Ethics & Law — MCQs
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A 70-year-old man with advanced prostate cancer metastatic to bone is receiving palliative care on the ward. He is in severe pain despite regular morphine. The palliative care team recommends commencing a syringe driver with increased doses of morphine and adding midazolam for anxiety. His daughter takes you aside and says 'You're not going to kill my father are you? I've heard about these pumps - they finish people off'. What is the most appropriate response?
A 38-year-old pregnant woman at 34 weeks gestation with severe pre-eclampsia is advised she needs emergency caesarean section to prevent serious harm to herself and the fetus. She has capacity but refuses the procedure on religious grounds, stating that 'God will protect me and my baby'. The obstetric team believes there is significant risk of maternal death and fetal demise without intervention. What is the legally correct course of action?
A 66-year-old man is admitted to the intensive care unit following a large intracerebral hemorrhage. After 72 hours, brainstem death testing is performed by two senior doctors and confirms brainstem death. His wife asks what will happen next. He was not on the organ donor register and had not discussed his wishes. What is the legally correct position regarding organ donation?
A 15-year-old boy with a known history of chronic fatigue syndrome presents to the emergency department with abdominal pain. Clinical examination and investigations suggest appendicitis requiring surgical intervention. He has capacity and consents to the appendicectomy. However, his parents refuse consent stating they do not believe in surgical interventions and wish to manage the problem with homeopathy. What is the most appropriate course of action?
A 51-year-old woman with metastatic lung cancer is receiving end-of-life care at home. She has been prescribed subcutaneous morphine for pain and midazolam for agitation as needed. Over the past 24 hours, she has become increasingly distressed and agitated despite regular medications. Her husband calls you urgently saying she is trying to pull out her syringe driver and is very frightened. She is now unable to communicate coherently. What is the most appropriate management?
Which of the following scenarios would meet the criteria for emergency treatment under Section 62 of the Mental Health Act 1983?
A 42-year-old woman is admitted following a serious suicide attempt by hanging. She suffered a hypoxic brain injury and remains in a minimally conscious state after 8 weeks. She has no advance decision and no Lasting Power of Attorney. Her husband believes she would not want to continue in this state and requests withdrawal of clinically assisted nutrition and hydration. Her parents disagree. What is the legally required course of action?
A 79-year-old man with end-stage heart failure is dying on the ward. He has capacity and requests that active measures be taken to end his life as he cannot bear his breathlessness any longer. He says 'Please just give me something to finish this - I've had enough'. What is the most appropriate response?
A 34-year-old woman with a history of chronic pain syndrome and previous self-harm presents to the emergency department requesting diamorphine for pain. She becomes verbally aggressive when told she cannot have opiates, then superficially cuts her forearm with a piece of glass. She refuses assessment and attempts to leave. What is the most appropriate immediate action?
A 62-year-old man with motor neurone disease has made a written advance decision to refuse artificial ventilation if he develops respiratory failure. He is admitted with pneumonia and worsening respiratory function. His saturation is 88% on high-flow oxygen and arterial blood gas shows type 2 respiratory failure with pH 7.28. He is drowsy but can communicate. He tells you 'I'm struggling, do whatever you need to help me breathe'. What is the most appropriate action?
Ethics & Law UK Medical PG Practice Questions and MCQs
Question 111: A 70-year-old man with advanced prostate cancer metastatic to bone is receiving palliative care on the ward. He is in severe pain despite regular morphine. The palliative care team recommends commencing a syringe driver with increased doses of morphine and adding midazolam for anxiety. His daughter takes you aside and says 'You're not going to kill my father are you? I've heard about these pumps - they finish people off'. What is the most appropriate response?
