Ethics & Law — MCQs
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A 33-year-old woman with severe learning disability (IQ 38) attends for routine cervical screening. She lives independently with support workers and manages her own finances. During the consultation, she becomes distressed and refuses the procedure. Her mother, who accompanies her, insists the screening must be performed and attempts to persuade her daughter to comply. The patient continues to refuse. What is the most appropriate immediate action?
A 62-year-old woman with motor neurone disease is receiving palliative care at home. She tells you she is 'ready to go' and asks you to prescribe her 'enough medication to end things when I choose'. She has full capacity and has researched lethal doses online. How should you respond?
A 77-year-old woman with advanced dementia (MMSE 11/30) is admitted from a nursing home with a perforated bowel requiring emergency surgery. She has no advance decision and no lasting power of attorney. She is assessed as lacking capacity for the surgical decision. Her three children disagree: two want surgery, one believes 'she would not have wanted this'. What is the appropriate legal framework for decision-making?
A 54-year-old man with locked-in syndrome following a brainstem stroke communicates by blinking. Over several weeks, he consistently indicates he wants all life-sustaining treatment withdrawn including his feeding tube. Capacity assessment confirms he can understand and communicate his wishes. His family strongly objects. What is the legal position regarding withdrawing treatment?
A 69-year-old man with metastatic lung cancer is receiving end-of-life care at home. He has capacity and has stated he wants to die at home. He develops severe pain and agitation requiring subcutaneous medications. His wife calls requesting admission because 'she cannot cope'. What is the most appropriate initial action?
A 32-year-old woman with severe anorexia nervosa (BMI 13.2 kg/m²) is admitted with bradycardia, hypotension, and hypoglycaemia. She has capacity and refuses all treatment including intravenous fluids, stating 'I want to die'. She is not detained under the Mental Health Act. What is the legal status of treating her against her wishes?
A 81-year-old woman with end-stage heart failure is dying in hospital. She has capacity and has requested no further active treatment. Her family asks you to tell her she is 'getting better' and not to inform her that she is dying because 'it would destroy her hope'. What is the most appropriate response?
A 16-year-old girl attends the emergency department alone requesting emergency hormonal contraception following unprotected intercourse 36 hours ago. She is anxious that her parents do not find out. During Fraser guideline assessment, what additional factor must be specifically considered beyond her capacity to consent?
A 74-year-old man with metastatic prostate cancer and bone metastases is deteriorating. He has capacity and requests that 'when the time comes, you help me die peacefully'. He asks about doses of morphine. The consultant discusses increasing analgesia for pain control, which may have the effect of shortening life. What ethical principle permits this action?
A 46-year-old man with advanced motor neurone disease has made a written, witnessed advance decision stating he does not want non-invasive ventilation (NIV) when he develops respiratory failure. He now presents with type 2 respiratory failure and is drowsy with CO2 retention. His wife states he has recently been more positive and she believes he has changed his mind about NIV. What is the most appropriate action?
Ethics & Law UK Medical PG Practice Questions and MCQs
Question 51: A 33-year-old woman with severe learning disability (IQ 38) attends for routine cervical screening. She lives independently with support workers and manages her own finances. During the consultation, she becomes distressed and refuses the procedure. Her mother, who accompanies her, insists the screening must be performed and attempts to persuade her daughter to comply. The patient continues to refuse. What is the most appropriate immediate action?
