives (Correct answer)
- Refuse and discharge the patient
- Refer to another doctor without explanation
Correct answer: Explain the clinical rationale, explore the patient's concerns, and offer appropriate alternatives
While patients can refuse treatment, they cannot demand a clinically unjustified intervention; the doctor should explain their reasoning, understand the patient's concerns, and offer evidence-based alternatives.
MSRA MSRA Ethics and Law 2
A patient discloses during consultation that they are HIV-positive but refuses to inform their regular sexual partner.
What is the doctor's responsibility?