Law & Ethics

Question 1

describe GMC guidelines on gaining consent in children

Answer 1

at 16 years or older a young person can be treated as an adult and can be presumed to have capacity to decide

under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved

where a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests (except Scotland)

Question 2

explain the Fraser guidelines for provision of contraception to patients under 16

Answer 2

• the young person understands the professional’s advice
• the young person cannot be persuaded to inform their parents
• the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
• unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
• the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent

Question 3

describe advance directives

Answer 3

must refer to specific treatment in a specific circumstance

individual must have been of sound mind

mental capacity act 2005 states that this is binding with the following exceptions
- decision has subsequently been withdrawn
- Lasting power of attorney overrules this
- since making this the patient has acted in a way that is clearly inconsistent with decision
- person is not incapacitated and can decide for themselves
- treatment in question is not specified in advanced directive
- reasonable grounds to believe that circumstances exist which the person did not anticipate at the time of advance decision

Question 4

Describe the law regarding advanced care directives

Answer 4

Advance directives are a document written at a time when a person is of sound mind, of that individual’s preferences with respect to medical treatment, should they later become unable to express those wishes directly

> refers to a specific treatment in a specific circumstance rather than a general statement

The Mental Capacity Act 2005 makes clear that such advance directives are binding, unless the following exceptions apply:

> The decision has been subsequently withdrawn

> Power to make such decisions has been conferred to another person by creating a Lasting Power of Attorney

> Since making the will the patient has acted in a way that is clearly inconsistent with the advance decision remaining their fixed decision

> The person is not incapacitated and can decide for themselves

> The treatment in question is not that specified in the advance decision

> Any of the circumstances specified in the advance decision do not exist

> There ‘are reasonable grounds for believing that circumstances exist which the person did not anticipate at the time of the advance decision and which would have affected his decision at the time of the advance decision.’

Question 5

list circumstances where the procurator fiscal must be informed about an adult death

Answer 5

• sudden death
• deaths related to neglect or complaint
• drug-related death
• food poisoning
• death during administration of GA
• Legionnaire’s

Question 6

Describe the classical triad of symptoms associated with normal pressure hydrocephalus and its diagnosis and treatment

Answer 6

Dementia + gait abnormality + urinary incontinence

Diagnosis
- Lumbar puncture (normal CSF opening pressure)
- head CT or MRI: ventriculomegaly without sulcal enlargement

Treatment is with ventriculo-peritoneal shunting.