- A. Proceed with screening as the mother has consented on her behalf
- B. Respect the patient's refusal and document the decision (Correct Answer)
- C. Sedate the patient to perform the screening as it is in her best interests
- D. Arrange a best interests meeting with the multidisciplinary team before making any decision
- E. Apply for a Lasting Power of Attorney for health decisions
Explanation: ***Respect the patient's refusal and document the decision*** - Every adult is presumed to have the **capacity** to make their own decisions unless proven otherwise; the fact that she manages her finances suggests she likely has capacity for this decision. - A **capacitous refusal** must be respected even if it appears unwise, and medical procedures like cervical screening cannot be forced upon a patient who explicitly refuses. *Proceed with screening as the mother has consented on her behalf* - In the UK and many other jurisdictions, **parents cannot consent** on behalf of their adult children, regardless of the child's level of learning disability. - Proceeding without the patient's valid consent would constitute **assault** or battery, especially when the patient is actively distressed and refusing. *Sedate the patient to perform the screening as it is in her best interests* - **Sedation** for a non-urgent, elective screening procedure against a patient's clear refusal is unethical and a disproportionate use of restraint. - Best interests decisions are only considered if a patient **lacks capacity**, but they must still be the least restrictive option and balanced against the patient's distress. *Arrange a best interests meeting with the multidisciplinary team before making any decision* - A **best interests meeting** is a secondary step used only after a formal assessment has proven the patient **lacks capacity** to make that specific decision. - For a routine, non-emergency screening, the immediate priority is to stop the procedure when the patient becomes **distressed** and communicates a refusal. *Apply for a Lasting Power of Attorney for health decisions* - A **Lasting Power of Attorney (LPA)** must be appointed by the individual themselves while they still have the **mental capacity** to do so; it cannot be applied for by others once capacity is lost. - Even if an LPA were in place, the attorney must act in the patient's best interests and generally cannot override a **contemporaneous capacitous refusal**.
Question 52: A 62-year-old woman with motor neurone disease is receiving palliative care at home. She tells you she is 'ready to go' and asks you to prescribe her 'enough medication to end things when I choose'. She has full capacity and has researched lethal doses online. How should you respond?
- A. Prescribe anticipatory medications for symptom control but explain you cannot prescribe with the intention of assisted suicide (Correct Answer)
- B. Refer her to a psychiatrist to assess for depression before any further discussions
- C. Provide information about Dignitas and other overseas assisted dying organizations
- D. Prescribe increased doses of morphine and leave dosing decisions to the patient
- E. Decline to prescribe any further medications to avoid being complicit in suicide
Explanation: ***Prescribe anticipatory medications for symptom control but explain you cannot prescribe with the intention of assisted suicide*** - In the UK, the **Suicide Act 1961** makes it a criminal offense to encourage or assist suicide; doctors must not prescribe specifically to facilitate a patient ending their life. - The correct approach is to provide **anticipatory medications** intended for **symptom relief** (e.g., pain or breathlessness) while clearly communicating legal boundaries and exploring the patient's underlying fears. *Refer her to a psychiatrist to assess for depression before any further discussions* - While it is important to screen for manageable mental health issues, the patient is stated to have **full capacity**, and expressing a desire to die in terminal illness does not automatically imply a psychiatric disorder. - Delaying clinical and ethical discussions solely for a **psychiatric referral** may damage the doctor-patient relationship and neglect immediate palliative needs. *Provide information about Dignitas and other overseas assisted dying organizations* - Proactively providing information or facilitating a referral to **assisted dying organizations** can be legally interpreted as **encouraging or assisting suicide**. - Doctors should maintain a neutral stance and are generally advised to avoid providing specific details that help a patient access such services to remain compliant with the law. *Prescribe increased doses of morphine and leave dosing decisions to the patient* - Prescribing **lethal quantities** of medication with the knowledge that the patient intends to use them for suicide constitutes **assisted suicide**. - Good medical practice requires medications to be prescribed for a specific **clinical indication** with clear dosing instructions, rather than leaving the patient to determine a lethal dose. *Decline to prescribe any further medications to avoid being complicit in suicide* - Refusing all further medication would be a denial of appropriate **palliative care** and **symptom management** for a patient with a terminal illness. - Doctors have a duty to alleviate suffering and provide **comfort care**, even while adhering to legal prohibitions against actively assisting suicide.
Question 53: A 77-year-old woman with advanced dementia (MMSE 11/30) is admitted from a nursing home with a perforated bowel requiring emergency surgery. She has no advance decision and no lasting power of attorney. She is assessed as lacking capacity for the surgical decision. Her three children disagree: two want surgery, one believes 'she would not have wanted this'. What is the appropriate legal framework for decision-making?