- A. Explain that the intention is symptom control and that you will use the minimum doses necessary to relieve his suffering (Correct Answer)
- B. Reassure her that you would never do anything to harm her father and will not proceed with the syringe driver
- C. Explain that her father is dying and the medications will make him comfortable in his final hours
- D. Tell her that the palliative care team are experts and she should trust their judgment
- E. Explain that the law permits you to hasten death if it relieves suffering
Explanation: ***Explain that the intention is symptom control and that you will use the minimum doses necessary to relieve his suffering*** - This response relies on the **principle of double effect**, where the primary intention is to provide **analgesia** and relieve suffering, not to hasten death. - It addresses the daughter's fears by emphasizing **proportionality** and careful **titration** of medication to the patient's specific clinical needs. *Reassure her that you would never do anything to harm her father and will not proceed with the syringe driver* - Refusing to provide the recommended treatment would leave the patient in **severe, uncontrolled pain**, which is a failure of the **duty of care**. - Withholding necessary **palliative care** based on a misconception does not serve the patient's best interest or follow specialist advice. *Explain that her father is dying and the medications will make him comfortable in his final hours* - While honest about the prognosis, this statement does not directly address the daughter's specific fear that the **medication itself** is the cause of death. - It may inadvertently confirm her suspicion that the "pump" is being used to end his life rather than simply manage his **symptoms**. *Tell her that the palliative care team are experts and she should trust their judgment* - This is a **paternalistic approach** that dismisses the family's concerns and fails to build a **therapeutic relationship** through communication. - Appealing to authority does nothing to educate the daughter or alleviate her distress regarding the **syringe driver**. *Explain that the law permits you to hasten death if it relieves suffering* - **Euthanasia** and the deliberate hastening of death remain illegal; the law only protects the treatment of symptoms where death is a **foreseeable but unintended** side effect. - This phrasing is legally inaccurate and would likely increase the daughter's anxiety by suggesting the team intends to **terminate life**.
Question 112: A 38-year-old pregnant woman at 34 weeks gestation with severe pre-eclampsia is advised she needs emergency caesarean section to prevent serious harm to herself and the fetus. She has capacity but refuses the procedure on religious grounds, stating that 'God will protect me and my baby'. The obstetric team believes there is significant risk of maternal death and fetal demise without intervention. What is the legally correct course of action?
- A. Perform the caesarean section under general anaesthetic as it is necessary to save lives
- B. Seek an urgent Court order to authorize the caesarean section
- C. Accept her refusal and document it clearly, providing supportive care only (Correct Answer)
- D. Detain her under the Mental Health Act to allow treatment
- E. Wait until she loses capacity from eclampsia then proceed in her best interests
Explanation: ***Accept her refusal and document it clearly, providing supportive care only***- A pregnant woman with **mental capacity** has the absolute legal right to refuse medical treatment, even if that decision results in her death or the death of the **fetus**.- Under established case law (e.g., **St George's Healthcare NHS Trust v S**), the fetus does not have a separate legal personality or rights that override the mother's **autonomy**.*Perform the caesarean section under general anaesthetic as it is necessary to save lives*- Proceeding without consent from a capacitous patient constitutes **battery** and a violation of the patient's **human rights**.- The principle of **beneficence** (doing good) cannot override the fundamental principle of **autonomy** when a patient is competent.*Seek an urgent Court order to authorize the caesarean section*- The Court cannot legally override a refusal of treatment made by a person who has been assessed to have full **mental capacity**.- Courts will only intervene if there is a doubt about the patient’s **capacity** or if the patient is unable to communicate their wishes.*Detain her under the Mental Health Act to allow treatment*- The **Mental Health Act** is used for the treatment of mental disorders and cannot be used to override a capacitous refusal of physical medical treatment.- Disagreeing with medical advice on **religious grounds** does not constitute evidence of a mental disorder or a lack of capacity.*Wait until she loses capacity from eclampsia then proceed in her best interests*- It is legally and ethically impermissible to wait for a patient to lose capacity specifically to override a **previously expressed capacitous refusal**.- A clear, competent refusal of a specific intervention remains **legally binding** even after the patient subsequently loses the ability to make decisions.
Question 113: A 66-year-old man is admitted to the intensive care unit following a large intracerebral hemorrhage. After 72 hours, brainstem death testing is performed by two senior doctors and confirms brainstem death. His wife asks what will happen next. He was not on the organ donor register and had not discussed his wishes. What is the legally correct position regarding organ donation?
