Consent in Medical Practice — MCQs
For medical termination of pregnancy, consent is given by-
Under which section of the BNS is the punishment for voluntarily causing criminal abortion primarily covered?
False about MTP is -
Certain obligations on the part of a doctor who undertakes a postmortem examination are the following, EXCEPT:
Doctor or nurse disclosing the identity of a rape victim is punishable under the following section of IPC?
Unreasonable conduct of a patient, combined with a doctor's negligence, contributes to:
India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes? 1. Insist on good communication 2. Insist on communication only via an interpreter 3. Treat them regardless of their cultural perceptions 4. The physician should consider the patient's religion and cultural perception Select the correct combination:
A doctor is not held guilty of negligence if
Death of a patient due to an unintentional act by a doctor, staff or hospital is
If faced with a surgical emergency in a child of 15 years for whom no consent is available for life-saving surgery and no time for seeking authority from someone, the next step should be :
Consent in Medical Practice Indian Medical PG Practice Questions and MCQs
Question 1: For medical termination of pregnancy, consent is given by-
- A. Guardian
- B. Husband of the lady
- C. Concerned lady (Correct Answer)
- D. Both husband and wife
Explanation: ***Concerned lady*** - For a medical termination of pregnancy, **informed consent** must be given directly by the woman seeking the procedure. - This upholds her **autonomy** and right to make decisions regarding her own body and healthcare. *Guardian* - A guardian's consent is typically required only if the woman is a **minor** or is otherwise **legally incapacitated** and unable to provide consent herself. - In most cases, an adult woman is presumed to be competent to consent for her own medical procedures. *Husband of the lady* - The husband's consent is **not legally required** for a medical termination of pregnancy, as it is the woman's fundamental right to decide. - Requiring a husband's consent would infringe upon the woman's **bodily autonomy** and reproductive rights. *Both husband and wife* - While open communication with a spouse is often encouraged, **joint consent** from both the husband and wife is not a legal prerequisite for a medical termination of pregnancy. - The ultimate decision-making authority rests solely with the **pregnant woman**.
Question 2: Under which section of the BNS is the punishment for voluntarily causing criminal abortion primarily covered?
- A. 89
- B. 90
- C. 91
- D. 88 (Correct Answer)
Explanation: ***Correct Option: 88*** - Section 88 of the Bharatiya Nyaya Sanhita (BNS) specifically deals with the **offense of voluntarily causing miscarriage**, outlining the conditions and punishments associated with it. - This section covers the core legal framework for prosecution in cases of **criminal abortion**. - It is the primary provision under which punishment for voluntarily causing abortion is covered. *Incorrect Option: 89* - Section 89 of the BNS deals with causing miscarriage **without the woman's consent**, which is a more severe form of the offense. - While related to abortion, this section addresses a specific aggravated circumstance rather than the general act of voluntarily causing miscarriage. *Incorrect Option: 90* - Section 90 of the BNS addresses the **death of an unborn child** caused by an act amounting to culpable homicide, which is a different offense altogether. - This section focuses on homicide of an unborn child, not primarily the act of voluntarily causing a miscarriage. *Incorrect Option: 91* - Section 91 of the BNS deals with acts done with intent to prevent a child from being born alive or to cause it to die after birth. - This section focuses on offenses related to the **life of a child around birth**, distinct from the act of causing a miscarriage.
Question 3: False about MTP is -
- A. Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks
- B. Consent of husband is must (Correct Answer)
- C. >16 weeks, hysterotomy can be done
- D. Illegal if >20 weeks of pregnancy
Explanation: ***Consent of husband is must*** - The **Medical Termination of Pregnancy (MTP) Act** (amended in 2021) in India explicitly states that **only the consent of the pregnant woman** is required for an abortion. - The husband's consent is **not legally necessary** and cannot be a barrier to accessing MTP services. - **This statement is FALSE**, making it the correct answer to this negation question. *Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks* - This statement is **TRUE**; for pregnancies between **12 and 20 weeks**, the opinion of **two registered medical practitioners** is required. - For pregnancies between **20 and 24 weeks**, two registered medical practitioners are required for specific vulnerable categories of women. *>16 weeks, hysterotomy can be done* - **Hysterotomy** is a surgical procedure similar to a mini-C-section, used in specific cases for MTP, often in later gestations or when other methods are contraindicated. - While exact gestational limits vary by clinical judgment and local regulations, it is indeed a method considered for **later second-trimester terminations**, including those beyond 16 weeks, under proper medical indication. - **This statement is TRUE**. *Illegal if >20 weeks of pregnancy* - This statement was largely true under the **MTP Act of 1971**, which set the upper limit for MTP at 20 weeks. - However, the **MTP (Amendment) Act of 2021** has expanded this limit, allowing termination up to **24 weeks for specific categories of women** and in cases of substantial fetal abnormalities, there is **no upper gestational limit** for termination. - **This statement is now FALSE** as per the 2021 amendments, though it requires contextual understanding.
