A 71-year-old woman with metastatic lung cancer and capacity is receiving end-of-life care at home. Her pain is increasingly difficult to control and the palliative care team recommends a continuous subcutaneous infusion of diamorphine and midazolam. She agrees but says 'I don't want to become unconscious - I want to stay alert to talk to my family'. The doses proposed would likely cause significant sedation. How should this be managed?
AStart the infusion as planned - adequate pain control is the priority
BReduce the doses even if pain control is suboptimal to maintain alertness
CExplain the likely effects of medication and explore her priorities regarding symptom control versus alertness
DDefer starting the infusion until she becomes less concerned about sedation
EStart lower doses and increase without further discussion once she becomes too drowsy to participate
A 37-year-old man with newly diagnosed HIV infection (CD4 250, undetectable viral load on treatment) works as a dentist. He has capacity and refuses to inform his employer or occupational health, citing concerns about discrimination. He follows standard infection control procedures. What is your professional obligation regarding disclosure?
AYou must immediately inform the General Dental Council
BYou must inform UK Health Security Agency who will inform his employer
CYou should maintain confidentiality as he poses minimal risk with standard precautions
DYou must inform his employer as patients have a right to know
EYou should seek advice from the GMC ethics department before taking any action
A 56-year-old man with motor neurone disease attended his GP 6 months ago when mobile and made a written advance decision refusing 'ventilation of any kind' if he developed respiratory failure. He is now admitted with type 2 respiratory failure. He has lost speech but can communicate by eye movements. When asked about non-invasive ventilation (NIV), he consistently indicates he wants it. What is the legal status of his advance decision?
AIt is valid and binding - NIV should not be started
BIt is not applicable as it was made more than 3 months ago
CIt is not valid as it was not registered with a solicitor
DIt is not applicable as his current wishes differ from the advance decision
ECourt of Protection authorization is required to override the advance decision
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