Ethics & Law — MCQs
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Under the Mental Capacity Act 2005, which of the following is a core principle that must be applied when assessing capacity?
A 58-year-old woman with a history of bipolar disorder is admitted with suspected bacterial meningitis. She is confused, febrile, and has neck stiffness. She is adamant she does not want a lumbar puncture and tries to leave. Her husband states she has capacity as she has always refused invasive procedures. What is the legal basis for proceeding with the lumbar puncture?
A 15-year-old boy with relapsed acute myeloid leukaemia is offered further intensive chemotherapy with a 20% chance of remission but significant toxicity. After detailed discussions, he understands the options and decides he does not want further chemotherapy, preferring palliative care. His parents strongly disagree and insist on treatment. Assessment confirms he has Gillick competence. What is the most appropriate legal position?
A 23-year-old man with severe learning disability (IQ 38) and autism requires dental extraction under general anaesthesia. He becomes very distressed during examination and is unable to understand the procedure despite repeated explanations using visual aids. His mother, who is his court-appointed welfare deputy, provides written consent. What is the legal basis for proceeding with the procedure?
A 67-year-old woman with advanced dementia (MMSE 12/30) is admitted with a large ischaemic stroke. The medical team discusses inserting a nasogastric tube for feeding. Her daughter produces a document signed by the patient 5 years ago stating 'I do not want tube feeding if I cannot feed myself'. The patient appears comfortable and is not attempting to eat or drink. What is the most appropriate next step?
A 52-year-old woman with widely metastatic ovarian cancer has been receiving palliative chemotherapy. She is admitted with progressive abdominal pain, ascites, and bowel obstruction. The surgical team assess her as not suitable for operative management due to extensive intra-abdominal disease. The palliative care team commence a continuous subcutaneous infusion of morphine and levomepromazine for symptom control. Over 48 hours, the doses are gradually increased to control her symptoms. Her husband becomes very distressed and asks to speak to you privately, stating 'I think you're giving her too much morphine. You're killing her aren't you? Isn't this euthanasia?' How should you respond?
A 77-year-old man with advanced prostate cancer metastatic to bone and spine is admitted with progressive weakness in both legs. MRI confirms metastatic spinal cord compression at T10. The oncology team recommend urgent surgical decompression followed by radiotherapy. Without surgery within 24-48 hours, he will likely become paraplegic. He has moderate cognitive impairment (MMSE 20/30) and formal capacity assessment suggests he lacks capacity for this complex surgical decision. He has no advance decision or lasting power of attorney. His two daughters disagree: one says 'Dad would want everything done', the other says 'He's had enough, no more operations'. What is the most appropriate approach?
A 14-year-old boy with newly diagnosed osteosarcoma of the left femur is discussed at the sarcoma MDT. The recommended treatment is neoadjuvant chemotherapy followed by limb-salvage surgery. Without treatment, the prognosis is very poor. He has been assessed as Gillick competent and understands the diagnosis and treatment. His parents both consent to treatment. However, the boy himself refuses, stating 'I don't want chemotherapy. I've seen what it did to my uncle. I'd rather die than go through that.' What is the legal position regarding proceeding with treatment?
A 58-year-old man with end-stage motor neurone disease is being cared for at home with regular visits from the palliative care team. He retains capacity and has an advance decision refusing invasive ventilation. He develops pneumonia and his breathing deteriorates. His wife calls you urgently stating 'He's struggling to breathe and very distressed. He's now saying he wants to go to hospital for ventilation. But his advance decision says no ventilation - what should I do?' You attend and he appears breathless and anxious but is able to communicate. How should you approach this situation?
A 28-year-old woman with emotionally unstable personality disorder is admitted following an overdose of 40 paracetamol tablets 6 hours ago. She has capacity and understands she will die without treatment, but refuses acetylcysteine stating 'I want to die, just let me go'. Blood tests show ALT 1850 U/L and INR 2.8. She has no history of chronic liver disease. Psychiatry assess and confirm she has capacity for this decision despite her personality disorder. What is the legal position regarding treatment?
Ethics & Law UK Medical PG Practice Questions and MCQs
Question 61: Under the Mental Capacity Act 2005, which of the following is a core principle that must be applied when assessing capacity?