- A. The majority view of the children should determine the decision as next of kin
- B. A best interests decision should be made by the clinical team considering all relevant factors (Correct Answer)
- C. The Court of Protection must make the decision due to family disagreement
- D. Surgery should proceed as it is life-saving treatment
- E. An Independent Mental Capacity Advocate (IMCA) must be appointed to decide
Explanation: ***A best interests decision should be made by the clinical team considering all relevant factors*** - Under the **Mental Capacity Act 2005 (MCA)**, when a patient lacks capacity and has no **Lasting Power of Attorney** or **Advance Decision**, the lead clinician acts as the decision-maker. - Decisions must be made in the patient's **best interests**, which includes consulting family to determine the patient's **past wishes, values, and beliefs** as well as medical prognosis. *The majority view of the children should determine the decision as next of kin* - The term **'next of kin'** confers no legal authority under UK law to grant or withhold consent for medical treatment. - Family members are **statutory consultees** whose role is to provide insight into the patient's perspective, not to provide a majority vote or make the decision themselves. *The Court of Protection must make the decision due to family disagreement* - Disagreement between family members does not automatically require the **Court of Protection**; the clinical team should first attempt to build a consensus through discussion and careful consideration of all views. - Court involvement is generally reserved for cases where there is an **unresolvable dispute** between the clinical team and the family, or when significant ethical dilemmas cannot be resolved at a local level. *Surgery should proceed as it is life-saving treatment* - While the life-saving nature of the surgery is a critical **clinical factor**, it is not the sole determinant of a **best interests** decision under the MCA. - The decision must also weigh the patient’s **quality of life**, the potential burden and risks of the treatment, and whether the patient would have viewed such an intervention as acceptable, based on their known values and wishes. *An Independent Mental Capacity Advocate (IMCA) must be appointed to decide* - An **IMCA** is only legally required for serious medical treatment decisions if the patient is **'unbefriended'**, meaning they have no family or friends to consult; this patient has three children. - Even when involved, an IMCA does not make the decision but provides **advocacy and representation** to ensure the patient's interests are protected and relevant factors are considered.
Question 54: A 54-year-old man with locked-in syndrome following a brainstem stroke communicates by blinking. Over several weeks, he consistently indicates he wants all life-sustaining treatment withdrawn including his feeding tube. Capacity assessment confirms he can understand and communicate his wishes. His family strongly objects. What is the legal position regarding withdrawing treatment?
- A. Treatment must continue as withdrawal would constitute assisted suicide
- B. The Court of Protection must decide as this involves withdrawal of life-sustaining treatment
- C. His refusal must be respected and treatment can be withdrawn (Correct Answer)
- D. A best interests decision should be made involving the family
- E. Treatment must continue as locked-in syndrome may improve with time
Explanation: ***His refusal must be respected and treatment can be withdrawn*** - A **capacitous adult** has an absolute legal and ethical right to refuse any medical treatment, including **life-sustaining measures** like a feeding tube, even if that refusal leads to death. - Since the patient has been assessed to have **mental capacity**, his autonomous decision overrides the objections of his family and the clinical opinions of the medical team. *Treatment must continue as withdrawal would constitute assisted suicide* - Legally, the withdrawal of treatment at the request of a capacitous patient is defined as **allowing a natural death** or respecting a refusal, not **assisted suicide**. - Assisted suicide involves an active intervention to end life, whereas this scenario concerns the right to **bodily integrity** and the right to refuse medical intrusion. *The Court of Protection must decide as this involves withdrawal of life-sustaining treatment* - The **Court of Protection** is primarily involved when there is a dispute or doubt regarding a patient's **mental capacity** to make a decision. - Because capacity has already been confirmed in this patient, the court has no jurisdiction to override his **competent refusal** of treatment. *A best interests decision should be made involving the family* - A **best interests** assessment is only applicable under the **Mental Capacity Act** when a patient lacks the capacity to make their own decisions. - When a patient has capacity, their **autonomous choice** is the sole deciding factor, and the family's wishes carry no legal weight in overriding that choice. *Treatment must continue as locked-in syndrome may improve with time* - The clinical prognosis or potential for **functional improvement** does not negate the right of a capacitous individual to refuse treatment. - Respect for **patient autonomy** applies regardless of whether the medical team believes the patient's decision is unwise or if the condition might change.
Question 55: A 69-year-old man with metastatic lung cancer is receiving end-of-life care at home. He has capacity and has stated he wants to die at home. He develops severe pain and agitation requiring subcutaneous medications. His wife calls requesting admission because 'she cannot cope'. What is the most appropriate initial action?
