PLAB 2 Ethics and Consent

Question 1

A 78-year-old man with advanced dementia is admitted with pneumonia.
He lacks capacity to make treatment decisions.
He has no advance directive or lasting power of attorney.
According to the Mental Capacity Act 2005, how should treatment decisions be made?

Accepted Answer

Decisions should be made in the patient's best interests, considering their past wishes, beliefs, values, and consulting relevant people (family, carers, IMCA if no one else)

Answer

The most senior doctor decides alone based on their clinical judgement

Answer

The family must make all decisions on the patient's behalf

Answer

Treatment cannot be given without the patient's consent under any circumstances

Question 2

According to the Mental Capacity Act 2005, what are the five key principles?

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 fidelity

Answer

Confidentiality, honesty, safety, dignity, and respect

Answer

Diagnosis, prognosis, treatment, consent, and discharge

Question 3

A 16-year-old patient wants to refuse a life-saving blood transfusion. Their parents consent to the treatment. According to UK law, can the young person's refusal be overridden?

Accepted Answer

Yes — while a 16-17 year old can consent to treatment, their refusal of life-saving treatment can be overridden by someone with parental responsibility or by a court order

Answer

No — a 16-year-old has the same rights as an adult and their refusal is absolute

Answer

No — if the patient is Gillick competent, their decision is final regardless of age

Answer

Yes — anyone under 18 has no say in their medical treatment

Question 4

A patient writes an Advance Decision to Refuse Treatment (ADRT) stating they do not want CPR. For this ADRT to be legally valid and applicable to life-sustaining treatment, which conditions must be met?

Accepted Answer

It must be in writing, signed, witnessed, and include a specific statement that it applies even if life is at risk

Answer

It can be verbal and does not need to be written

Answer

It only needs to be discussed with a family member

Answer

It must be registered with the GMC

Question 5

A doctor discovers that a patient is HIV positive while treating them for an unrelated condition. Under what circumstances can this information be disclosed without the patient's consent?

Accepted Answer

Disclosure without consent may be justified if there is a serious and identifiable risk to a specific individual (e.g., a sexual partner), and the patient has refused to disclose despite counselling — as per GMC guidance on confidentiality

Answer

It can never be disclosed without consent under any circumstances

Answer

It can be freely shared with all healthcare staff regardless of need

Answer

It must be disclosed to the patient's employer immediately

Question 6

A patient is admitted to hospital under Section 2 of the Mental Health Act for assessment. Can this section be used to treat their physical health conditions (e.g., diabetes)?

Accepted Answer

No — the Mental Health Act only authorises treatment for mental disorder. Physical health conditions require separate consent or, if the patient lacks capacity for that decision, the Mental Capacity Act 2005 applies

Answer

Yes — Section 2 allows treatment for any medical condition

Answer

Yes — detained patients lose all rights to refuse treatment

Answer

No — physical health conditions cannot be treated at all while a patient is sectioned

A 78-year-old man with advanced dementia is admitted with pneumonia.He lacks capacity to make treatment decisions.He has no advance directive or lasting power of attorney.According to the Mental Capacity Act 2005, how should treatment decisions be made?

A 78-year-old man with advanced dementia is admitted with pneumonia.
He lacks capacity to make treatment decisions.
He has no advance directive or lasting power of attorney.
According to the Mental Capacity Act 2005, how should treatment decisions be made?