Membership of the Royal College of General Practitioners (MRCGP) Medical Ethics, Law and Safeguarding Syllabus

Medical Ethics, Law and Safeguarding syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Medical Ethics, Law and Safeguarding in Membership of the Royal College of General Practitioners (MRCGP), not a summary of it.

1. 1

   Core Ethical and Legal Principles

   5 topics

   • Consent and mental capacity
     • Mental Capacity Act and best interests
     • Gillick competence and Fraser guidelines
   • Confidentiality and disclosure
     • Public interest disclosure
     • Information sharing with third parties
   • The four principles of medical ethics
   • GMC Good Medical Practice standards
   • Complaints, candour and duty of candour
2. 2

   End-of-Life Care and Mental Health Law

   5 topics

   • Advance care planning and advance decisions
   • DNACPR and ReSPECT processes
   • Lasting power of attorney
   • Mental Health Act sections and community treatment
   • Deprivation of liberty safeguards
3. 3

   Safeguarding Children and Adults

   6 topics

   • Recognising child maltreatment
     • Physical, emotional and sexual abuse
     • Neglect and fabricated illness
   • Safeguarding referral pathways and multi-agency working
   • Domestic abuse identification and response
   • Vulnerable adults and adult safeguarding
   • Female genital mutilation and modern slavery duties
   • Prevent duty and radicalisation awareness

Medical Ethics, Law and Safeguarding flashcards for Membership of the Royal College of General Practitioners (MRCGP)

25 of 51 cards from the Medical Ethics, Law and Safeguarding deck — real questions with worked answers.

1. What are the two stages of the test for mental capacity under the Mental Capacity Act 2005?

   Stage 1 (diagnostic test): Is there an impairment of, or disturbance in, the functioning of the mind or brain? Stage 2 (functional test): Does that impairment mean the person is unable to make this particular decision at this time?

2. Under the Mental Capacity Act 2005, what four abilities must a person have to be deemed to have capacity for a decision?

   They must be able to: (1) Understand the information relevant to the decision, (2) Retain that information, (3) Use or weigh it as part of the decision-making process, and (4) Communicate their decision (by any means).

3. List the five statutory principles of the Mental Capacity Act 2005.

   1) Presume capacity. 2) Support the person to make their own decision before treating them as unable. 3) An unwise decision does not itself indicate lack of capacity. 4) Acts/decisions for someone lacking capacity must be in their best interests. 5) Choose the least restrictive option for their rights and freedoms.

4. What are the three core elements of valid consent to treatment?

   Consent must be: (1) given by a person with capacity, (2) voluntary (free from coercion or undue influence), and (3) informed (the person understands the nature, purpose, risks, benefits and alternatives).

5. What did the Montgomery v Lanarkshire (2015) ruling establish about consent and risk disclosure?

   Doctors must disclose any material risk — a risk to which a reasonable person in the patient's position would attach significance, or that this particular patient would. It replaced the doctor-centred Bolam test for consent with a patient-centred standard of informed consent.

6. At what age is a person in England presumed to have capacity to consent to their own medical treatment, and what concept applies to younger children?

   At 16 a young person is presumed competent to consent to treatment. Children under 16 may consent if they are 'Gillick competent' — having sufficient understanding and intelligence to fully appreciate what is proposed.

7. What are the four principles of medical ethics (Beauchamp and Childress)?

   Autonomy (respecting the patient's right to self-determination), Beneficence (acting in the patient's best interest), Non-maleficence (avoiding harm; 'first do no harm'), and Justice (fair distribution of benefits, risks and resources).

8. Distinguish beneficence from non-maleficence.

   Beneficence is the active duty to do good and promote the patient's wellbeing; non-maleficence is the duty to avoid causing harm ('primum non nocere'). Beneficence is a positive obligation to act; non-maleficence is largely a negative obligation to refrain from harm.

9. What are the four domains of the GMC's Good Medical Practice (2024)?

   Domain 1: Knowledge, skills and development. Domain 2: Patients, partnership and communication. Domain 3: Colleagues, culture and safety. Domain 4: Trust and professionalism.

10. According to GMC guidance, what is a doctor's duty when a patient lacks capacity and there is no one to consult about their best interests?

    For serious medical decisions, an Independent Mental Capacity Advocate (IMCA) must be instructed to represent and support the person who has no appropriate family or friends to consult.

