PLAB 1 Ethics Questions: 10 Free Practice MCQs
Ten PLAB 1-style ethics questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 38 ethics questions and many more across every topic.
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?
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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 / 10
A 14-year-old girl is assessed by her GP as Gillick competent and receives a subdermal contraceptive implant. Her mother discovers the implant two weeks later and contacts the GP surgery, demanding that the implant be removed immediately, stating that her daughter is a minor and she has parental responsibility.
What is the correct legal and professional course of action for the GP?
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Answer: A. Refuse to remove the implant without the daughter's consent, as a Gillick-competent minor's consent to treatment cannot be overridden by parental demands
Why: In UK law (Gillick v West Norfolk), a minor under 16 who has sufficient understanding and intelligence to fully understand what is proposed has the capacity to consent to treatment. Once a child is Gillick competent, parental authority to override that consent is lost. The GP must maintain confidentiality and cannot remove the implant unless the daughter herself consents.
- B. Removing the implant against the daughter's consent would constitute an assault and breach of confidentiality, violating her autonomy as a competent minor.
- C. This does not address the legal boundary; the key point is that the mother cannot demand removal, and the daughter's confidentiality must be maintained.
- D. Neither parent can override the consent of a Gillick-competent minor to receive or maintain treatment.
Sources: Gillick v West Norfolk [1985]; GMC Guidelines: Consent in children and young people
3 / 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?
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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
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4 / 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?
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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
5 / 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?
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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
6 / 10
An 82-year-old man with early-stage Alzheimer's disease writes a document expressing his preference to be cared for at home rather than in a nursing home, and stating he would prefer to receive palliative care and avoid hospital admissions if his condition deteriorates.
How is this document classified under the Mental Capacity Act 2005, and what is its legal standing?
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Answer: D. Advance Statement; it is not legally binding, but must be taken into account when determining the patient's best interests
Why: The Mental Capacity Act 2005 distinguishes between: (1) Advance Decisions to Refuse Treatment (ADRT), which are legally binding refusals of specific treatments, and (2) Advance Statements, which are statements of wishes, preferences, and values. Advance Statements are not legally binding, but they carry significant weight and must be documented and considered in any 'best interests' decision.
- A. This is a statement of positive preferences (where to be cared for) rather than a specific refusal of treatment, so it is an Advance Statement, not an ADRT.
- B. An LPA is a legal document appointing a proxy person, not a statement of the patient's own treatment preferences.
- C. 'Living Will' is an informal term; legally the MCA classifies these as either ADRTs (binding refusals) or Advance Statements (non-binding preferences).
Sources: Mental Capacity Act 2005; GMC Treatment and care towards the end of life
7 / 10
An 84-year-old woman with severe Alzheimer's dementia is admitted to a medical ward with urosepsis. She is disoriented, lacks decision-making capacity, and frequently attempts to wander out of the ward. To keep her safe, the ward doors are locked, and a nurse is assigned to monitor her 1:1, preventing her from leaving. She is not receiving treatment for a psychiatric disorder.
What is the appropriate legal framework required to authorize these restrictions on her liberty?
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Answer: D. Deprivation of Liberty Safeguards (DoLS) authorization under the Mental Capacity Act 2005
Why: Under the 'acid test' established in the Cheshire West Supreme Court ruling, a person is deprived of their liberty if they lack capacity, are under continuous supervision and control, and are not free to leave. In hospital medical wards, this must be authorized via the Deprivation of Liberty Safeguards (DoLS) pathway. If the patient has a mental illness requiring psychiatric ward admission, the Mental Health Act is used instead.
- A. The Mental Health Act is used for detaining patients for assessment/treatment of a mental disorder, not for physical treatment of urosepsis in a medical ward.
- B. While necessity allows immediate restraint in an emergency (e.g. stopping a patient running into traffic), it does not authorize ongoing, structured deprivation of liberty on a ward; DoLS is required.
- C. Under the Cheshire West ruling, a deprivation of liberty must be legally authorized even if it is in the patient's best interests; lack of capacity alone does not permit unauthorized deprivation.
Sources: Mental Capacity Act 2005 (Deprivation of Liberty Safeguards); Cheshire West Supreme Court Ruling [2014]
8 / 10
A 25-year-old conscious patient refuses a life-saving blood transfusion due to religious beliefs.
What is the most appropriate action?
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Answer: A. Assess capacity
Why: A competent adult has the absolute right to refuse treatment, even if that refusal leads to death. Capacity must be assumed unless there is evidence to the contrary.
- B. Competent adults can refuse treatment.
- C. Only if capacity is doubtful or in children.
- D. Family cannot override a competent adult's decision.
Sources: Mental Capacity Act 2005
9 / 10
A 30-year-old man is brought to the emergency department unconscious following a high-speed motorcycle crash. He has a fluctuating level of consciousness, a dilated right pupil, and a suspected extradural haematoma. He requires emergency intubation, CT head, and transfer to neurosurgery. No family members or friends are present, and there is no record of his medical history or wishes.
Under what legal authority should the medical team proceed with these emergency interventions?
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Answer: B. Principle of 'best interests' under the Mental Capacity Act 2005
Why: Under the Mental Capacity Act 2005, if a patient lacks capacity due to an acute event (such as unconsciousness from trauma), clinicians can provide necessary, life-saving treatment that is in the patient's best interests. Treatment should not be delayed to search for family or obtain consent unless there is clear evidence of a valid and applicable ADRT refusing such treatment.
- A. The police do not have the legal authority to consent to or authorize medical treatment for citizens.
- C. Implied consent is for minor non-invasive actions (e.g. rolling up a sleeve for a blood test), not major invasive interventions in unconscious patients.
- D. Seeking a court order in a life-threatening emergency is inappropriate as the delay would result in the patient's death.
Sources: Mental Capacity Act 2005; GMC Consent: Decision-making and consent
10 / 10
A 24-year-old patient contacts her GP practice manager. She requests that a consultation entry from 3 years ago, which details a consultation regarding an unwanted pregnancy and subsequent termination, be permanently deleted from her electronic health record. She states she is worried her family might access her records.
What is the correct response by the practice manager under UK data protection laws and GMC guidelines?
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Answer: C. Refuse to delete the entry, as clinical records are a factual account of consultations and must be preserved, but reassure the patient of confidentiality and discuss secure access controls (e.g. proxy access)
Why: Medical records are legal documents. Under the Data Protection Act 2018 (DPA) and GDPR Article 17, the 'right to erasure' (right to be forgotten) is restricted for health data, as processing is necessary for the purposes of preventative or occupational medicine, medical diagnosis, and the provision of health or social care. Patients cannot demand the deletion of factual clinical consults, though they can ask for inaccuracies to be corrected or note their objection.
- A. The right to erasure has exemptions; medical records are exempt as they are required for legal/clinical record-keeping and duty of care.
- B. Hiding entries from other healthcare staff involved in the patient's care can lead to clinical errors and is not standard practice.
- D. Refusal is based on statutory record-keeping duties and data accuracy laws, not on liability disclaimers.
Sources: Data Protection Act 2018 / GDPR; GMC Good Medical Practice: Keeping records
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