Medical School Interview Ethics
Tutorial on Consent and Capacity in Medicine
Understanding the principles of consent and capacity is crucial for medical professionals, and it's a common topic in medical school interviews. Here's a detailed guide to help you prepare effectively! 🩺
1. What is Consent?
Definition: Consent is the agreement or permission a patient gives to a medical professional to proceed with a specific intervention, examination, or treatment.
🔑 Key Points:
Voluntary: Consent must be given freely without any coercion.
Informed: The patient must have all the necessary information about the procedure, including risks, benefits, and alternatives.
Capacity: The patient must have the ability to understand the information and make an informed decision.
🚨 Types of Consent:
Explicit: Clearly stated, either verbally or in writing. For example, signing a consent form for surgery.
Implied: Indicated through actions, such as rolling up a sleeve for a blood test.
Relevant UK Legal Case:
Montgomery v Lanarkshire Health Board (2015): This landmark case established that patients must be informed of any material risks involved in a procedure and any reasonable alternatives. It emphasised a patient-centred approach to informed consent.
Example Interview Question:
"Why is informed consent important in medicine, and how would you handle a situation where a patient refuses treatment?"
2. What is Capacity?
Definition: Capacity refers to a patient’s ability to understand, retain, and evaluate information to make an informed decision about their medical care.
🔑 Key Points:
Age of Capacity: In the UK, the legal age of capacity is typically 16. However, under-16s can consent if they are deemed Gillick competent.
Mental State: A patient’s mental health, consciousness level, or medical conditions (like dementia) can impact their capacity.
🧠 The Four Pillars of Capacity (as per the Mental Capacity Act 2005):
Understand the information relevant to the decision.
Retain the information long enough to make a decision.
Weigh up the information to make an informed choice.
Communicate their decision (verbally, in writing, or other methods).
Key Legal Concepts:
A person is assumed to have capacity unless proven otherwise.
Lack of capacity must be documented clearly and assessed rigorously.
Relevant UK Legal Case:
Re C (Adult: Refusal of Treatment) (1994): A schizophrenic patient successfully refused amputation of a gangrenous leg, as he was deemed to have the capacity to make this decision despite his mental illness.
Example Interview Question:
"How would you assess whether a patient has the capacity to refuse treatment?"
3. Key Legal Frameworks
📜 The Mental Capacity Act 2005:
Protects patients who lack capacity.
Ensures decisions made on behalf of such patients are in their best interests.
👶 Gillick Competence:
Applies to under-16s to determine if they can consent to medical treatment without parental approval.
Used in cases such as contraception advice.
📖 Bolam Test:
A legal principle determining whether a medical professional’s actions align with accepted practice within their profession.
Relevant UK Legal Case:
Gillick v West Norfolk and Wisbech Area Health Authority (1986): Established the principle of Gillick competence, allowing under-16s to consent to medical treatment if they demonstrate sufficient maturity and understanding.
Example Interview Question:
"What is the role of the Mental Capacity Act in safeguarding vulnerable patients?"
4. Challenges in Consent and Capacity
⚠️ Common Scenarios:
Emergency Situations: If a patient is unconscious, doctors can act in their best interests under the principle of necessity.
Language Barriers: Using interpreters ensures patients can provide informed consent.
Cultural Sensitivities: Respecting beliefs while providing adequate information.
Refusal of Treatment: Balancing respect for autonomy with potential harm.
Relevant UK Legal Case:
Airedale NHS Trust v Bland (1993): Addressed the withdrawal of life-sustaining treatment from a patient in a persistent vegetative state, highlighting the balance between best interests and the sanctity of life.
Example Interview Question:
"What would you do if a Jehovah's Witness refused a blood transfusion?"
5. Ethical Principles in Consent and Capacity
⚖️ The Four Pillars of Medical Ethics:
Autonomy: Respecting the patient’s right to make decisions about their care.
Beneficence: Acting in the patient’s best interests.
Non-maleficence: Avoiding harm to the patient.
Justice: Ensuring fair treatment for all patients.
Mnemonic: “All Beings Need Justice”
6. Practical Tips for Interviews
💡 Use the SPIKES Framework: If discussing bad news or consent issues, structure your response clearly.
S - Set the scene.
P - Perception (gauge what the patient understands).
I - Invitation (ask how much detail they want).
K - Knowledge (provide clear and balanced information).
E - Empathy (acknowledge their emotions).
S - Summarise and strategise.
Practice Role-Play: Simulate scenarios like gaining consent for surgery or assessing capacity.
7. Sample Scenarios
Scenario 1: Refusal of Treatment
A 72-year-old patient with pneumonia refuses antibiotics. They appear confused and agitated.
Key Points: Assess capacity, clarify confusion, respect autonomy if they have capacity, act in their best interests if they lack capacity.
Scenario 2: Treating an Unconscious Patient
A 35-year-old involved in a car accident is unconscious and requires urgent surgery.
Key Points: Consent is implied in emergencies. Act in the patient’s best interests.
Scenario 3: Disagreement Between Parents and Doctors
Parents refuse a blood transfusion for their child due to religious beliefs.
Key Points: If the child’s life is at risk, courts can intervene to ensure treatment in the child’s best interests.
Relevant Case: Re B (A Minor) (Wardship: Medical Treatment) (1981)
8. Top Tips for Success
🎯 Stay Calm: Ethical questions test your reasoning, not just your knowledge. 🎯 Be Logical: Structure your answers with clear reasoning. 🎯 Show Empathy: Highlight the importance of communication and understanding. 🎯 Use Examples: Refer to relevant laws, frameworks, and real-life scenarios.
Good luck! 🎉 Understanding consent and capacity not only prepares you for interviews but also forms the foundation of ethical medical practice. Remember, this is about ensuring patient-centred care while upholding professional and legal standards. 💙
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