MSRA MSRA Ethics and Law 1 — Questions and Answers
Question 1: A competent adult patient refuses a blood transfusion on religious grounds despite life-threatening haemorrhage. What should the clinician do?
- Administer the transfusion to save the patient's life
- Respect the refusal, document it, and provide alternative management (Correct answer)
- Apply for emergency court order to override the patient
- Refer the patient to psychiatry
Correct answer: Respect the refusal, document it, and provide alternative management
Competent adults have an absolute right to refuse treatment, even if that decision may result in death; the clinician must respect this, document clearly, and offer all alternative measures.
Question 2: A 15-year-old patient presents alone requesting oral contraception. She demonstrates good understanding of the risks and benefits. What does the Fraser competency assessment determine?
- Whether the patient can consent to any treatment without parental involvement
- Whether the specific treatment can be provided without parental knowledge if the patient is competent (Correct answer)
- Whether parents must be notified regardless of the patient's wishes
- Whether a court order is needed
Correct answer: Whether the specific treatment can be provided without parental knowledge if the patient is competent
Fraser guidelines allow a clinician to provide contraception to a competent young person under 16 without parental consent if specific criteria are met, respecting confidentiality.
Question 3: A patient with schizophrenia refuses antipsychotic medication. He is currently detained under Section 3 of the Mental Health Act. Can treatment be given without consent?
- No — detention does not authorise treatment without consent
- Yes — Section 3 allows treatment for mental disorder without consent after 3 months under Part IV MHA (Correct answer)
- Yes — immediately on detention with no restrictions
- Only with a second opinion from an independent doctor from admission
Correct answer: Yes — Section 3 allows treatment for mental disorder without consent after 3 months under Part IV MHA
Under Part IV of the Mental Health Act, a patient detained under Section 3 can be treated for mental disorder without consent after 3 months, subject to second opinion (SOAD) safeguards.
Question 4: A junior doctor is asked to obtain consent from a patient for a complex bowel resection they have never performed. What is the ethically correct action?
- Obtain consent as instructed and document it
- Refuse and ensure the consenting clinician has the knowledge and skill to perform the procedure (Correct answer)
- Obtain consent but note they are not the operating surgeon
- Ask the patient to sign a generic consent form
Correct answer: Refuse and ensure the consenting clinician has the knowledge and skill to perform the procedure
GMC guidance states that consent should be obtained by a clinician who has sufficient knowledge of the procedure to answer questions; delegating to an uninformed person renders consent invalid.
Question 5: A doctor discovers their colleague is performing procedures while impaired by alcohol. What is the appropriate first action under GMC duty of candour?
- Confront the colleague privately and monitor the situation
- Report immediately to the Clinical Director or nominated responsible officer (Correct answer)
- Document the observation and review in 1 month
- Advise the colleague to self-refer to occupational health
Correct answer: Report immediately to the Clinical Director or nominated responsible officer
GMC Good Medical Practice requires doctors to act promptly when patient safety is at risk from a colleague's health, conduct, or performance — escalation to the responsible officer is mandatory.
Question 6: Which ethical principle underpins the obligation to obtain informed consent before any medical procedure?
- Beneficence
- Non-maleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Informed consent is rooted in the principle of autonomy — the patient's right to make informed decisions about their own body and treatment.
MSRA MSRA Ethics and Law 1
A competent adult patient refuses a blood transfusion on religious grounds despite life-threatening haemorrhage.
What should the clinician do?