PLAB 1 Consent and capacity Questions: 10 Free Practice MCQs

Ten PLAB 1-style consent and capacity questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 45 consent and capacity questions and many more across every topic.

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1. 1 / 10

   A 78-year-old male is admitted with a severe upper gastrointestinal bleed. He is vomiting blood, and his blood pressure is 85/50 mmHg. The medical team determines that an urgent blood transfusion is required to save his life. The patient, who is fully alert, coherent, and understands the risks of refusing, states that he does not want a blood transfusion due to personal beliefs. He does not have an advance decision or a lasting power of attorney.

   What is the most appropriate course of action for the medical team?

   • A. Respect the patient's refusal and do not administer the blood transfusion
   • B. Obtain consent from the patient's next of kin and proceed with the transfusion
   • C. Administer the transfusion under the doctrine of necessity as it is a life-saving emergency
   • D. Apply to the Court of Protection for an emergency order to administer the blood transfusion
   Show answer

   Answer: A. Respect the patient's refusal and do not administer the blood transfusion

   Why: Under the Mental Capacity Act 2005 and GMC Good Medical Practice, if an adult patient has the capacity to make a decision, their decision must be respected. This includes a decision to refuse life-saving treatment (such as a blood transfusion). Next of kin cannot consent on behalf of a competent patient, and emergency necessity cannot override a valid competent refusal.

   • B. In UK law, no adult can consent to or refuse medical treatment on behalf of another competent adult. Next of kin have no legal authority to override a competent patient's decision.
   • C. The doctrine of necessity only applies if a patient lacks capacity and their wishes are unknown. It cannot be used to override a competent refusal.
   • D. The Court of Protection resolves disputes when a patient lacks capacity. It has no jurisdiction to force treatment on a competent patient.

   Sources: GMC Good Medical Practice; Mental Capacity Act 2005

2. 2 / 10

   A 16-year-old who received confidential contraceptive care asks her GP to remove an implant because of persistent spotting. Her mother sees the appointment reminder on a shared calendar and phones the practice demanding the reason for the visit and removal. The young person has not authorised disclosure and there is no known safeguarding concern.

   What should the GP do?

   • A. Decline to confirm confidential details, invite the young person to discuss whether she wants her mother involved, and assess any concern about her welfare.
   • B. Remove the implant at the mother's request because a parent can overrule contraception consent given by a competent person under 16.
   • C. Tell the mother the details because she has already discovered the implant.
   • D. Refuse to speak to the young person again unless her mother attends.
   Show answer

   Answer: A. Decline to confirm confidential details, invite the young person to discuss whether she wants her mother involved, and assess any concern about her welfare.

   Why: GMC guidance permits confidential contraceptive advice and treatment for an under-16 who meets the specified criteria. The GP should not disclose the consultation or remove treatment at a parent's demand without considering the young patient's own views and consent. The clinician should still assess safeguarding concerns if facts emerge that justify sharing information in the young person's best interests or public interest.

   • B. A parent cannot automatically overrule the decision of a young person who is competent to consent.
   • C. The mother's discovery does not itself authorise the GP to disclose information from a confidential consultation.
   • D. This would undermine access to confidential care and is not required by GMC guidance.

   Sources: GMC, 0-18 years: confidentiality and contraception, abortion and sexually transmitted infections

3. 3 / 10

   In England and Wales, a 58-year-old man with advanced motor neurone disease has capacity and asks his palliative care doctor to prescribe a dose intended to end his life. He is frightened of future breathlessness and has not yet had a review of symptom control or palliative support.

   What is the most appropriate response?

   • A. Prescribe the lethal dose because the patient has capacity, understands the outcome, and insists that this is his settled decision.
   • B. Refuse to discuss the request because it is a criminal matter.
   • C. Explain that the lethal prescription cannot be provided, explore the fear and symptoms prompting the request, and offer palliative care and future-care planning.
   • D. Refer him to psychiatry because a request to end life proves that he lacks capacity.
   Show answer

   Answer: C. Explain that the lethal prescription cannot be provided, explore the fear and symptoms prompting the request, and offer palliative care and future-care planning.