- A. Organs can be retrieved as brainstem death means he is legally dead and family consent is not required
- B. The wife must give consent for organ donation to proceed as she has parental responsibility
- C. Approach the family sensitively to explore the patient's likely wishes regarding donation and seek their agreement (Correct Answer)
- D. Apply to the Court of Protection for authorization to retrieve organs
- E. Wait 24 hours to see if the family raises the subject of donation themselves
Explanation: ***Approach the family sensitively to explore the patient's likely wishes regarding donation and seek their agreement*** - In the UK, even with **deemed consent** (opt-out), the family is consulted to determine if the patient had expressed a decision not to donate; their agreement is sought to maintain **public trust** and respect for the deceased. - The **Human Tissue Act 2004** emphasizes that the patient’s wishes are paramount, but healthcare professionals work with those in a **qualifying relationship** (like a spouse) to authorize the process. *Organs can be retrieved as brainstem death means he is legally dead and family consent is not required* - While **brainstem death** is the legal definition of death, it does not provide automatic legal authorization for organ retrieval without checking for the patient's **prior consent** or family views. - Proceeding without any family discussion or checking the register violates ethical guidelines and the **Human Tissue Act** framework. *The wife must give consent for organ donation to proceed as she has parental responsibility* - **Parental responsibility** is a legal concept specific to children under 18 and does not apply to a relationship between a husband and wife. - The wife acts as the **highest-ranking person** in a qualifying relationship, but her role is to represent the patient's views rather than exercise parental-style authority. *Apply to the Court of Protection for authorization to retrieve organs* - The **Court of Protection** makes decisions for living individuals who lack **mental capacity**; its jurisdiction ends upon the death of the individual. - Decisions regarding deceased donation are governed by the **Human Tissue Authority (HTA)** guidelines and relevant national tissue acts, not court orders. *Wait 24 hours to see if the family raises the subject of donation themselves* - Delaying the discussion can lead to **hemodynamic instability** in the donor, potentially making organs unviable for transplant. - It is the responsibility of the clinical team and the **Specialist Nurse for Organ Donation (SNOD)** to initiate timely, sensitive conversations rather than waiting for grieving families to broach the topic.
Question 114: A 15-year-old boy with a known history of chronic fatigue syndrome presents to the emergency department with abdominal pain. Clinical examination and investigations suggest appendicitis requiring surgical intervention. He has capacity and consents to the appendicectomy. However, his parents refuse consent stating they do not believe in surgical interventions and wish to manage the problem with homeopathy. What is the most appropriate course of action?
- A. Proceed with surgery based on the child's consent as he is Gillick competent
- B. Accept the parents' refusal as they have parental responsibility
- C. Seek an urgent Court order to authorize surgery
- D. Wait 24 hours to see if the parents change their mind
- E. Proceed with surgery under common law in the child's best interests despite parental refusal (Correct Answer)
Explanation: ***Proceed with surgery under common law in the child's best interests despite parental refusal*** - In an **emergency situation** where a minor faces serious harm or death, clinicans can proceed with treatment in the **best interests** of the child under **common law**. - Although parental refusal is generally respected, it cannot override the **duty of care** to prevent life-threatening complications like **appendiceal perforation** or peritonitis. *Proceed with surgery based on the child's consent as he is Gillick competent* - While **Gillick competence** allows a child under 16 to consent to treatment, it is legally complex and may be challenged if parents actively refuse vital care. - Relying solely on the child's consent is less legally robust in an acute emergency than the **best interests** principle which overrides parental refusal. *Accept the parents' refusal as they have parental responsibility* - **Parental responsibility** does not grant parents an absolute right to refuse life-saving or essential medical treatment for their children. - The **Children Act 1989** establishes that the child’s welfare is the **paramount consideration**, and clinicians must intervene if parental decisions place the child at risk. *Seek an urgent Court order to authorize surgery* - Seeking a **Court order** is the preferred route for elective or non-emergency disputes, but it is not necessary in a **surgical emergency**. - The delay involved in legal proceedings could lead to **clinical deterioration**, making immediate action under common law appropriate. *Wait 24 hours to see if the parents change their mind* - **Appendicitis** is a time-sensitive condition where a 24-hour delay significantly increases the risk of **rupture** and systemic sepsis. - Clinical judgment and the **safety of the patient** must take precedence over attempts to achieve parental consensus in an acute setting.
Question 115: A 51-year-old woman with metastatic lung cancer is receiving end-of-life care at home. She has been prescribed subcutaneous morphine for pain and midazolam for agitation as needed. Over the past 24 hours, she has become increasingly distressed and agitated despite regular medications. Her husband calls you urgently saying she is trying to pull out her syringe driver and is very frightened. She is now unable to communicate coherently. What is the most appropriate management?