- A. A person's capacity should be assessed annually to ensure it remains stable
- B. A person must not be treated as unable to make a decision merely because they make an unwise decision (Correct Answer)
- C. All people with diagnosed mental health conditions lack capacity to make healthcare decisions
- D. Capacity assessments should always be performed by a psychiatrist
- E. A person lacking capacity for one decision lacks capacity for all decisions
Explanation: ***A person must not be treated as unable to make a decision merely because they make an unwise decision*** - This is a core principle of the **Mental Capacity Act 2005**, acknowledging that individuals have the right to make choices that others may perceive as **irrational** or dangerous. - Under Section 1, capacity must be presumed unless proven otherwise, and an **unwise decision** does not constitute evidence of the inability to understand or weigh information. *A person's capacity should be assessed annually to ensure it remains stable* - Capacity is **decision-specific** and **time-specific**, meaning it must be assessed at the moment a specific decision needs to be made. - There is no requirement for a scheduled **annual assessment**; instead, changes in clinical status or the emergence of new decisions trigger a review. *All people with diagnosed mental health conditions lack capacity to make healthcare decisions* - The law protects individuals by stating that a **diagnosis** of mental illness, dementia, or learning disability does not automatically equate to a lack of capacity. - Lack of capacity must be established through a **functional test** regarding a specific decision, rather than based on a person's condition or appearance. *Capacity assessments should always be performed by a psychiatrist* - Any **healthcare professional** or person proposing the intervention/treatment can perform a capacity assessment if they are appropriately trained. - While **psychiatrists** may be consulted for complex cases, the responsibility often lies with the doctor or nurse directly involved in the patient's care. *A person lacking capacity for one decision lacks capacity for all decisions* - Capacity is **not global**; a patient may have the capacity to decide on simple daily tasks but lack the capacity to consent to complex surgery. - The assessment must be repeated for **different decisions** to ensure the patient is allowed as much autonomy as possible.
Question 62: A 58-year-old woman with a history of bipolar disorder is admitted with suspected bacterial meningitis. She is confused, febrile, and has neck stiffness. She is adamant she does not want a lumbar puncture and tries to leave. Her husband states she has capacity as she has always refused invasive procedures. What is the legal basis for proceeding with the lumbar puncture?
- A. She lacks capacity due to acute confusion from meningitis affecting decision-making (Correct Answer)
- B. Emergency treatment can proceed under common law without assessing capacity
- C. Her husband can provide proxy consent as her next of kin
- D. The Mental Health Act can be used to enforce treatment for her bipolar disorder
- E. She has capacity and her refusal must be respected regardless of consequences
Explanation: ***She lacks capacity due to acute confusion from meningitis affecting decision-making***- Under the **Mental Capacity Act 2005**, capacity is decision-specific; the patient’s **acute confusion** likely prevents her from understanding, retaining, or weighing medical information.- Since the impairment of her mind is caused by the **meningitis**, clinical assessment of her current state overrules her husband's claim based on her prior history.*Emergency treatment can proceed under common law without assessing capacity*- While common law allows for life-saving treatment, the **Mental Capacity Act (MCA)** provides the primary statutory framework and requires a **capacity assessment** first.- Treatment in an emergency should follow the **best interests** principle once a lack of capacity has been established.*Her husband can provide proxy consent as her next of kin*- In English law, a **Next of Kin** has no legal authority to provide consent for an adult unless they have a **Lasting Power of Attorney (LPA)** for Health and Welfare.- The husband should be consulted to help determine the patient's **prior wishes and best interests**, but the final clinical decision rests with the doctors.*The Mental Health Act can be used to enforce treatment for her bipolar disorder*- The **Mental Health Act (MHA)** is used for the treatment of **mental disorders**, not for the treatment of primary **physical conditions** like meningitis.- Even if she were detained under the MHA, it would not provide the legal basis for an **invasive lumbar puncture** for a physical illness.*She has capacity and her refusal must be respected regardless of consequences*- A competent refusal is binding, but a patient is only considered to have capacity if they are not suffering from an **impairment or disturbance** of the mind.- Her **clinical presentation of confusion** and fever suggests she fails the functional test of capacity, making her refusal invalid in this acute setting.