   Why: The doctor should respond compassionately, explore the fear of breathlessness, review symptom management, and discuss palliative and future-care options. Section 2 of the Suicide Act 1961 makes intentional acts capable of encouraging or assisting suicide an offence in England and Wales. A capacitous patient may refuse treatment, but the doctor cannot provide a lethal prescription to bring about death.

   • A. Capacity supports the patient's right to make decisions about treatment, but it does not make intentional assistance with suicide lawful.
   • B. The doctor must not assist suicide, but should listen, explore the patient's fears, and continue providing care.
   • D. The request alone does not prove incapacity; capacity is presumed unless there is a specific reason to assess it.

   Sources: Suicide Act 1961, section 2; GMC, Treatment and care towards the end of life: good practice in decision making

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5. 4 / 10

   A 34-year-old man presents with a 2-day history of a dry cough, rhinorrhoea, and a sore throat. He has no fever and chest is clear. The GP explains it is a viral upper respiratory tract infection and advises rest and paracetamol. The patient becomes angry and demands a prescription for oral Amoxicillin, stating: 'I know my body and I need antibiotics.'

   What is the GP's professional obligation in this scenario?

   • A. Prescribe the Amoxicillin to maintain the doctor-patient relationship and avoid conflict, documenting that the patient requested it
   • B. Offer a private prescription for Amoxicillin so the NHS does not bear the cost of a treatment that is not clinically indicated
   • C. Refuse to prescribe the antibiotics, explain the reasons for the decision, and offer advice on symptomatic management
   • D. Suggest the patient purchase the antibiotics over-the-counter from a pharmacy
   Show answer

   Answer: C. Refuse to prescribe the antibiotics, explain the reasons for the decision, and offer advice on symptomatic management

   Why: GMC Good Medical Practice states that doctors must prescribe drugs only when they are satisfied they serve the patient's needs. Patients have a right to refuse treatment, but they do not have a right to demand treatments that are clinically inappropriate. The GP should explain that antibiotics are ineffective against viral infections and discuss antimicrobial resistance.

   • A. Prescribing antibiotics when not indicated is clinically inappropriate, contributes to antimicrobial resistance, and violates prescribing guidelines.
   • B. Whether the prescription is NHS or private is irrelevant; if a drug is not clinically indicated, it should not be prescribed.
   • D. Antibiotics are prescription-only medicines (POM) in the UK and cannot be purchased over-the-counter.

   Sources: GMC Good practice in prescribing and managing medicines and devices; NICE NG63: Antimicrobial stewardship

6. 5 / 10

   A 42-year-old man is admitted to the emergency department with severe necrotising fasciitis of his right lower limb. He is hemodynamically unstable, and the surgical consultant determines that an emergency amputation is required immediately to save his life. The patient is conscious, alert, and fully understands that he will die without the surgery. However, he refuses to consent, stating he would rather die than live without his leg.

   What is the most appropriate course of action for the medical team?

   • A. Perform the amputation under the principle of 'best interests' to save the patient's life
   • B. Formally assess the patient's capacity; if he has capacity, his refusal must be respected, and surgery cannot be performed
   • C. Obtain consent from the patient's next of kin and proceed with the surgery as a life-saving emergency
   • D. Detain the patient under Section 2 of the Mental Health Act 1983 to authorize the surgery, as refusal of life-saving care implies a mental disorder
   Show answer

   Answer: B. Formally assess the patient's capacity; if he has capacity, his refusal must be respected, and surgery cannot be performed

   Why: Under English law and the Mental Capacity Act 2005, a person is presumed to have capacity. A competent adult has the absolute right to refuse medical treatment, even if it is life-saving and the refusal results in death. The doctor's duty of beneficence is overridden by the patient's autonomy. If capacity is present after formal assessment, the refusal must be respected, and palliative care should be offered.