- A. Arrange emergency admission to hospital for specialist palliative care assessment
- B. Increase the subcutaneous midazolam dose and add levomepromazine for terminal agitation (Correct Answer)
- C. Commence a subcutaneous infusion of high-dose morphine and midazolam to achieve rapid sedation
- D. Advise the husband to restrain her gently until the agitation settles
- E. Stop all medications as they may be contributing to her confusion and agitation
Explanation: ***Increase the subcutaneous midazolam dose and add levomepromazine for terminal agitation*** - The patient is experiencing severe **terminal agitation** or **delirium**, which requires prompt and effective pharmacological management. Increasing **midazolam**, a benzodiazepine, helps reduce anxiety and agitation. - Adding an antipsychotic like **levomepromazine** is crucial in refractory cases to provide synergistic sedation and anti-delirium effects, ensuring comfort and allowing the patient to remain in their preferred place of care (home).*Arrange emergency admission to hospital for specialist palliative care assessment* - The primary aim in home-based end-of-life care is to manage symptoms effectively at home, respecting the patient's preference for their familiar environment. - Emergency hospital admission for a patient with **terminal delirium** can exacerbate distress, disorientation, and agitation, and should generally be avoided unless home management is genuinely impossible or unsafe.*Commence a subcutaneous infusion of high-dose morphine and midazolam to achieve rapid sedation* - While midazolam is appropriate, using
Question 116: Which of the following scenarios would meet the criteria for emergency treatment under Section 62 of the Mental Health Act 1983?
- A. A detained patient with schizophrenia refusing antipsychotic medication that has been prescribed for 6 weeks
- B. A detained patient requiring immediate electroconvulsive therapy to save their life (Correct Answer)
- C. A detained patient requiring depot antipsychotic medication for the first time
- D. A detained patient requiring treatment for a physical health condition unrelated to mental disorder
- E. A detained patient requiring psychological therapy for their mental disorder
Explanation: ***A detained patient requiring immediate electroconvulsive therapy to save their life***- **Section 62** of the Mental Health Act allows for **urgent treatment** that is immediately necessary to **save the patient's life** or prevent a serious deterioration of their condition.- While **ECT** usually requires specific safeguards under Section 58A, these are bypassed in **emergencies** where the treatment is vital and the delay of a second opinion would be life-threatening.*A detained patient with schizophrenia refusing antipsychotic medication that has been prescribed for 6 weeks*- Medication for mental disorders can generally be given without consent for up to **three months** under Section 58 before a **Second Opinion Appointed Doctor (SOAD)** is required.- Refusal at 6 weeks does not constitute an **emergency** under Section 62 unless there is an **immediate necessity** to prevent serious harm or suffering.*A detained patient requiring depot antipsychotic medication for the first time*- Routine administration of **depot antipsychotics** falls under standard treatment provisions of the Act and does not meet the **urgent criteria** of Section 62.- Section 62 is reserved for **crisis situations** rather than the initiation of standard maintenance therapy or changing medication routes.*A detained patient requiring treatment for a physical health condition unrelated to mental disorder*- The **Mental Health Act** specifically governs treatment for **mental disorders**; physical health issues are typically managed under the **Mental Capacity Act** if the patient lacks capacity.- Section 62 cannot be used to bypass consent for **non-psychiatric** medical procedures that are unrelated to the patient's mental health diagnosis.*A detained patient requiring psychological therapy for their mental disorder*- **Psychological therapies** are rarely considered "immediately necessary" in the life-saving context defined by Section 62.- Emergency provisions are designed for **medical interventions** like medication or ECT where immediate biological stabilization is required to prevent **dangerous behavior** or death.
Question 117: A 42-year-old woman is admitted following a serious suicide attempt by hanging. She suffered a hypoxic brain injury and remains in a minimally conscious state after 8 weeks. She has no advance decision and no Lasting Power of Attorney. Her husband believes she would not want to continue in this state and requests withdrawal of clinically assisted nutrition and hydration. Her parents disagree. What is the legally required course of action?