Question 63: A 15-year-old boy with relapsed acute myeloid leukaemia is offered further intensive chemotherapy with a 20% chance of remission but significant toxicity. After detailed discussions, he understands the options and decides he does not want further chemotherapy, preferring palliative care. His parents strongly disagree and insist on treatment. Assessment confirms he has Gillick competence. What is the most appropriate legal position?
- A. The parents' consent overrides the child's refusal and treatment can proceed (Correct Answer)
- B. The child's refusal must be respected as he is Gillick competent
- C. The court must decide as there is disagreement between child and parents
- D. Treatment can proceed as it is in the child's best interests despite his refusal
- E. A second opinion from another consultant is required before proceeding
Explanation: ***The parents' consent overrides the child's refusal and treatment can proceed*** - Under UK law, while **Gillick competence** allows a child under 16 to consent to treatment, it does not provide an absolute right for a minor to **refuse life-saving treatment**. - Legal precedents such as **Re W (1992)** established that consent from either a **Gillick competent minor** or a person with **parental responsibility** is sufficient to authorize treatment, meaning parents can legally override a refusal. *The child's refusal must be respected as he is Gillick competent* - Unlike adults with full **autonomy**, a minor's refusal of treatment is not absolute and can be legally bypassed if it results in **significant harm** or death. - **Gillick competence** is a "shield" to allow treatment without parental knowledge, not a "sword" to block life-saving interventions sanctioned by parents or the court. *The court must decide as there is disagreement between child and parents* - While a court application is the **recommended clinical pathway** for resolving such a complex ethical conflict, the underlying **legal position** is that parental consent remains valid. - The court would ultimately decide based on the **child's best interests**, but it is not technically required for the parents' consent to be legally operative. *Treatment can proceed as it is in the child's best interests despite his refusal* - While **best interests** are the guiding principle, treatment proceeds legally because of the existence of **parental consent**, not solely on a clinician's unilateral determination. - This distinction is vital because the clinician requires a **legal authority** (parental consent or court order) to perform an intervention against a patient's will. *A second opinion from another consultant is required before proceeding* - A second opinion is a matter of **good clinical practice** and ethical diligence, but it is not a **legal requirement** to override a minor's refusal. - Lawful authority is derived from **parental responsibility** or the court, regardless of the number of medical opinions obtained.
Question 64: A 23-year-old man with severe learning disability (IQ 38) and autism requires dental extraction under general anaesthesia. He becomes very distressed during examination and is unable to understand the procedure despite repeated explanations using visual aids. His mother, who is his court-appointed welfare deputy, provides written consent. What is the legal basis for proceeding with the procedure?
- A. Parental consent as he lacks capacity to consent
- B. Best interests decision under the Mental Capacity Act 2005
- C. Consent from the welfare deputy who has legal authority (Correct Answer)
- D. Implied consent as he has attended the appointment
- E. Emergency treatment under common law doctrine of necessity
Explanation: ***Consent from the welfare deputy who has legal authority*** - Under the **Mental Capacity Act 2005**, a court-appointed **welfare deputy** has the specific legal power to make healthcare decisions and provide consent for an adult who lacks capacity. - Since the mother has been legally granted this authority by the **Court of Protection**, her written consent serves as the primary legal basis for the procedure to proceed. *Parental consent as he lacks capacity to consent* - **Parental responsibility** ends when a child turns 18; therefore, parents cannot automatically consent to medical treatment for their adult children. - Without a formal legal role like a **welfare deputy** or **Lasting Power of Attorney**, a parent has no more legal standing to consent than any other third party. *Best interests decision under the Mental Capacity Act 2005* - While all decisions for the patient must be in their **best interests**, a formal "best interests decision" by the clinician is only the primary legal basis when no **legal proxy** (like a deputy) exists. - In this scenario, the presence of a **welfare deputy** shifts the legal authority to the deputy's consent rather than a clinician-led best interests determination. *Implied consent as he has attended the appointment* - **Implied consent** is only sufficient for minor, non-invasive procedures and cannot be used for complex treatments requiring **general anaesthesia**. - The patient's **distress and lack of understanding** clearly demonstrate that he has not provided valid consent, either express or implied. *Emergency treatment under common law doctrine of necessity* - The **doctrine of necessity** applies only in life-threatening emergencies where there is no time to obtain consent or consult a legal proxy. - Dental extraction under general anaesthesia is typically a **planned procedure**, and since a welfare deputy is available to consent, this doctrine does not apply.