Question 4: Certain obligations on the part of a doctor who undertakes a postmortem examination are the following, EXCEPT:
- A. Routinely record all positive findings and important negative ones
- B. He must keep the police informed about the findings (Correct Answer)
- C. The examination should be meticulous and complete
- D. He must preserve viscera and send for toxicology examination in case of poisoning
Explanation: ***He must keep the police informed about the findings*** - This is **NOT a formal obligation** of the doctor conducting a postmortem examination. - The doctor's primary duty is to conduct a thorough, objective examination and prepare a **formal postmortem report** that is submitted to the authority who requisitioned the examination (magistrate/police as per CrPC Section 174). - While findings may eventually reach the police through the official report, there is **no obligation to informally update or keep police informed** during the examination process. - The doctor's role is that of an **independent expert witness** to the court, not an investigative assistant to the police. - Maintaining independence and objectivity requires the doctor to document findings formally rather than providing ongoing informal updates to investigating officers. *Routinely record all positive findings and important negative ones* - This IS a **fundamental obligation** for any doctor performing a postmortem examination. - Both positive findings (pathological changes, injuries) and significant negative findings (absence of expected pathology) must be documented to provide a comprehensive and accurate record. - This meticulous documentation ensures the **integrity, reliability, and legal validity** of the postmortem examination and its conclusions. *The examination should be meticulous and complete* - This IS a **professional, ethical, and legal obligation** for any doctor undertaking a postmortem examination. - A systematic and thorough examination of all body systems is essential to accurately determine the cause of death and identify all relevant findings. - Incomplete examinations can lead to **missed diagnoses and miscarriage of justice** in medico-legal cases. *He must preserve viscera and send for toxicology examination in case of poisoning* - This IS a **crucial obligation** when poisoning is suspected or cannot be ruled out based on the postmortem findings. - Relevant viscera (liver, kidney, stomach contents) and bodily fluids (blood, urine) must be preserved in appropriate containers for subsequent toxicological analysis. - This step is **essential to confirm or exclude toxicological involvement** in the death and is a standard protocol in medico-legal postmortem examinations as per established guidelines.
Question 5: Doctor or nurse disclosing the identity of a rape victim is punishable under the following section of IPC?
- A. Section 224A
- B. Section 226A
- C. Section 222A
- D. Section 228A (Correct Answer)
Explanation: ***Section 228A IPC*** - This section of the Indian Penal Code specifically deals with the **disclosure of the identity of a victim of rape and certain sexual offenses** (Sections 376, 376A, 376AB, 376B, 376C, 376D, 376DA, 376DB, 376E). - Making public the name or any matter that can reveal the identity of a rape victim by **any person, including doctors and nurses**, is a punishable offense. - **Punishment**: Imprisonment up to **2 years** and fine. - **Exception**: Disclosure is permitted only to authorized persons like police officers for investigation purposes. - **Important**: This is now covered under **Section 72 of Bharatiya Nyaya Sanhita (BNS) 2023**, which replaced the IPC. *Section 224A* - This is **not a valid or recognized provision** within the Indian Penal Code. - It does not relate to offenses concerning privacy or the identity of sexual assault victims. *Section 226A* - This is **not a valid or recognized provision** within the Indian Penal Code. - It does not pertain to the confidentiality of victims of sexual offenses. *Section 222A* - This is **not a valid or recognized provision** within the Indian Penal Code. - There is no such specific section addressing disclosure of victim identity in the IPC.
Question 6: Unreasonable conduct of a patient, combined with a doctor's negligence, contributes to:
- A. Contributory negligence (Correct Answer)
- B. Corporate negligence
- C. Civil negligence
- D. Criminal negligence
Explanation: ***Contributory negligence*** * When a patient's **unreasonable conduct** contributes to their own injury, it is termed **contributory negligence**. * This legal doctrine can **limit or bar recovery** for damages even if a doctor's negligence was also present. *Corporate negligence* * This refers to the **liability of a healthcare organization** for its own acts of negligence. * It primarily involves the hospital's duties to its patients, such as **proper credentialing of staff** or maintaining safe facilities, rather than patient conduct. *Civil negligence* * This is a broad term for negligence that results in **harm to another person**, leading to a civil lawsuit. * While a doctor's negligence falls under civil negligence, the specific scenario of a patient's unreasonable conduct contributing to harm points to the more precise term of **contributory negligence**. *Criminal negligence* * This involves a **reckless disregard for the safety of others** that goes beyond ordinary carelessness. * It is a more severe form of negligence that typically results in **criminal charges**, not just civil liability, and does not involve patient conduct as a contributing factor.
