PLAB 1 Medical Ethics, Consent & Evidence-Based Medicine

Question 1

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

Accepted Answer

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

Answer

Administer the blood transfusion as it is life-saving

Answer

Apply to the Court of Protection to override the decision

Answer

Delay treatment until a second opinion is obtained

Question 2

What are the four components of valid informed consent?

Accepted Answer

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

Answer

Signature, witness, medical assessment, and doctor's agreement

Answer

Written form, two witnesses, patient's signature, and consultant approval

Answer

Patient request, clinical indication, family agreement, and legal approval

Question 3

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

Accepted Answer

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

Answer

Beneficence, non-maleficence, autonomy, justice, and veracity

Answer

Informed consent, autonomy, confidentiality, beneficence, and justice

Answer

Competence, disclosure, understanding, voluntariness, and decision-making

Question 4

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?

Accepted 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

Answer

No — anyone under 18 requires parental consent

Answer

Only if she is 'Gillick competent' but only for emergency contraception

Answer

Only with a court order

Question 5

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

Accepted 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

Answer

Following the patient's family's wishes

Answer

Making the medically optimal decision regardless of personal values

Answer

Applying for a court order before any decision

Question 6

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

Accepted 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

Answer

Children under 16 can never consent to medical treatment

Answer

All children under 16 need parental consent for any procedure

Answer

Gillick competence only applies to contraception decisions