- A. Follow the husband's wishes as he is the next of kin
- B. Continue treatment as there is family disagreement
- C. Make a best interests decision with the multidisciplinary team without court involvement
- D. Apply to the Court of Protection as withdrawal of clinically assisted nutrition and hydration requires court approval in cases of prolonged disorder of consciousness (Correct Answer)
- E. Arrange a best interests meeting and follow the majority family view
Explanation: ***Apply to the Court of Protection as withdrawal of clinically assisted nutrition and hydration requires court approval in cases of prolonged disorder of consciousness***- In the UK, specifically for patients in a **prolonged disorder of consciousness** where there is **disagreement** among family members regarding the patient’s **best interests** and withdrawal of life-sustaining treatment, an application to the **Court of Protection** is legally required.- This legal process ensures that decisions about withdrawing **Clinically Assisted Nutrition and Hydration (CANH)**, which is considered life-sustaining treatment, are made with the highest level of scrutiny and protection for the patient's **fundamental rights** under the **Mental Capacity Act 2005**.*Follow the husband's wishes as he is the next of kin*- Under the **Mental Capacity Act 2005**, the designation of **'next of kin'** does not confer any legal authority to consent to or refuse medical treatment for an adult who lacks capacity.- The husband's views are crucial for determining the patient's **past wishes and feelings**, but without an **advance decision** or a **Lasting Power of Attorney (LPA)**, his request is not legally binding when there is family disagreement.*Continue treatment as there is family disagreement*- While family disagreement highlights complexity, simply continuing treatment indefinitely without resolution does not meet the legal duty to act in the patient's **best interests**.- In cases of dispute over **life-sustaining treatment**, clinicians have a duty to seek a legal determination rather than defaulting to the current treatment, which could be challenged as a failure to act in the patient's best interests.*Make a best interests decision with the multidisciplinary team without court involvement*- The **multidisciplinary team (MDT)** is responsible for conducting a thorough **best interests assessment**, considering all relevant factors, but in cases of **prolonged disorder of consciousness** where there is an irresolvable family dispute, court involvement is mandatory.- Proceeding without court approval in a contested case of **CANH withdrawal** for a patient in a **prolonged disorder of consciousness** would expose all parties to significant legal and ethical risks.*Arrange a best interests meeting and follow the majority family view*- **Best interests decisions** are not determined by a simple majority vote among family members, but by a comprehensive assessment of what is best for the patient, including their known wishes, values, and clinical prognosis.- A **best interests meeting** is an important step to gather views, but if significant disagreement persists among those close to the patient regarding **life-sustaining treatment**, particularly **CANH**, the matter must be referred to the **Court of Protection**.
Question 118: A 79-year-old man with end-stage heart failure is dying on the ward. He has capacity and requests that active measures be taken to end his life as he cannot bear his breathlessness any longer. He says 'Please just give me something to finish this - I've had enough'. What is the most appropriate response?
- A. Explain that you cannot actively end his life but will ensure optimal symptom control (Correct Answer)
- B. Arrange urgent psychiatric assessment as he is expressing suicidal ideation
- C. Commence a subcutaneous infusion of high-dose morphine and midazolam with the intention of hastening death
- D. Explain that euthanasia is permitted if the patient has capacity and makes a persistent request
- E. Document his request and inform him the decision will be made by the consultant
Explanation: ***Explain that you cannot actively end his life but will ensure optimal symptom control*** - In the UK, **euthanasia** and **assisted suicide** are illegal; a doctor must act within the law regardless of a patient's capacity or request. - The appropriate ethical and clinical response is to prioritize **palliative care** and **symptom management** to address the patient's breathlessness and distress. *Arrange urgent psychiatric assessment as he is expressing suicidal ideation* - A request to hasten death in a terminally ill patient is often a response to **unmanaged physical suffering** rather than a primary psychiatric disorder. - While psychological support is vital, an urgent referral for **suicidal ideation** is inappropriate when the patient lacks intent to self-harm outside of his clinical condition. *Commence a subcutaneous infusion of high-dose morphine and midazolam with the intention of hastening death* - Administering medication with the specific **intent to hasten death** is legally considered murder or manslaughter in the UK. - Under the **doctrine of double effect**, clinicians may provide treatment to relieve pain even if death is a foreseeable but unintended secondary consequence. *Explain that euthanasia is permitted if the patient has capacity and makes a persistent request* - This statement is factually incorrect; **active euthanasia** is not permitted under current UK law, even with capacity and persistent requests. - Providing such information would be misleading and violates the **legal and ethical standards** of medical practice. *Document his request and inform him the decision will be made by the consultant* - The decision to end a life is not a matter of **clinical discretion** for a consultant; it remains an illegal act for any medical professional. - This response avoids giving the patient an honest explanation of the **legal limitations** and fails to address his immediate symptoms.
Question 119: A 34-year-old woman with a history of chronic pain syndrome and previous self-harm presents to the emergency department requesting diamorphine for pain. She becomes verbally aggressive when told she cannot have opiates, then superficially cuts her forearm with a piece of glass. She refuses assessment and attempts to leave. What is the most appropriate immediate action?