- A. Arrange immediate hospital admission as the family can no longer manage at home
- B. Explore the wife's specific concerns and what additional support might enable home care to continue (Correct Answer)
- C. Explain that the patient's wish to die at home must take priority over the wife's concerns
- D. Increase the patient's sedative medications to reduce the burden on the wife
- E. Inform the patient he needs hospital admission as home care is no longer feasible
Explanation: ***Explore the wife's specific concerns and what additional support might enable home care to continue*** - This approach respects the patient's **autonomy** and his explicit wish to die at home, while simultaneously acknowledging and addressing the **caregiver's distress** and burden. - By identifying the wife's specific challenges, the healthcare team can implement **targeted interventions** such as increased home care support, **palliative care team involvement**, or **respite services**, which may prevent an unwanted hospital admission. *Arrange immediate hospital admission as the family can no longer manage at home* - This is a premature action that bypasses the opportunity to reinforce **home-based care** and explore solutions, potentially going against the patient's stated wish. - It fails to engage in **shared decision-making** with the family and patient, which is crucial in end-of-life care planning. *Explain that the patient's wish to die at home must take priority over the wife's concerns* - This response is unhelpful and risks alienating the primary **caregiver**, whose support is essential for the patient to remain at home. - Effective end-of-life care considers the **patient and family as a unit**, requiring support for both to achieve the desired outcome. *Increase the patient's sedative medications to reduce the burden on the wife* - Medication management, especially **sedation**, should always be guided by the patient's **symptoms** (pain and agitation) and clinical need, not primarily by caregiver burden. - Increasing sedatives solely for caregiver relief without appropriate clinical indication raises **ethical concerns** regarding patient well-being and appropriate use of medication. *Inform the patient he needs hospital admission as home care is no longer feasible* - This disregards the patient's **capacity** and his expressed desire to die at home, potentially undermining his **autonomy**. - A decision for hospital admission should only be made after a comprehensive assessment of available **home support options** and in collaboration with the patient and family.
Question 56: A 32-year-old woman with severe anorexia nervosa (BMI 13.2 kg/m²) is admitted with bradycardia, hypotension, and hypoglycaemia. She has capacity and refuses all treatment including intravenous fluids, stating 'I want to die'. She is not detained under the Mental Health Act. What is the legal status of treating her against her wishes?
- A. Treatment can proceed under the Mental Capacity Act as her anorexia impairs her decision-making
- B. Treatment cannot proceed as she has capacity and is refusing
- C. She should be detained under Section 2 or 3 of the Mental Health Act to provide treatment (Correct Answer)
- D. Treatment can proceed as this is a medical emergency under common law necessity
- E. Treatment requires Court of Protection approval as she has a mental disorder
Explanation: ***She should be detained under Section 2 or 3 of the Mental Health Act to provide treatment*** - In cases of **anorexia nervosa**, physical complications like bradycardia and hypoglycemia are considered manifestations of the **mental disorder**, allowing for compulsory treatment under the **Mental Health Act (MHA)**. - Section 63 of the MHA permits treatment for a mental disorder (including feeding) without consent if the patient is detained, even if they are deemed to have **mental capacity** regarding that specific treatment. *Treatment can proceed under the Mental Capacity Act as her anorexia impairs her decision-making* - The **Mental Capacity Act (MCA)** only applies if a patient is found to lack capacity; the vignette explicitly states she **has capacity**, making this act inapplicable. - Diagnosis of a mental disorder like anorexia does not automatically equate to a **lack of capacity** to make specific medical decisions. *Treatment cannot proceed as she has capacity and is refusing* - While patients with capacity generally have the right to refuse treatment, the **Mental Health Act** provides a legal framework to override refusal if the treatment is for a **mental disorder** or its direct physical consequences. - Because her life-threatening physical state is a direct result of her **anorexia**, the MHA can be used to provide life-saving rehydration and nutrition against her wishes. *Treatment can proceed as this is a medical emergency under common law necessity* - **Common law necessity** is generally reserved for situations where a patient lacks capacity and no other legal framework (like the MHA) is immediately applicable. - In this scenario, because the patient has a known mental disorder and **detention criteria** are likely met, the MHA is the more appropriate and legally robust framework to use. *Treatment requires Court of Protection approval as she has a mental disorder* - The **Court of Protection** primarily makes decisions for individuals who **lack mental capacity** to make decisions for themselves. - It is not the standard clinical pathway for managing acute risks in a patient who qualifies for detention and treatment under the **Mental Health Act**.
