Ethics and law questions trip up more IMGs than any clinical topic — not because the medicine is hard, but because the legal framework is genuinely different from what you trained in. The GMC's Good Medical Practice and UK statute create a specific, consistent logic, and once you internalise that logic, these questions become reliable marks rather than coin-flips.
Why IMGs Lose Marks Here
The most common error is importing assumptions from your home country's consent culture. In many training environments, a senior doctor decides, family members are routinely consulted before patients, and confidentiality yields easily to institutional or family pressure. UK law and the GMC framework work differently — and PLAB 1 tests that difference deliberately.
The examiners are not testing whether you can recall a statute by name. They are testing whether you understand the underlying principle well enough to apply it to a clinical vignette you have never seen before. That is an important distinction: memorising facts will not protect you; understanding the reasoning will.
Capacity: The Principle That Drives Everything
The Mental Capacity Act 2005 (applicable in England and Wales) establishes that every adult must be assumed to have capacity unless it is established that they do not. This presumption of capacity is the single most tested concept in this area.
An MCQ on capacity will typically give you an adult who makes a decision you find alarming — refusing a blood transfusion, declining surgery for a gangrenous limb, insisting on leaving hospital. The distractor answers will include "consult the family," "refer to a senior colleague to decide," or "override the decision in the patient's best interests." The correct answer will almost always be to respect the decision, provided the patient demonstrates they can:
- Understand the information given to them
- Retain it long enough to make a decision
- Weigh it up and use it
- Communicate their decision
If all four are present, the patient has capacity. Full stop. Their choice may seem unwise, even dangerous — that is legally irrelevant. The GMC's Good Medical Practice reinforces this: patient autonomy is not a courtesy you extend when you agree with the decision; it is a right you uphold when you do not.
Where capacity is genuinely absent, the decision moves to the patient's best interests — not to what the family wants, which is a separate matter. Family members, including next of kin, have no legal authority to consent or refuse on behalf of an incapacious adult unless they hold a relevant Lasting Power of Attorney. Examiners test this distinction regularly.
Gillick Competence and the Under-16s
Questions about consent in patients under 16 almost always follow one of two patterns: a young person requesting contraception or sexual health advice, or a young person seeking treatment that a parent opposes (or vice versa).
The principle from Gillick v West Norfolk and Wisbech AHA (widely referenced in GMC guidance) is this: a young person under 16 who fully understands the nature and consequences of the proposed treatment can consent to it themselves. You do not need parental involvement if the young person is Gillick competent and it would not be in their interest to involve parents.
The practical MCQ trap is the reverse scenario — a parent refusing treatment for a child. A competent young person can consent independently, but cannot refuse a treatment in a way that is absolutely binding when the refusal would result in serious harm. The court, or those with parental responsibility, can authorise treatment in that situation. This asymmetry catches candidates who apply the principle too broadly.
Confidentiality: When Disclosure Is Justified
The GMC's guidance on confidentiality is clear: information shared in a consultation is confidential and should not be disclosed without consent. But the guidance also identifies the circumstances where disclosure without consent is justified — and these are exactly what PLAB 1 tests.
Disclosure is justified when:
- There is a serious, identifiable risk to a third party — for example, a patient with uncontrolled epilepsy who continues to drive despite your advice, or a patient who discloses an intention to harm a named person
- It is required by law — notifiable diseases, certain court orders
- It is in the overwhelming public interest — a narrower and more carefully applied test than it sounds
The MCQ pattern here is a vignette in which a patient discloses something alarming but refuses to allow you to tell anyone. The distractor answers include doing nothing (respecting confidentiality absolutely) or immediately involving police without any further steps. The correct answer usually involves first encouraging the patient to disclose themselves, making clear you may have to act, and then disclosing to the appropriate authority if the risk is serious and imminent.
Sharing information with a patient's GP without consent, sharing with employers, or informing family members who ask — these are not automatically justified. Each requires a specific rationale.
Drilling these scenarios as single-best-answer questions in the Ant PLAB question bank, and reviewing the detailed explanations for each wrong option, will make the distinctions between these situations intuitive rather than theoretical.
The Duty of Candour
Since the introduction of the statutory duty of candour in England (reinforced in GMC Good Medical Practice), doctors are required to be open and honest with patients when something goes wrong that causes, or has the potential to cause, harm. This applies even if the patient has not yet noticed that anything has gone wrong.
The MCQ pattern is a clinical error or near-miss. The distractor answers include waiting to see whether harm materialises, discussing it with colleagues before deciding whether to tell the patient, or only disclosing if the patient asks. The correct answer is to inform the patient, acknowledge what happened, apologise (which is not an admission of legal liability — examiners know candidates conflate these), and ensure they know what is being done to address it.
Covering up an error — even a minor one — is a fitness-to-practise matter. That weight behind the concept is what gives it its force in both clinical practice and MCQ design.
Putting It Together in the Exam
These four areas — capacity, Gillick competence, confidentiality, and duty of candour — share a common examiner strategy: they all test whether you default to paternalism under pressure. The vignette is constructed to make the paternalistic answer feel safe and responsible. It rarely is.
Before you select an answer in this domain, ask yourself: whose autonomy am I protecting, and am I using a genuine legal or ethical justification, or just discomfort with the patient's choice?
The Ant PLAB question bank's analytics will show you which of these blueprint areas you are dropping marks in — useful if you have limited revision time and need to prioritise.
FAQ
Is a patient's next of kin legally able to refuse treatment on their behalf? No. Next of kin have no automatic legal authority to make medical decisions for an incapacious adult in England and Wales. That authority rests with the clinical team acting in the patient's best interests, unless the patient has granted a relevant Lasting Power of Attorney to a named person.
Can a 15-year-old consent to their own treatment without parental involvement? Yes, if they are assessed as Gillick competent — meaning they demonstrate sufficient understanding of the nature, purpose, and consequences of the proposed treatment. The treating clinician makes that assessment; there is no fixed age threshold below 16.
Does apologising to a patient after an error count as admitting legal liability? No. The GMC is explicit that offering an apology is not an admission of legal liability. Under the duty of candour, doctors are expected to apologise when harm occurs; failing to do so on legal grounds is not a sound defence and would itself raise professional concerns.