- A. Allow her to leave as she has capacity to refuse assessment (Correct Answer)
- B. Detain her under Section 5(2) of the Mental Health Act for psychiatric assessment
- C. Restrain her and treat the laceration under common law doctrine of necessity
- D. Call security to prevent her leaving until she has been assessed by the psychiatric team
- E. Detain her under Section 136 of the Mental Health Act as she is a danger to herself
Explanation: ***Allow her to leave as she has capacity to refuse assessment*** - A patient is presumed to have **capacity** unless proven otherwise; self-harm or making an unwise decision does not automatically mean a patient lacks the ability to **understand, retain, and weigh** information. - Under the **Mental Capacity Act 2005**, a person with capacity has the legal right to refuse treatment or leave the hospital, even if their choice may result in harm. *Detain her under Section 5(2) of the Mental Health Act for psychiatric assessment* - **Section 5(2)** is a holding power that can only be applied to **inpatients** already admitted to a hospital ward; it cannot be used on patients in the **Emergency Department** (ED). - The ED is legally considered a public place/outpatient setting, making this specific section of the **Mental Health Act** inapplicable in this scenario. *Restrain her and treat the laceration under common law doctrine of necessity* - The **doctrine of necessity** allows for treatment only when a patient **lacks capacity** and the treatment is in their **best interests** to prevent serious harm. - Restraining a patient with capacity involves a risk of **assault and battery** charges, as her refusal must be respected regardless of the medical urgency of the superficial wound. *Call security to prevent her leaving until she has been assessed by the psychiatric team* - Preventing a patient with capacity from leaving constitutes **false imprisonment** and is a violation of their civil liberties. - Security should only be used to **de-escalate** violence or restrain a patient if there is an immediate, demonstrable lack of capacity or a specific legal detention in place. *Detain her under Section 136 of the Mental Health Act as she is a danger to herself* - **Section 136** can only be exercised by a **police officer**, not by medical or nursing staff, to remove someone from a public place to a place of safety. - While hospitals were previously excluded, current legislation allows its use in EDs, but only by the **police** and not as a justification for doctors to prevent a person with capacity from leaving.
Question 120: A 62-year-old man with motor neurone disease has made a written advance decision to refuse artificial ventilation if he develops respiratory failure. He is admitted with pneumonia and worsening respiratory function. His saturation is 88% on high-flow oxygen and arterial blood gas shows type 2 respiratory failure with pH 7.28. He is drowsy but can communicate. He tells you 'I'm struggling, do whatever you need to help me breathe'. What is the most appropriate action?
- A. Proceed with non-invasive ventilation as the patient is currently requesting treatment despite the advance decision (Correct Answer)
- B. Refuse ventilation as the advance decision is legally binding and cannot be overridden
- C. Contact the next of kin to decide whether to follow the advance decision
- D. Apply to the Court of Protection for an urgent decision
- E. Sedate the patient to relieve distress and allow natural death as per the advance decision
Explanation: ***Proceed with non-invasive ventilation as the patient is currently requesting treatment despite the advance decision***- An **Advance Decision to Refuse Treatment (ADRT)** is only legally binding if the patient **lacks capacity** to make the decision at the time treatment is needed.- Since the patient is **drowsy but can communicate** and explicitly states "do whatever you need to help me breathe", he is currently demonstrating **capacity** and expressing a **contemporaneous wish** for treatment, which overrides his previous advance decision.*Refuse ventilation as the advance decision is legally binding and cannot be overridden*- While a valid **ADRT** is legally binding when a patient **lacks capacity**, it can be **overridden or withdrawn** if the patient regains or retains capacity and expresses a different wish.- The patient's verbal request for help constitutes a **withdrawal** of his previous advance decision, provided he has the present **capacity** to make this new decision.*Contact the next of kin to decide whether to follow the advance decision*- The **next of kin** does not have the legal authority to make medical decisions on behalf of a patient who has **capacity** in the UK, nor to override a patient's own valid advance decision.- Clinical decisions are based on the patient's **current capacity** and wishes, or their **best interests** if they lack capacity, rather than relative preference.*Apply to the Court of Protection for an urgent decision*- Recourse to the **Court of Protection** is typically reserved for complex cases where there is significant doubt or dispute regarding the validity of an ADRT or the patient's capacity.- In an acute setting where a communicating patient is clearly requesting life-saving treatment, waiting for a court order is **clinically inappropriate** and unnecessary.*Sedate the patient to relieve distress and allow natural death as per the advance decision*- This action would ignore the patient's **current, expressed desire** for life-sustaining treatment, potentially leading to an unlawful death.- Providing **palliative sedation** instead of requested respiratory support directly contradicts the principle of **patient autonomy** when the patient is actively seeking intervention and appears to have capacity.
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