Question 57: A 81-year-old woman with end-stage heart failure is dying in hospital. She has capacity and has requested no further active treatment. Her family asks you to tell her she is 'getting better' and not to inform her that she is dying because 'it would destroy her hope'. What is the most appropriate response?
- A. Agree to avoid discussions about prognosis to respect the family's cultural values
- B. Explore the family's concerns but explain you have a duty to be honest with the patient if she asks (Correct Answer)
- C. Inform the patient she is dying despite the family's wishes, as honesty is paramount
- D. Ask the family to leave before any further discussions with the patient
- E. Document the family's request and avoid any prognostic discussions with the patient
Explanation: ***Explore the family's concerns but explain you have a duty to be honest with the patient if she asks***- In medical ethics, patients with **capacity** have a fundamental right to **autonomy** and honest communication regarding their diagnosis and prognosis.- While it is important to understand the family's perspective through **empathy and exploration**, a physician cannot proactively lie to a patient or withhold information if the patient desires to know.*Agree to avoid discussions about prognosis to respect the family's cultural values*- Respecting **cultural values** is important, but it does not override the legal and professional duty of **veracity** (truth-telling) to a patient with capacity.- Agreeing to a conspiracy of silence can lead to a **breach of trust** and prevents the patient from making informed end-of-life decisions.*Inform the patient she is dying despite the family's wishes, as honesty is paramount*- Although honesty is key, the delivery of bad news should be **patient-centered**; you must first assess how much information the patient actually wants to receive.- This approach is too blunt and ignores the **therapeutic alliance** with the family, which can be maintained by exploring their concerns first.*Ask the family to leave before any further discussions with the patient*- Requesting the family to leave abruptly is confrontational and can damage the **doctor-family relationship** during a sensitive end-of-life period.- Professional communication involves **negotiation and explanation** of duties rather than the exclusion of the support system.*Document the family's request and avoid any prognostic discussions with the patient*- Simple documentation does not resolve the ethical dilemma or the physician's duty to provide **honest disclosure** when prompted by the patient.- Avoiding discussions effectively allows the family to make decisions for a patient who still possesses **decision-making capacity**, which is ethically inappropriate.
Question 58: A 16-year-old girl attends the emergency department alone requesting emergency hormonal contraception following unprotected intercourse 36 hours ago. She is anxious that her parents do not find out. During Fraser guideline assessment, what additional factor must be specifically considered beyond her capacity to consent?
- A. Whether she has been in a long-term relationship with her partner
- B. Whether providing contraception will encourage further sexual activity
- C. Whether her physical and mental health would likely suffer without the contraception (Correct Answer)
- D. Whether her parents have religious objections to contraception
- E. Whether she has previously requested contraception or sexual health advice
Explanation: ***Whether her physical and mental health would likely suffer without the contraception*** - One of the crucial criteria in the **Fraser guidelines** is to determine if the young person's **physical or mental health** (or both) would likely suffer if they are *not* provided with contraceptive advice or treatment. - This assessment is paramount, as the guidelines empower medical professionals to act in the **best interests** of the minor, even without parental consent, to prevent harm. *Whether she has been in a long-term relationship with her partner* - The **nature or duration of a relationship** is not a specific criterion within the **Fraser guidelines** for assessing a young person's competence to consent to contraception. - The focus is on the individual's understanding, maturity, and potential harm, not their relationship status. *Whether providing contraception will encourage further sexual activity* - The **Fraser guidelines** explicitly state that practitioners should consider if the young person is likely to **continue sexual intercourse** irrespective of whether contraception is provided. - The underlying principle is to protect the health of a sexually active minor, not to deter or **encourage** sexual activity. *Whether her parents have religious objections to contraception* - **Parental religious views** or objections are not factors in the **Fraser guidelines** when assessing a young person's capacity to consent or the necessity of providing contraception. - The guidelines prioritize the minor's **autonomy** and **confidentiality** once deemed competent and at risk of harm without treatment. *Whether she has previously requested contraception or sexual health advice* - A **previous history** of seeking contraception or sexual health advice is not a requirement or specific factor in the **Fraser guidelines**. - Each consultation is assessed on its own merits, focusing on the young person's **current capacity** and the immediate need for care.
Question 59: A 74-year-old man with metastatic prostate cancer and bone metastases is deteriorating. He has capacity and requests that 'when the time comes, you help me die peacefully'. He asks about doses of morphine. The consultant discusses increasing analgesia for pain control, which may have the effect of shortening life. What ethical principle permits this action?