Question 65: A 67-year-old woman with advanced dementia (MMSE 12/30) is admitted with a large ischaemic stroke. The medical team discusses inserting a nasogastric tube for feeding. Her daughter produces a document signed by the patient 5 years ago stating 'I do not want tube feeding if I cannot feed myself'. The patient appears comfortable and is not attempting to eat or drink. What is the most appropriate next step?
- A. Insert the nasogastric tube as the advance decision is not valid for this specific treatment
- B. Apply to the Court of Protection for a decision on tube feeding
- C. Respect the advance decision and do not insert the nasogastric tube (Correct Answer)
- D. Insert the nasogastric tube temporarily while seeking legal advice
- E. Convene a best interests meeting with the family before making any decision
Explanation: ***Respect the advance decision and do not insert the nasogastric tube*** - A valid and applicable **Advance Decision to Refuse Treatment (ADRT)** is legally binding under the **Mental Capacity Act 2005**, carrying the same weight as a contemporaneous decision by a patient with capacity. - Since the patient lacked capacity at the time of admission and had previously specified a refusal of **tube feeding** under the current circumstances (inability to feed self), the medical team must honor this request. *Insert the nasogastric tube as the advance decision is not valid for this specific treatment* - The document specifically names **tube feeding** and the condition (inability to feed self), making it highly specific and legally applicable to the current clinical scenario. - An ADRT does not need to use formal medical terminology to be valid; clear, understandable language like "cannot feed myself" is legally sufficient. *Apply to the Court of Protection for a decision on tube feeding* - Recourse to the **Court of Protection** is only necessary if there is significant doubt regarding the **validity or applicability** of the ADRT that cannot be resolved. - In this case, there is no evidence of a dispute or ambiguity that would justify the delay and resources of a court application. *Insert the nasogastric tube temporarily while seeking legal advice* - Implementing a treatment that a patient has validly refused in an ADRT can be considered **assault or battery** under the law. - Seeking legal advice is unnecessary when a documented, specific refusal is presented by a family member and is clearly applicable to the patient's current state. *Convene a best interests meeting with the family before making any decision* - A **best interests decision** is only required when there is no valid ADRT and no **Lasting Power of Attorney (LPA)** in place to make the decision. - Because a valid ADRT represents the patient's own exercise of **autonomy**, it supersedes any "best interests" assessment performed by the clinical team or family.
Question 66: A 52-year-old woman with widely metastatic ovarian cancer has been receiving palliative chemotherapy. She is admitted with progressive abdominal pain, ascites, and bowel obstruction. The surgical team assess her as not suitable for operative management due to extensive intra-abdominal disease. The palliative care team commence a continuous subcutaneous infusion of morphine and levomepromazine for symptom control. Over 48 hours, the doses are gradually increased to control her symptoms. Her husband becomes very distressed and asks to speak to you privately, stating 'I think you're giving her too much morphine. You're killing her aren't you? Isn't this euthanasia?' How should you respond?
