Medical Ethics, Law and Professionalism: Duties in Context
Core concepts
Ethics and law questions test the application of principles to specific facts. Know the four principles - autonomy, beneficence, non-maleficence, justice - and how they interact when they conflict. Understand consent: capacity, voluntariness, and adequate information, including the standard of what a reasonable patient would want to know. Learn the legal framework for treating patients without capacity, the role of advance decisions, and the limits of proxy decision-making.
Confidentiality is a duty with defined exceptions: consent, statutory reporting, court order, and public interest where the risk is serious and identifiable. Understand professional boundaries, the duty of candour after harm, and the management of complaints and errors. Know the principles of resource allocation and the difference between clinical and distributive decisions. Understand the regulation of medical practice, the meaning of registration, and the process of appraisal and revalidation.
Traps
Questions often present a competent adult refusing treatment that the doctor believes is best - autonomy prevails. Beware of confusing the duty to report with a general permission to disclose. Do not assume a relative can consent for an adult without capacity; the decision is made in the patient's best interests under the legal framework.
Rule of thumb
For any ethics question, identify the competing duties, then ask whose decision it is. If the patient has capacity, the decision is theirs.
Worked example
A competent adult Jehovah's Witness refuses a blood transfusion that is likely to be life-saving. The refusal must be respected after confirming capacity and ensuring the decision is informed and voluntary; the team should document carefully and continue all other care.