Medical Ethics, Consent & Evidence-Based Medicine Flashcards

A competent 35-year-old patient with a life-threatening condition refuses a blood transfusion on religious grounds. What should you do?

Answer: Respect the patient's decision, document it, and explore alternatives — a competent adult has the right to refuse any treatment

A competent adult has an absolute right to refuse medical treatment, even if that refusal may result in death. This is enshrined in UK law (Mental Capacity Act 2005, common law). The patient must be given full information, their decision must be documented, and alternative treatments explored. Overriding consent is battery.

What are the four components of valid informed consent?

Answer: Voluntary decision, capacity, adequate information/disclosure, and the ability to communicate the decision

Valid consent requires: (1) voluntariness — free from undue pressure; (2) capacity — the ability to understand, retain, weigh, and communicate information; (3) adequate information — enough to make an informed decision including risks, benefits, and alternatives; (4) communication of the decision. All four must be present.

Under the Mental Capacity Act 2005 (England and Wales), what are the five principles that underpin the Act?

Answer: Presumption of capacity; support to make decisions; right to make unwise decisions; best interests; least restrictive option

The MCA 2005 five principles: (1) Presume capacity unless proven otherwise; (2) Support people to make decisions; (3) Respect the right to make unwise decisions; (4) Any action/decision for those lacking capacity must be in their best interests; (5) Choose the least restrictive option. These apply to all healthcare decisions.

A 16-year-old presents alone requesting contraception. She appears to understand the information given and the consequences of her decision. Under the Fraser guidelines, can you prescribe contraception without parental consent?

Answer: Yes — if she meets Fraser guidelines: understands advice, cannot be persuaded to involve parents, will likely have unprotected sex otherwise, her physical/mental health requires contraception, and it is in her best interests

Fraser guidelines (from Gillick v West Norfolk, 1985) allow prescription of contraception to under-16s without parental consent if: they understand the advice; parental involvement cannot be achieved; they will likely proceed without contraception; their health requires contraception; it is in their best interests. Parental consent is not automatically required for 16–17-year-olds either.

What does 'best interests' decision-making require under the MCA 2005 when a patient lacks capacity?

Answer: Considering all relevant factors including the patient's past wishes, values, and beliefs; consulting those close to them; and choosing the least restrictive option that meets their needs

Best interests under the MCA 2005 requires a structured approach: consider all relevant factors, consult family/carers/advocates (IMCA if needed), consider the patient's past and present wishes/values, do not make assumptions based on age/appearance, and identify the least restrictive option. It is broader than just medical best interests.

What is the principle of 'Gillick competence' and how does it apply to children under 16?

Answer: A child under 16 has capacity to consent to treatment if they have sufficient maturity and understanding to fully comprehend what is proposed — the competence level must match the complexity of the decision

Gillick competence holds that a child under 16 may consent to medical treatment if they demonstrate sufficient intelligence and maturity to understand the nature and implications of the proposed treatment. The more complex or serious the decision, the higher the threshold of understanding required. Parents cannot overrule a Gillick-competent child's consent.