   • A. The principle of 'best interests' only applies when a patient lacks capacity. Performing surgery on a competent patient who refuses constitutes battery and a breach of autonomy.
   • C. No relative has the authority to consent to or refuse treatment on behalf of a competent adult in UK law.
   • D. The Mental Health Act cannot be used to detain a patient to authorize treatment for physical illnesses, unless the refusal is directly caused by a mental disorder, which is not the case for this rational refusal.

   Sources: Mental Capacity Act 2005; GMC Consent: Decision-making and consent

7. 6 / 10

   A 75-year-old woman with advanced dementia is admitted to a care home for assessment. She has a history of falls and is at risk of further injury. The care home staff wish to implement a fall prevention strategy, including the use of a bed rail to prevent her from getting out of bed.

   What is the most appropriate course of action regarding the patient's consent?

   • A. Obtain the patient's explicit consent to the use of the bed rail
   • B. Perform the procedure without the patient's consent, as it is in her best interests
   • C. Involve the patient's family in the decision-making process and obtain their consent
   • D. Keep the patient in a single room with minimal supervision, as this is less restrictive than using a bed rail
   Show answer

   Answer: B. Perform the procedure without the patient's consent, as it is in her best interests

   Why: In situations where a patient lacks capacity to make decisions about their own care, healthcare professionals must act in their best interests. This may involve performing procedures that are necessary to prevent further injury or harm, even if the patient is unable to provide consent. In this scenario, the use of a bed rail is necessary to prevent further injury and ensure the patient's safety and well-being.

   • A. This is not feasible, as the patient lacks capacity to make decisions about her own care.
   • C. The patient's family may not be able to provide informed consent on her behalf, and the patient's autonomy should be respected.
   • D. This would be a breach of the patient's safety and well-being, and could potentially lead to further injury.

   Sources: Mental Capacity Act 2005; GMC Guidance on Consent

8. 7 / 10

   In England, a 72-year-old with mild dementia and suspected urosepsis refuses blood cultures and an intravenous cannula, saying, “No needles.” They are alert but have not yet been asked to explain the proposed treatment or its consequences.

   What should the junior doctor do first?

   • A. Proceed immediately because suspected sepsis overrides consent
   • B. Assess capacity for this specific decision and support the patient to decide
   • C. Use the Mental Health Act to detain the patient for antibiotics
   • D. Ask an old-age psychiatrist to determine capacity before speaking with the patient
   Show answer

   Answer: B. Assess capacity for this specific decision and support the patient to decide

   Why: The doctor should explain the proposed procedures and assess capacity for this decision, offering practical support. Dementia or refusal alone does not establish incapacity, and the Mental Health Act does not authorise treatment for physical illness.

   • A. Urgency does not remove the need to seek consent or assess capacity; emergency treatment without consent is limited to appropriate circumstances.
   • C. The Mental Health Act is not a route to authorise treatment for a physical illness such as urosepsis.
   • D. A clinician involved in care can assess capacity; specialist advice is useful only if the assessment is complex or disputed.

   Sources: Mental Capacity Act 2005, sections 1 to 3

9. 8 / 10

   A 60-year-old man with a learning disability is staying on a psychiatric ward after a fall. Staff are considering bed rails, but he says he dislikes being enclosed. The team has not yet explained the purpose, checked his understanding, or considered alternatives such as a low bed and assisted toileting.

   What is the most appropriate next step?

   • A. Discuss the options accessibly, assess his capacity for this decision, and consider the least restrictive safe plan.
   • B. Fit bed rails without asking because preventing falls is the ward duty and a safety measure never requires consent or review.
   • C. Leave him at risk of another fall because any safety intervention would be unlawful.
   • D. Delay all discussion until a formal psychiatric capacity report is completed.
   Show answer

   Answer: A. Discuss the options accessibly, assess his capacity for this decision, and consider the least restrictive safe plan.

