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

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.

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.

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.

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.

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.

A valid ADRT and a Health & Welfare LPA conflict over refusing treatment. Which takes precedence?

Whichever was made LATER takes precedence. An LPA made after a valid ADRT (giving the attorney relevant authority) overrides the ADRT; an ADRT made after the LPA was granted overrides the attorney's decision on that treatment.

What is the purpose and duration of detention under Section 2 of the Mental Health Act 1983?

Section 2 is admission for assessment (and treatment) for up to 28 days. It cannot be renewed; it requires two doctors (one Section 12 approved) and an Approved Mental Health Professional (AMHP).

What is the purpose and duration of detention under Section 3 of the Mental Health Act 1983?

Section 3 is admission for treatment for up to 6 months initially, renewable (for a further 6 months, then yearly). It requires two doctors and an AMHP, and a known diagnosis with an identified treatment plan.

Compare Section 4, Section 5(2) and Section 5(4) of the Mental Health Act.

Section 4: emergency admission for assessment, up to 72 hours, one doctor + AMHP. Section 5(2): doctor's holding power for an already-admitted inpatient, up to 72 hours. Section 5(4): nurse's holding power, up to 6 hours, to await a doctor.

Compare police powers under Section 135 and Section 136 of the Mental Health Act.

Section 135: police enter a private property (with a warrant) to remove a person to a place of safety. Section 136: police remove a person from a public place to a place of safety. Both last up to 24 hours (extendable to 36) for assessment.

What is a Community Treatment Order (CTO) under the Mental Health Act, and who can be placed on one?

A CTO (Section 17A) allows a patient previously detained under Section 3 (or equivalent) to be treated in the community under conditions, with a power of recall to hospital if needed. It is made by the Responsible Clinician with AMHP agreement.

What are the Deprivation of Liberty Safeguards (DoLS) and which Act do they sit under?

DoLS are part of the Mental Capacity Act 2005. They provide legal authorisation to deprive a person who lacks capacity of their liberty in a hospital or care home, where this is necessary and in their best interests, with safeguards to protect their rights.

What is the 'acid test' for a deprivation of liberty established in Cheshire West (2014)?

A person is deprived of their liberty if they are (1) under continuous supervision and control AND (2) not free to leave — regardless of whether they object, the placement is comfortable, or the purpose is benign.

What scheme is intended to replace DoLS, and what is one key way it differs?

The Liberty Protection Safeguards (LPS). It is designed to extend protections beyond hospitals and care homes (e.g. to supported living and people's own homes), cover ages 16+, and streamline the authorisation process.

What does the safeguarding mnemonic and category list for child maltreatment include?

The four categories of child abuse are: Physical abuse, Emotional (psychological) abuse, Sexual abuse, and Neglect. Neglect is the most common category.

List clinical features that should raise suspicion of physical child maltreatment ('red flags').

Injuries inconsistent with the history or developmental stage; delayed presentation; bruising in a non-mobile baby; injuries to protected sites (ears, neck, inner thighs, buttocks); patterned marks (bites, ligatures); fractures (especially metaphyseal, rib, multiple ages); and frequent attendances.

What is the key legal principle governing all safeguarding decisions about children, and which Act sets it?

The child's welfare is the paramount consideration. This 'paramountcy principle' is set out in the Children Act 1989 (Section 1).

What is the difference between a Section 17 'child in need' and a Section 47 enquiry under the Children Act 1989?

Section 17: duty to safeguard and promote the welfare of a 'child in need' (needs services to achieve a reasonable standard of health/development). Section 47: a more urgent statutory duty for the local authority to investigate where there is reasonable cause to suspect a child is suffering, or likely to suffer, significant harm.

Outline the basic safeguarding referral pathway when a clinician suspects a child is at risk.

Recognise and document concerns; discuss with the named/designated safeguarding lead; refer to local authority children's social care (MASH); if a child is at immediate risk, contact police (999); share information on a need-to-know basis; follow up the verbal referral in writing (usually within 48 hours).

What does MASH stand for and what is its function in multi-agency working?

Multi-Agency Safeguarding Hub. It co-locates professionals from agencies (social care, police, health, education) to share information, triage safeguarding referrals, assess risk and coordinate a proportionate response.

Define domestic abuse as set out in the Domestic Abuse Act 2021.

Abusive behaviour between people aged 16+ who are 'personally connected', where the behaviour is physical/sexual abuse, violent/threatening behaviour, controlling or coercive behaviour, economic abuse, or psychological/emotional/other abuse. The Act also recognises children who see, hear or experience the abuse as victims.

What is coercive control and why is it significant in domestic abuse?

A pattern of acts of assault, threats, humiliation, intimidation or other abuse used to harm, punish, frighten and control a victim. It is a criminal offence (Serious Crime Act 2015 / Domestic Abuse Act 2021) and is a strong predictor of escalation and serious harm.

Name a validated tool used to assess risk in domestic abuse and the high-risk referral pathway.

The DASH (Domestic Abuse, Stalking and Honour-based violence) risk checklist. High-risk cases are referred to MARAC (Multi-Agency Risk Assessment Conference) and an IDVA (Independent Domestic Violence Advisor) can support the victim.

Define a 'vulnerable adult' / 'adult at risk' under the Care Act 2014.

An adult who (a) has needs for care and support (whether or not the authority is meeting them), (b) is experiencing, or at risk of, abuse or neglect, and (c) as a result of those needs is unable to protect themselves from the abuse or neglect.

List the categories of abuse recognised in adult safeguarding under the Care Act 2014.

Physical, sexual, psychological/emotional, financial/material, neglect and acts of omission, discriminatory, organisational/institutional, domestic, modern slavery, and self-neglect (10 categories).

What are the six safeguarding principles under the Care Act 2014?

Empowerment, Prevention, Proportionality, Protection, Partnership, and Accountability.

What is the FGM mandatory reporting duty for healthcare professionals?

Regulated health and social care professionals and teachers in England and Wales must personally report to the police any case where a girl under 18 discloses she has had FGM, or where they observe physical signs of FGM, via 101 (normally within one month, or sooner if at risk).

What are the four classified types of FGM (WHO classification)?

Type 1: clitoridectomy (partial/total removal of clitoral glans). Type 2: excision (removal of clitoris and labia minora ± labia majora). Type 3: infibulation (narrowing the vaginal opening by creating a covering seal). Type 4: all other harmful non-medical procedures (pricking, piercing, cauterising).

What are the two main forms of modern slavery, and what is the referral mechanism for victims?

Human trafficking and slavery/servitude/forced or compulsory labour (Modern Slavery Act 2015). Potential victims are referred to the National Referral Mechanism (NRM); first responders submit referrals, and there is a separate 'duty to notify' the Home Office.

What is the Prevent duty and which Act places it on public bodies?

Prevent is one of the four strands of the UK counter-terrorism strategy CONTEST, aiming to stop people being drawn into terrorism. The Counter-Terrorism and Security Act 2015 places a statutory duty on specified bodies (including the NHS) to have due regard to preventing people being drawn into terrorism.

What is 'Channel' in the context of the Prevent duty?

Channel is a voluntary, confidential, multi-agency safeguarding programme that provides tailored support to individuals identified as vulnerable to being drawn into terrorism or radicalisation, following a referral and panel assessment.