PLAB 2 Consent, Capacity & Mental Capacity Act

Question 1

A 78-year-old woman with advanced dementia requires a hip replacement following a fractured neck of femur.
She lacks capacity to consent.
Under the Mental Capacity Act 2005, what is the most appropriate way to proceed?

Accepted Answer

Proceed under best interests following a best interests assessment, consulting the patient's family, carers, and any advance decisions, and consider appointing an IMCA if there is no one to consult

Answer

Seek consent from her next of kin

Answer

Apply to the Court of Protection before any treatment

Answer

Wait until she regains capacity

Question 2

A 45-year-old man with paranoid schizophrenia refuses oral antipsychotic medication. His community psychiatric nurse reports he is responding to command hallucinations and there is risk to others. Under which legislation can he be treated without consent?

Accepted Answer

Mental Health Act 1983 (as amended 2007) — compulsory detention and treatment for mental disorder is governed by the MHA, not the MCA

Answer

Mental Capacity Act 2005

Answer

Common law doctrine of necessity

Answer

Consumer Rights Act

Question 3

Under the MCA 2005, what are the two diagnostic tests required to establish that a person lacks capacity?

Accepted Answer

A diagnostic threshold (the person has an impairment or disturbance in mind or brain) AND a functional test (as a result, they cannot understand, retain, weigh, or communicate information relevant to the decision)

Answer

Age over 65 and confirmed diagnosis of dementia

Answer

Psychiatric assessment and neuroimaging

Answer

GP assessment and consultant review

Question 4

What is a 'Lasting Power of Attorney' (LPA) for health and welfare, and what can the attorney decide?

Accepted Answer

A legal document (registered with the Office of the Public Guardian) appointing a trusted person to make health and welfare decisions on behalf of someone who has lost capacity, including consent to and refusal of medical treatment

Answer

A legal document allowing a solicitor to manage medical decisions

Answer

A document allowing a family member to access medical records

Answer

A document giving a GP the power to override a patient's treatment preferences

Question 5

An 82-year-old woman has a valid Advance Decision to Refuse Treatment (ADRT) refusing artificial ventilation. She is now incapacitated with respiratory failure. The family is insisting on ventilation. What should you do?

Accepted Answer

Respect the valid ADRT — it is legally binding under the MCA 2005, and the patient's prior autonomous refusal overrides the family's request

Answer

Follow the family's wishes as next of kin

Answer

Proceed with ventilation pending court review

Answer

Discuss with ethics committee before deciding

Question 6

A 20-year-old patient with a learning disability is to have a dental procedure. His carer says he needs to give consent but she will sign the form on his behalf if needed. What is the correct approach?

Accepted Answer

Assess the patient's capacity for this specific decision; if he has capacity (even with support), he must consent himself; if he lacks capacity, proceed under best interests under the MCA — no one else can sign a consent form on his behalf in England and Wales

Answer

Allow the carer to sign the consent form — this is standard practice for those with learning disabilities

Answer

Ask a senior clinician to decide without involving the patient

Answer

Apply a general rule that all patients with learning disabilities lack capacity