- A. Explain that the intention is to relieve her suffering, not to cause death, and that appropriate symptom control is legal and ethical even if it may shorten life as an unintended consequence (Correct Answer)
- B. Reassure him that the doses being used are below those that would cause respiratory depression and will not shorten life
- C. Explain that she has requested these medications and you are respecting her autonomous choice
- D. Acknowledge his concerns and offer to reduce the doses of analgesia and sedation
- E. Explain that this is a best interests decision made by the palliative care team in consultation with the family
Explanation: ***Explain that the intention is to relieve her suffering, not to cause death, and that appropriate symptom control is legal and ethical even if it may shorten life as an unintended consequence*** - This response correctly applies the **Doctrine of Double Effect**, distinguishing between the **intended good effect** (symptom relief) and the **foreseen but unintended bad effect** (potential shortening of life). - It clearly states that providing adequate **palliative care** for severe suffering is both **legal and ethical**, even if high doses of medication are required. *Reassure him that the doses being used are below those that would cause respiratory depression and will not shorten life* - This statement could be **clinically inaccurate**, as escalating doses of **opioids** and **sedatives** to manage refractory symptoms can potentially hasten death in a critically ill patient. - It fails to address the husband's core ethical concern about **intention** behind the treatment, which is central to distinguishing palliative care from euthanasia. *Explain that she has requested these medications and you are respecting her autonomous choice* - While **patient autonomy** is a vital principle, the primary justification for high-dose palliation in severe suffering is the **clinical necessity** of symptom control rather than solely a patient's request. - This response does not fully address the husband's specific concern about **euthanasia** and the legal/ethical framework of end-of-life care. *Acknowledge his concerns and offer to reduce the doses of analgesia and sedation* - Reducing effective **analgesia** and **sedation** solely due to family distress, when the patient is clearly suffering, violates the principle of **beneficence** and could cause the patient unnecessary harm. - The focus must remain on the **patient's comfort** and symptom control, with dose adjustments guided by clinical needs and effects, not primarily by family anxiety. *Explain that this is a best interests decision made by the palliative care team in consultation with the family* - A **best interests decision** is specifically applicable when a patient **lacks mental capacity** to make their own decisions, which is not indicated in this scenario for the patient. - This response deflects from the husband's direct question about **euthanasia** and does not clearly explain the ethical and legal principles guiding symptom management at the end of life.
Question 67: A 77-year-old man with advanced prostate cancer metastatic to bone and spine is admitted with progressive weakness in both legs. MRI confirms metastatic spinal cord compression at T10. The oncology team recommend urgent surgical decompression followed by radiotherapy. Without surgery within 24-48 hours, he will likely become paraplegic. He has moderate cognitive impairment (MMSE 20/30) and formal capacity assessment suggests he lacks capacity for this complex surgical decision. He has no advance decision or lasting power of attorney. His two daughters disagree: one says 'Dad would want everything done', the other says 'He's had enough, no more operations'. What is the most appropriate approach?
- A. Make a best interests decision urgently considering all relevant factors including views of both daughters, the clinical situation, and any available evidence of the patient's values and wishes (Correct Answer)
- B. Follow the wishes of the daughter who advocates for surgery as surgery is clearly clinically indicated
- C. Follow the wishes of the daughter who is against surgery as the patient is in the terminal phase of his illness
- D. Proceed with surgery based on the clinical team's recommendation without delay as this is an emergency
- E. Apply to the Court of Protection for an urgent hearing to decide about surgery
Explanation: ***Make a best interests decision urgently considering all relevant factors including views of both daughters, the clinical situation, and any available evidence of the patient's values and wishes*** - Under the **Mental Capacity Act 2005**, when a patient lacks capacity and has no **Lasting Power of Attorney (LPA)** or **Advance Decision**, clinicians must make a holistic **best interests** decision. - This involves weighing the clinical benefit of preventing **paraplegia** against the patient's known **values**, beliefs, and the conflicting views of family members, especially given the urgent clinical need. *Follow the wishes of the daughter who advocates for surgery as surgery is clearly clinically indicated* - Family members without **LPA** do not have the legal authority to consent to or refuse treatment on behalf of the patient. - Their role is to provide insight into the patient's **wishes and feelings**, not to dictate the clinical management based on their own preferences. *Follow the wishes of the daughter who is against surgery as the patient is in the terminal phase of his illness* - The clinical team cannot simply follow one relative's refusal; they must assess if treatment is **futile** or if the burden outweighs the benefit for this specific patient. - Even in **palliative** stages, preventing a catastrophic event like **cord compression** can be in the patient's best interests to maintain remaining quality of life or prevent severe suffering. *Proceed with surgery based on the clinical team's recommendation without delay as this is an emergency* - While the situation is urgent (24-48 hours), it is not a "life-or-death" second-to-second emergency that justifies bypassing the **best interests consultation** process. - Clinicians must still attempt to consult those interested in the patient's welfare to determine his likely **prior preferences** before proceeding, even if briefly. *Apply to the Court of Protection for an urgent hearing to decide about surgery* - Seeking a **Court of Protection** ruling is generally reserved for cases where there is **intractable disagreement** and time allows for legal intervention. - Given the **24-48 hour window** to prevent permanent paraplegia, the delay of a court hearing would likely cause the very harm the surgery aims to prevent, making it inappropriate in this acute scenario.