- A. The principle of autonomy, as the patient has capacity and has consented
- B. The principle of justice, ensuring equal access to pain relief
- C. The doctrine of double effect, where foreseen but unintended harm may be acceptable (Correct Answer)
- D. The principle of beneficence, acting in the patient's best interests
- E. Implied consent to euthanasia under common law
Explanation: ***The doctrine of double effect, where foreseen but unintended harm may be acceptable*** - This principle allows an action with both a **good effect** (pain relief) and a **bad effect** (shortening life) if the **primary intention** is solely the good effect. - It ethically justifies increasing palliative analgesia, such as morphine, to alleviate suffering, even if it foreseeably but unintentionally hastens death. *The principle of autonomy, as the patient has capacity and has consented* - While **autonomy** empowers patients to make informed choices and refuse treatment, it does not permit them to request illegal actions like **euthanasia** or **assisted suicide**. - A patient's consent to potentially lethal doses of medication does not absolve a physician from the legal and ethical prohibition against intentionally ending life. *The principle of justice, ensuring equal access to pain relief* - **Justice** relates to the fair and equitable distribution of healthcare resources and treatment among all individuals. - It does not specifically address the ethical conflict arising when a medical intervention intended for comfort also carries the risk of shortening life. *The principle of beneficence, acting in the patient's best interests* - **Beneficence** involves acting to benefit the patient and promote their welfare, which includes alleviating pain and suffering. - However, the doctrine of double effect is the specific ethical framework that helps navigate situations where beneficence (pain relief) might be intertwined with a foreseen but unintended negative outcome (hastened death). *Implied consent to euthanasia under common law* - **Euthanasia** is explicitly illegal under UK common law and in many other common law jurisdictions; there is no legal concept of "implied consent" for it. - Intentionally causing a patient's death, even with their consent, is considered **murder or manslaughter**, making this option invalid.
Question 60: A 46-year-old man with advanced motor neurone disease has made a written, witnessed advance decision stating he does not want non-invasive ventilation (NIV) when he develops respiratory failure. He now presents with type 2 respiratory failure and is drowsy with CO2 retention. His wife states he has recently been more positive and she believes he has changed his mind about NIV. What is the most appropriate action?
- A. Start NIV immediately as his wife's statement suggests the advance decision may no longer be valid
- B. Respect the advance decision and commence palliative care without NIV
- C. Start NIV temporarily while attempting to assess his current wishes when he improves (Correct Answer)
- D. Convene a best interests meeting to decide on NIV
- E. Contact the hospital legal team before making any decision about NIV
Explanation: ***Start NIV temporarily while attempting to assess his current wishes when he improves*** - Under the **Mental Capacity Act 2005**, if there is **reasonable doubt** about the validity or applicability of an **Advance Decision to Refuse Treatment (ADRT)**, clinicians should provide life-sustaining treatment. - Starting **non-invasive ventilation (NIV)** may improve the patient's **CO2 retention** and drowsiness, potentially restoring capacity to allow him to state his current wishes directly. *Start NIV immediately as his wife's statement suggests the advance decision may no longer be valid* - While the wife's observation provides grounds for **doubt**, it does not automatically **invalidate** a written, witnessed legal document. - The decision to treat is based on the clinical need to **clarify the situation**, rather than assuming the ADRT is legally void solely on her statement. *Respect the advance decision and commence palliative care without NIV* - Ignoring the potential change in the patient's views reported by the wife carries a risk of failing to respect the patient's **current autonomy**. - Provided there is **uncertainty**, GMC guidance suggests that clinicians should err on the side of **preserving life** until clarity is reached. *Convene a best interests meeting to decide on NIV* - A **best interests** meeting is the framework used when a patient lacks capacity and has **no valid ADRT**; here, the primary issue is the **validity/applicability** of the existing ADRT. - In an acute setting with **respiratory failure**, there is usually insufficient time for a formal meeting before emergency treatment is required. *Contact the hospital legal team before making any decision about NIV* - Seeking **legal advice** causes unnecessary delay in a life-threatening situation where immediate clinical action is required. - Doctors are protected under the **Mental Capacity Act** when acting in good faith to provide life-sustaining treatment while resolving **uncertainty** about an ADRT.
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