NMC CBT - Nursing and Midwifery Council Computer-Based Test Legal Frameworks, Consent, and Capacity 1 — Questions and Answers
Question 1: A 15-year-old girl attends a sexual health clinic requesting contraceptive advice without her parents' knowledge. The nurse assesses that she fully understands the implications. Which legal principle allows the nurse to provide treatment without parental consent?
- The Fraser Guidelines
- Gillick competence (Correct answer)
- The Welfare Checklist under the Children Act 1989
- The Principle of Assent
Correct answer: Gillick competence
Gillick competence is the overarching legal principle established in Gillick v West Norfolk (1985) that a child under 16 can consent to treatment if they have sufficient maturity and understanding. The Fraser Guidelines are a narrower set of criteria specifically for contraceptive advice and are derived from this broader principle.
Question 2: A 79-year-old woman with severe dementia is living in a care home. Staff prevent her from leaving the building daily because they believe it keeps her safe. She lacks capacity to consent to this restriction. What is the FIRST legal step staff must take to ensure this is lawfully authorised?
- Document the decision in the care plan and inform the family
- Apply to the Court of Protection for a welfare order
- Request a Deprivation of Liberty Safeguards (DoLS) authorisation from the supervisory body (Correct answer)
- Contact the Care Quality Commission to notify them of the restriction
Correct answer: Request a Deprivation of Liberty Safeguards (DoLS) authorisation from the supervisory body
Where a person who lacks capacity is deprived of their liberty in a care home or hospital, the Deprivation of Liberty Safeguards (DoLS) under the Mental Capacity Act 2005 (Schedule A1) require the managing authority to apply to the supervisory body for authorisation before or as soon as possible after the deprivation begins. Documentation and family notification are good practice but do not legally authorise the restriction.
Question 3: A patient who lacks capacity has a registered Lasting Power of Attorney (LPA) for Property and Financial Affairs held by their son. The son attends the ward and states he wishes to consent to his father's upcoming surgical procedure. What should the nurse advise?
- The son may consent as he holds a registered LPA
- A Property and Financial Affairs LPA does not cover healthcare decisions; only a Health and Welfare LPA grants this authority (Correct answer)
- The son must obtain a separate court order before consenting to medical treatment
- The nurse can accept the son's consent provided two clinicians agree it is in the patient's best interests
Correct answer: A Property and Financial Affairs LPA does not cover healthcare decisions; only a Health and Welfare LPA grants this authority
There are two types of LPA under the Mental Capacity Act 2005: Property and Financial Affairs, and Health and Welfare. Only a Health and Welfare LPA, when registered and activated, grants an attorney the authority to make decisions about medical treatment. A Property and Financial Affairs LPA is strictly limited to financial matters.
Question 4: Under the Mental Health Act 1983, what is the correct distinction between a Section 2 and a Section 3 detention?
- Section 2 authorises treatment for up to six months; Section 3 authorises assessment for up to 28 days
- Section 2 authorises assessment for up to 28 days; Section 3 authorises treatment for up to six months (Correct answer)
- Both sections are for assessment only and require renewal after 28 days
- Section 3 can only be applied in approved secure mental health units
Correct answer: Section 2 authorises assessment for up to 28 days; Section 3 authorises treatment for up to six months
Under the Mental Health Act 1983, Section 2 detains a patient for assessment (and any necessary treatment) for up to 28 days and cannot be renewed. Section 3 detains a patient for treatment for up to six months and can be renewed. Both require recommendations from two registered medical practitioners and an application by an Approved Mental Health Professional or nearest relative.
Question 5: When making a best interests decision for an adult who lacks capacity under the Mental Capacity Act 2005, which approach is explicitly prohibited by the Act?
- Considering what the person's wishes and feelings might have been when they had capacity
- Basing the decision solely on the person's age, appearance, or diagnosis (Correct answer)
- Consulting with family members, carers, and relevant others
- Appointing an Independent Mental Capacity Advocate (IMCA) where appropriate
Correct answer: Basing the decision solely on the person's age, appearance, or diagnosis
Section 4(1) of the Mental Capacity Act 2005 explicitly states that a person must not make a best interests determination merely on the basis of the person's age, appearance, a condition they have, or an aspect of their behaviour. The Act requires a holistic approach that includes past wishes, values, and consultation with relevant others.
Question 6: A 4-year-old child is admitted requiring urgent surgery. His parents are not married and were never in a formal relationship. His mother is present and consents. His biological father, whose name does not appear on the birth certificate, also arrives and objects to the procedure. Whose decision is legally determinative under the Children Act 1989?
- The father's objection overrides consent as both biological parents share equal rights
- The mother's consent is sufficient as the father does not hold parental responsibility (Correct answer)
- The surgeon must apply to the Family Court before proceeding
- Both parents must reach agreement before treatment can proceed
Correct answer: The mother's consent is sufficient as the father does not hold parental responsibility
Under the Children Act 1989, an unmarried father does not automatically acquire parental responsibility. Parental responsibility is obtained by being named on the birth certificate (for registrations after 1 December 2003 in England and Wales), entering a Parental Responsibility Agreement, or obtaining a court order. As the father is not on the birth certificate, he has no parental responsibility, and the mother's consent alone is legally sufficient.
NMC CBT - Nursing and Midwifery Council Computer-Based Test Legal Frameworks, Consent, and Capacity 1
A 15-year-old girl attends a sexual health clinic requesting contraceptive advice without her parents' knowledge.
The nurse assesses that she fully understands the implications.
Which legal principle allows the nurse to provide treatment without parental consent?