11. Define a 'patient's confidentiality' duty and name the legal/professional sources that underpin it.

    The duty to keep patient information private and use it only for the purpose for which it was given. It is underpinned by the common law duty of confidence, the Data Protection Act 2018/UK GDPR, the Human Rights Act 1998 (Article 8), and GMC professional guidance.

12. Name the broad circumstances in which a doctor may lawfully disclose confidential patient information without consent.

    (1) Required by law (e.g. statutory notification, court order); (2) In the public interest (preventing serious harm/crime); (3) Where it is in the patient's vital interests and they lack capacity; and where consent is the basis it is not 'without consent'. Disclosure should be the minimum necessary.

13. What is the 'public interest' test for breaching confidentiality?

    Disclosure without consent may be justified when the benefit to an individual or society of disclosing outweighs both the public and patient's interest in keeping the information confidential — typically to prevent a risk of death or serious harm.

14. Give three examples of conditions or events that require statutory notification, overriding usual confidentiality.

    Notifiable infectious diseases (e.g. measles, TB, COVID-19) to public health; births and deaths; female genital mutilation in under-18s (to police); and certain road traffic incidents (identifying a driver) under the Road Traffic Act.

15. What is the statutory 'duty of candour' and which two bodies set it out?

    A legal and professional duty to be open and honest with patients (or families) when something goes wrong and harm has or may have occurred. It is set by the CQC (organisational duty, Regulation 20, Health and Social Care Act 2008 regulations) and by the GMC/NMC (individual professional duty).

16. List the key steps a clinician must take to fulfil the professional duty of candour after a patient safety incident.

    Tell the patient (or family) when something has gone wrong; apologise/say sorry; offer an appropriate remedy or support; and explain fully and promptly the short- and long-term effects of what happened. Document the conversation.

17. Distinguish between a complaint, an apology, and an admission of liability in the context of candour.

    An apology (saying sorry) is an expression of sorrow or regret and is NOT an admission of legal liability. The duty of candour requires apology and explanation; it does not require admitting legal fault, which is a separate determination.

18. What is an Advance Decision to Refuse Treatment (ADRT) and when is it legally binding?

    A decision made by a person with capacity to refuse specified treatment in future when they lack capacity. It is legally binding if the person was 18+, had capacity when making it, it is valid and applies to the situation. To refuse life-sustaining treatment it must be in writing, signed, witnessed and state it applies 'even if life is at risk'.

19. How does an advance statement differ from an advance decision (ADRT)?

    An advance statement expresses a person's wishes, preferences and values (e.g. where they want to be cared for) and is not legally binding but must be considered in best-interests decisions. An ADRT specifically refuses named treatments and, if valid and applicable, is legally binding.

20. What is advance care planning (ACP)?

    A voluntary process of discussion between a person, their care providers and often family about their future wishes and priorities for care, anticipating possible deterioration and loss of capacity. It may produce advance statements, ADRTs, and decisions about preferred place of care/death.

21. What does a DNACPR decision mean, and what does it NOT mean?

    DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) means CPR will not be attempted if the heart/breathing stops. It does NOT affect any other treatment — the patient continues to receive all other appropriate active or palliative care.

22. Is patient consent legally required to make a DNACPR decision, and what is the clinician's duty?

    Consent is not legally required because CPR is a clinical decision and no one can demand treatment that will not work. However, there is a legal duty (per Tracey, 2014) to consult and inform the patient (or, if they lack capacity, those close to them) unless doing so would cause physical or psychological harm.

23. What is the ReSPECT process and how does it differ from a standalone DNACPR form?

    ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) creates personalised recommendations for a person's clinical care in a future emergency. Unlike a standalone DNACPR, it records preferences for all emergency treatment (including but not limited to CPR), balancing realistic goals with the patient's priorities.

24. What are the two types of Lasting Power of Attorney (LPA) in England and Wales?

    (1) Property and Financial Affairs LPA, and (2) Health and Welfare LPA. They must be registered with the Office of the Public Guardian to be valid.

25. What additional condition must a Health and Welfare LPA contain for the attorney to refuse life-sustaining treatment?

    The LPA document must explicitly state that the attorney has authority to give or refuse consent to life-sustaining treatment; without this specific provision, the attorney cannot make such decisions and they fall to the clinical team in the person's best interests.

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