Question 7: India is a country with different cultures and diverse languages. Which steps should a physician take to address the patient for better outcomes? 1. Insist on good communication 2. Insist on communication only via an interpreter 3. Treat them regardless of their cultural perceptions 4. The physician should consider the patient's religion and cultural perception Select the correct combination:
- A. 1,4 (Correct Answer)
- B. 1,2
- C. 2,3
- D. 3,4
Explanation: ***1,4*** - **Good communication** is paramount in healthcare, especially in a diverse country like India, to ensure **patient understanding**, **adherence** to treatment plans, and overall patient satisfaction. - Considering a patient's **religion and cultural perceptions** allows the physician to tailor treatment and communication in a sensitive and **respectful manner**, fostering trust and better **health outcomes**. *1,2* - While good communication (1) is vital, **insisting solely on an interpreter** (2) may not always be feasible or necessary, particularly if the physician and patient share a common language or if the patient prefers direct communication. This can also disrupt the flow of rapport building. - **Over-reliance on interpreters** can sometimes lead to misinterpretations or loss of non-verbal cues if the interpreter is not trained in medical interpretation. *2,3* - **Insisting only on an interpreter** (2) can be restrictive and may compromise direct patient-physician rapport, as discussed above. - **Treating patients regardless of their cultural perceptions** (3) is an ethnocentric approach that can lead to mistrust, non-adherence, and ultimately **poor health outcomes** as it disregards the patient's beliefs and values regarding health and illness. *3,4* - **Treating patients regardless of their cultural perceptions** (3) can result in a lack of understanding and non-adherence if the treatment conflicts with the patient's deeply held beliefs. - While considering religion and cultural perception (4) is crucial, this option includes an incorrect approach (3) that can undermine patient care.
Question 8: A doctor is not held guilty of negligence if
- A. He has not obtained informed consent from patient
- B. He has exercised reasonable care and skill (Correct Answer)
- C. Others suffer disease from his patient
- D. He fails to give proper instructions
Explanation: ***He has exercised reasonable care and skill*** - A doctor is not held guilty of **negligence** if they have acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art (**Bolam test**). - This implies employing the **degree of care, diligence, and skill** that a reasonably competent practitioner would use under similar circumstances. *He has not obtained informed consent from patient* - Failure to obtain **informed consent** can lead to liability for **battery** (unlawful touching) or negligence, especially if the patient can prove they would not have undergone the procedure had they been properly informed of the risks. - Ethical and legal standards mandate that patients provide **voluntary, informed consent** before medical interventions. *Others suffer disease from his patient* - A doctor's primary responsibility is to their patient; however, there are situations where a **duty to warn** third parties exists, especially in cases of foreseeable harm from a communicable disease or dangerous psychiatric patient. - Failure to warn when such a **duty is established** could lead to negligence claims if specific harm to identifiable third parties occurs. *He fails to give proper instructions* - Providing **clear and adequate post-operative or post-treatment instructions** is a fundamental part of a doctor's duty of care. - Failure to give proper instructions can result in **patient harm** and can be grounds for a negligence claim if it leads to complications or a poor outcome.
Question 9: Death of a patient due to an unintentional act by a doctor, staff or hospital is
- A. Diminished liability
- B. Therapeutic privilege
- C. Vicarious liability
- D. Therapeutic misadventure (Correct Answer)
Explanation: ***Therapeutic misadventure*** - This term refers to an **unintentional or unexpected complication or death** that occurs during appropriate medical treatment, despite the absence of negligence. - It acknowledges that medical interventions carry inherent risks and that adverse outcomes can occur even when healthcare providers act reasonably and skillfully. *Diminished liability* - This concept typically arises in **criminal law**, referring to a partial defense that may reduce the degree of criminal responsibility due to mental impairment. - It does not apply to situations involving unintentional harm or death during medical treatment in the absence of negligence. *Therapeutic privilege* - This is a legal doctrine allowing a physician to **withhold information** from a patient if disclosure would likely cause significant harm to the patient. - It is unrelated to unintentional adverse outcomes or death in the context of medical treatment. *Vicarious liability* - This legal doctrine holds one party (e.g., a hospital or employer) responsible for the actions of another (e.g., a doctor or employee), especially when the latter is acting within the scope of their employment. - While a hospital might be vicariously liable for a doctor's negligence, the term itself describes the *type* of liability, not the unintentional adverse event itself.
Question 10: If faced with a surgical emergency in a child of 15 years for whom no consent is available for life-saving surgery and no time for seeking authority from someone, the next step should be :
- A. Conservative management till lawyer is available
- B. Consent arrangement through Hospital Social Worker
- C. Go ahead with surgery without consent (Correct Answer)
- D. Search for relatives or neighbours
Explanation: ***Go ahead with surgery without consent*** - In a **life-threatening emergency**, when a child's life is at stake and there is no time to obtain consent from parents or legal guardians, the **principle of implied consent** or necessity overrides the need for explicit consent. - The primary ethical and legal responsibility is to save the patient's life, and delaying surgery for consent could be considered **negligent** and harmful. *Conservative management till lawyer is available* - Delaying life-saving surgery in an emergency for legal consultation would be a breach of the **duty of care** and could result in the child's death. - The immediate priority in a surgical emergency is to provide the necessary medical intervention, not to seek legal advice on consent. *Consent arrangement through Hospital Social Worker* - While a hospital social worker can assist in locating family or arranging consent in non-emergent situations, the question specifies "no time for seeking authority from someone" and a "surgical emergency." - This option would still involve a delay that could be fatal in a life-saving scenario. *Search for relatives or neighbours* - This option directly contradicts the premise that there is "no time for seeking authority from someone" for life-saving surgery. - While efforts should be made to contact guardians, in a dire emergency, the **immediate medical intervention** takes precedence over searching for individuals who can provide consent.
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