   Why: The MCA requires capacity to be presumed and assessed for the particular decision after practical support has been provided. If the patient has capacity, his choice must be respected; if he lacks capacity, the team should make a documented, proportionate best-interests decision. Less restrictive measures should be considered, and any restraint or deprivation-of-liberty implications reviewed.

   • B. The ward's safety duty does not remove the need to consider consent, capacity, proportionality, and the patient's wishes.
   • C. The team should assess and manage risk; the MCA does not prohibit proportionate safety measures.
   • D. A psychiatric report is not automatically required; the responsible clinician can assess decision-specific capacity with appropriate support.

   Sources: Mental Capacity Act 2005, sections 1-4; Mental Capacity Act 2005 Code of Practice

10. 9 / 10

    A 15-year-old boy is diagnosed with acute lymphoblastic leukaemia. He is assessed by the clinical psychologist and lead oncologist as being Gillick competent to make treatment decisions. He states he understands the prognosis but refuses to consent to the recommended chemotherapy regimen because he is terrified of hair loss and nausea, and states he would rather let the disease take its course.

    What is the legal position under English law regarding overriding this minor's refusal of life-saving treatment?

    • A. His refusal can be overridden by a person holding parental responsibility or by a court order, as a minor's refusal of life-saving treatment is not legally absolute
    • B. His refusal is legally binding because he is Gillick competent, and no treatment can be administered, in the same way as an adult's refusal under the Mental Capacity Act
    • C. The medical team can immediately administer the chemotherapy without parental consent or court order, under emergency doctrine
    • D. The patient must be detained under the Mental Health Act to authorize the chemotherapy, since refusing curative treatment indicates impaired judgement
    Show answer

    Answer: A. His refusal can be overridden by a person holding parental responsibility or by a court order, as a minor's refusal of life-saving treatment is not legally absolute

    Why: In English law, the legal status of minors (under 18) differs from adults. Under Gillick principles, a child under 16 can consent to treatment if they have sufficient understanding. However, case law (Re R [1991] and Re W [1992]) established that a minor's refusal does not have the same veto power. Consent from a parent or the court can 'flak jacket' the doctor against liability, allowing them to treat despite the child's refusal.

    • B. Unlike competent adults, a Gillick-competent minor's refusal is not legally absolute and can be overridden by parents or the court under English law.
    • C. Chemotherapy is a planned, ongoing treatment and not an immediate acute resuscitation event; overriding the refusal requires formal parental consent or a court order.
    • D. The Mental Health Act is not used to authorize physical treatments for physical disease in patients refusing due to side effects.

    Sources: Re R [1991] / Re W [1992] case law; GMC Guidelines: Consent in children and young people

11. 10 / 10

    On the day of elective surgery, a 29-year-old who could become pregnant says there is a possibility they may be pregnant.

    What should the team do about pregnancy testing?

    • A. Explain the anaesthetic and procedural risks, discuss testing sensitively, obtain consent if there is doubt, and document the discussion
    • B. Perform a pregnancy test without discussion or consent, as it is a routine part of preoperative checks for everyone
    • C. Proceed without asking because pregnancy status is private and the operation is elective
    • D. Cancel surgery automatically without assessment and rebook after the next period
    Show answer

    Answer: A. Explain the anaesthetic and procedural risks, discuss testing sensitively, obtain consent if there is doubt, and document the discussion

    Why: NICE NG45 recommendations 1.3.1 to 1.3.4 advise sensitively asking on the day of surgery, explaining anaesthetic and procedural risks to the fetus, documenting discussions, and testing with consent if there is doubt about possible pregnancy.

    • B. NICE recommends a test with the person’s consent if there is doubt.
    • C. NICE recommends sensitively asking all women of childbearing potential on the day of surgery.
    • D. NICE calls for discussion and consent-based testing where doubt exists, not automatic cancellation in every case.

    Sources: NICE NG45 recommendations 1.3.1 to 1.3.4

Exam-style questions written by MedHub for practice. They are not official exam questions.