Consent and confidential care for adolescents — branching viva

Stem

The examiner will test whether you can run a consent and confidentiality encounter under pressure. [5] [4]

Branch 1 — Consent principles

Examiner: What are the pillars of valid consent, and how do consent, permission and assent differ? [5]

Strong answer: Valid consent needs capacity, information and voluntariness. Consent is the decision of someone with capacity; parental permission authorises care for a child who lacks capacity; assent is the age-appropriate agreement of the child, sought even when a parent gives permission. [5]

Examiner: What is the mature-minor or Gillick principle? [6]

Strong answer: A young person who can understand, retain, weigh and communicate a decision may consent in their own right. It is capacity-based and task-specific, not tied to a single age; local statute governs operative detail. [6] [7]

Branch 2 — Capacity at the bedside

Examiner: A 14-year-old refuses a recommended treatment. How do you judge capacity? [6]

Strong answer: Assess capacity for this decision specifically — understands the treatment, alternatives, risks and the consequence of refusal; retains it; weighs it in their own situation; communicates a stable, voluntary choice. Use teach-back. Check voluntariness and coercion. Re-assess if mental state or circumstances change. [6] [8]

Examiner: She is capable but the parents want you to override her. [8]

Strong answer: A capable minor's consent stands, but keep negotiating with the family where safe. If the refusal is of life-sustaining treatment, slow down and involve ethics and legal advice — this is high-stakes and contested. [6] [8]

Branch 3 — Confidentiality script and override

Examiner: Give your confidentiality line. [4]

Strong answer: Conditional confidentiality — private unless serious harm to self or others, abuse, or a legal duty to act; if that happens, I tell the young person what I must share and we plan it together. [4] [2]

Examiner: During the interview she discloses an active suicide plan for tonight and begs secrecy. [4]

Strong answer: Override ethically. Secure immediate safety, do not leave her alone, remove means if safe, escalate to ED or crisis teams. Tell her what must be shared and why, share the minimum necessary, involve parent or carer and safeguarding as required, and document the reasoning. [4]

Branch 4 — Electronic-record hazard

Examiner: Your portal is about to send an explanation-of-benefit that exposes her contraception visit to a parent. [9]

Strong answer: Modern confidentiality failure mode. Use local sensitive-note and confidential-content workflows, confirm confidential contact details, and check what the portal will release before it releases it. The Cures Act and open-notes era make this a live risk. [9]

Examiner: How do you preserve the relationship after an unavoidable breach? [1]

Strong answer: An ethical override that is told in advance, proportionate and explained can preserve trust. Stay engaged for follow-up so the breach does not become abandonment. [1] [4]

Examiner extras

• Capacity is task-specific; do not stamp "capable" once for all decisions. [6] [7]
• Never use family members as interpreters for sensitive or confidential content. [4]
• Encourage parent involvement where safe and the young person agrees — confidentiality and family are not opposites. [3]
• State the principle and check local statute; do not invent a universal consent age. [6] [4]