Professional Ethics, Law and Safeguarding
Ethics, law and safeguarding questions test consent, confidentiality, capacity and your duty to protect children and vulnerable adults. The exam often uses a short scenario where the right answer balances the woman's autonomy with legal obligations and professional accountability.
Core rules and concepts
- Valid consent requires capacity, sufficient information and voluntariness. The standard is what a reasonable person in the patient's position would want to know, including material risks (Montgomery).
- Capacity: assume capacity unless there is evidence otherwise. Assess understanding, retention, weighing and communication. Unwise decisions do not prove incapacity.
- Gillick and Fraser: a child under 16 may consent to contraception if they understand the implications and cannot be persuaded to involve parents. Confidentiality is maintained unless there is a safeguarding risk.
- Confidentiality: disclose only with consent or where required by law or public interest. Share on a need-to-know basis and document decisions.
- Safeguarding: ask about domestic abuse, female genital mutilation, trafficking and coercive control. Follow local safeguarding procedures. Female genital mutilation in a child is a mandatory report in the UK.
- Duty of candour: apologise, explain, remedy and record when harm occurs.
- Record keeping: contemporaneous, factual, signed and dated. Record conversations and escalation.
- Professional regulation: work within your scope, refer when needed and maintain competence.
Worked example
A 15-year-old asks for the contraceptive implant and says her parents must not know. Reasoning: assess Fraser competence, including understanding of sex, contraception, sexually transmitted infection risk and the benefits of parental involvement. If competent, provide confidential care and document the assessment. If there are concerns about coercion or abuse, safeguarding takes priority over confidentiality.
Traps
- Equating a decision you disagree with to incapacity.
- Telling parents automatically because the patient is under 16.
- Breaching confidentiality without a legal or safeguarding justification.
- Recording opinions as fact.
- Failing to escalate a disclosure of domestic abuse.
Key points
- Consent requires capacity, information and voluntariness; apply the Montgomery standard.
- Under-16s: assess Fraser competence; maintain confidentiality if competent.
- Safeguarding overrides confidentiality when there is risk of harm.
- Duty of candour: apologise, explain, remedy and record.
- Record contemporaneously and document escalation.