Consent, parental responsibility and mature-minor frameworks — viva

Stem

Examiner-led viva on a high-stakes adolescent consent scenario. [10]

Examiner: She is drowsy. How does that change your consent approach? [3]

Strong answer: Drowsiness is a red flag for transient incapacity. Before I treat her refusal as informed, I check reversible causes — oxygenation, perfusion, pain, glucose and evolving shock — because impaired consciousness can erode the four capacity domains. A refusal given in shock is not a valid refusal. [3]

Examiner: Assume she is now alert and oriented. What do you assess? [3]

Strong answer: I assess decision-making capacity for this specific, high-stakes, potentially irreversible decision across the four Appelbaum domains: does she understand the transfusion, appreciate that she could die without it, reason through the trade-off, and communicate a stable choice? I assess voluntariness and coercion, and I recognise that capacity for an irreversible life-saving refusal is a higher bar than for a low-risk decision. [3] [6]

Examiner: She is capable and refuses. Parents support her. What now? [10]

Strong answer: This is a genuine legal-ethical crisis, not a solo registrar override. I escalate immediately to the senior clinician on call and request an ethics consultation and legal input, because courts internationally have moved toward overriding refusal of life-saving treatment in minors under defined conditions. I treat the reversible threats now, document the capacity assessment, and pursue urgent judicial review. [10] [8]

Examiner: How does the harm principle fit here? [8]

Strong answer: The harm principle sets the threshold for overriding a refusal where the consequences are serious, foreseeable and imminent. In this case life is at stake, so the threshold is engaged — but for a capable minor the mechanism is judicial, via the courts, rather than unilateral clinical override. [8]

Examiner: The family asks for absolute confidentiality about all of this. Your reply? [1]

Strong answer: I am honest that confidentiality has limits, and that a life-threatening situation and safeguarding duties may override it. Promising absolute secrecy I cannot keep would itself undermine trust and valid consent. [1] [12]

Examiner: One key pitfall to avoid? [3]

Strong answer: Treating her age as capacity. Even an alert adolescent's capacity for an irreversible life-saving refusal must be assessed and documented domain by domain, with senior and legal input — never assumed. [3]