Question 68: A 14-year-old boy with newly diagnosed osteosarcoma of the left femur is discussed at the sarcoma MDT. The recommended treatment is neoadjuvant chemotherapy followed by limb-salvage surgery. Without treatment, the prognosis is very poor. He has been assessed as Gillick competent and understands the diagnosis and treatment. His parents both consent to treatment. However, the boy himself refuses, stating 'I don't want chemotherapy. I've seen what it did to my uncle. I'd rather die than go through that.' What is the legal position regarding proceeding with treatment?
- A. Treatment can proceed based on parental consent as they have parental responsibility and can override his refusal (Correct Answer)
- B. Treatment cannot proceed without his consent as he is Gillick competent and his refusal must be respected
- C. An application to the Court of Protection should be made to override his refusal
- D. He can be detained under the Mental Health Act to enable treatment to proceed
- E. Treatment can only proceed if two doctors certify it is in his best interests under the Mental Capacity Act
Explanation: ***Treatment can proceed based on parental consent as they have parental responsibility and can override his refusal***- In UK law, while a **Gillick competent** minor can provide valid consent, their **refusal** of life-saving treatment can be overridden by someone with **parental responsibility** or by a court.- The legal principle established in cases like **Re W** (A Minor) [1992] indicates that parental consent can act as a protective 'flak jacket' for doctors treating a minor who is refusing life-saving treatment.*Treatment cannot proceed without his consent as he is Gillick competent and his refusal must be respected*- **Gillick competence** is often described as 'asymmetric'; it allows a minor to **consent** to treatment independently, but it does not automatically grant them the right to **refuse life-saving treatment** if competent adults (parents or courts) deem it to be in their best interest.- When a Gillick competent minor refuses treatment that is clearly in their **best interest** and necessary to prevent death or severe harm, this refusal can be overridden.*An application to the Court of Protection should be made to override his refusal*- The **Court of Protection** primarily deals with decisions for **adults (18+)** who lack mental capacity, or for 16-17 year olds who lack capacity under the **Mental Capacity Act 2005**.- For a 14-year-old, legal proceedings to override a refusal of treatment would fall under the jurisdiction of the **Family Division of the High Court**, not the Court of Protection.*He can be detained under the Mental Health Act to enable treatment to proceed*- The **Mental Health Act** is specifically for the assessment and treatment of **mental disorder**, not for forcing physical medical treatment on a patient whose refusal stems from a rational decision, even if that decision is deemed ill-advised.- Refusing treatment for a physical condition, even a life-threatening one, does not automatically constitute a **mental disorder** sufficient for detention under the Act.*Treatment can only proceed if two doctors certify it is in his best interests under the Mental Capacity Act*- The **Mental Capacity Act (2005)** applies to individuals aged **16 and over** who lack capacity. This patient is 14 years old.- For children under 16, common law and the **Children Act 1989** govern capacity and best interest decisions, not the specific certification process under the Mental Capacity Act.
Question 69: A 58-year-old man with end-stage motor neurone disease is being cared for at home with regular visits from the palliative care team. He retains capacity and has an advance decision refusing invasive ventilation. He develops pneumonia and his breathing deteriorates. His wife calls you urgently stating 'He's struggling to breathe and very distressed. He's now saying he wants to go to hospital for ventilation. But his advance decision says no ventilation - what should I do?' You attend and he appears breathless and anxious but is able to communicate. How should you approach this situation?
- A. Assess his capacity for this decision now; if he has capacity, his current expressed wish overrides the advance decision (Correct Answer)
- B. Follow the advance decision as it remains legally binding once the circumstances it describes have arisen
- C. Treat the pneumonia with antibiotics at home but do not offer ventilation as per the advance decision
- D. Contact the palliative care team to make a best interests decision about whether to follow his current wishes or the advance decision
- E. Provide emergency treatment including transfer to hospital, then assess the validity of his change of mind when he is less distressed
Explanation: ***Assess his capacity for this decision now; if he has capacity, his current expressed wish overrides the advance decision***- Under the **Mental Capacity Act 2005**, an **Advance Decision to Refuse Treatment (ADRT)** only becomes operative and legally binding when a person **lacks capacity** to make the specific decision at the time it needs to be made.- If a patient currently has **capacity**, they are legally entitled to change their mind and **withdraw or modify** their advance decision at any time; their current, contemporaneous wish takes absolute precedence over any prior written directive.*Follow the advance decision as it remains legally binding once the circumstances it describes have arisen*- An **ADRT** is not a "fixed" document that locks a patient into a choice; it is a safeguard for when **autonomy** is lost, not a tool to override current autonomy.- Ignoring a patient’s current expressed wish when they still have **capacity** would violate the fundamental principle of **contemporaneous consent** and patient autonomy.*Treat the pneumonia with antibiotics at home but do not offer ventilation as per the advance decision*- This approach incorrectly prioritizes a prior written document over the **live verbal request** of a patient who may still be competent to make their own decision.- Withholding treatment that a patient is currently requesting without first assessing their **current capacity** is professionally and legally indefensible, as it denies potential life-sustaining treatment.*Contact the palliative care team to make a best interests decision about whether to follow his current wishes or the advance decision*- A **Best Interests** decision under the **Mental Capacity Act** is only applicable if the patient **lacks capacity** to decide for themselves.- If the patient has capacity, there is no role for a Best Interests meeting, as the **patient's own choice** is the deciding factor, regardless of previous statements.*Provide emergency treatment including transfer to hospital, then assess the validity of his change of mind when he is less distressed*- While it is important to stabilize the patient, the **capacity assessment** is crucial and must happen *immediately* to determine the legal basis for any intervention, especially invasive ones.- Delaying the assessment of his **change of mind** risks providing invasive treatment against a potentially valid ADRT if it turns out he actually lacked capacity due to **delirium or hypoxia** affecting his decision-making ability.
Question 70: A 28-year-old woman with emotionally unstable personality disorder is admitted following an overdose of 40 paracetamol tablets 6 hours ago. She has capacity and understands she will die without treatment, but refuses acetylcysteine stating 'I want to die, just let me go'. Blood tests show ALT 1850 U/L and INR 2.8. She has no history of chronic liver disease. Psychiatry assess and confirm she has capacity for this decision despite her personality disorder. What is the legal position regarding treatment?
- A. She has capacity and the right to refuse treatment even if this decision will result in her death (Correct Answer)
- B. Treatment should be given under the Mental Capacity Act as her personality disorder affects her capacity despite psychiatry assessment
- C. She can be detained under Section 5(2) of the Mental Health Act and treated for the overdose
- D. Treatment should be given under common law doctrine of necessity as this is a life-threatening emergency
- E. A Court of Protection order should be sought urgently to authorize treatment
Explanation: ***She has capacity and the right to refuse treatment even if this decision will result in her death***- According to the **Mental Capacity Act 2005**, an adult with **capacity** has the absolute right to refuse medical treatment, even if that refusal leads to death.- Capacity is **decision-specific**; the presence of a mental health condition (like **personality disorder**) does not automatically invalidate a patient's legal right to make an autonomous choice.*Treatment should be given under the Mental Capacity Act as her personality disorder affects her capacity despite psychiatry assessment*- The **Mental Capacity Act** cannot be used to override the choice of a patient who has been formally assessed and confirmed to have **capacity**.- Capacity is presumed unless proven otherwise, and it is **legally wrong** to assume incapacity simply because a patient's decision seems irrational or unwise.*She can be detained under Section 5(2) of the Mental Health Act and treated for the overdose*- The **Mental Health Act** is used for the treatment of **mental disorders**, not for the treatment of physical conditions resulting from self-harm.- Detaining someone under the MHA does not grant the right to provide **medical treatment for paracetamol toxicity** against the will of a capacitous patient.*Treatment should be given under common law doctrine of necessity as this is a life-threatening emergency*- The **doctrine of necessity** applies only when the patient's wishes are unknown or if they lack capacity during an emergency.- It cannot be invoked to override a **capacitous refusal** that has been clearly communicated by the patient.*A Court of Protection order should be sought urgently to authorize treatment*- The **Court of Protection** makes decisions for individuals who lack the **mental capacity** to do so themselves.- Since the patient has been assessed by psychiatry as having **capacity** for this specific decision, the court would have no jurisdiction to intervene and authorize treatment.
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