Law, consent and capacity in pre-hospital care: DipIMC practice questions
PHEM curriculum unit 1.6 · Theme 1: Working in Emergency Medical Systems
The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit 1.6, Understand the law relevant to Pre-hospital Emergency Medicine practice.
Below are 3 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 42 questions on this unit.
Question 1 · Law, Ethics & Human Factors · Easy
Under the Mental Capacity Act 2005, a person is unable to make a decision if they cannot do which of the following?
AAgree with the clinician's recommendation once the risks and benefits have been explained
BUnderstand, retain, use or weigh the relevant information, or communicate the decision
CUnderstand the information and still recall it accurately 24 hours after it was explained
DExplain the decision in writing, giving reasons that the assessing clinician finds rational
EShow that the decision serves their best interests and matches their previously stated wishes
Show answer
Answer: B
Understand, retain, use or weigh the relevant information, or communicate the decision
Section 3(1) of the Mental Capacity Act 2005 sets out the functional test: a person is unable to make a decision if they cannot understand the information relevant to it, retain that information, use or weigh it as part of deciding, or communicate the decision by any means, whether by talking, sign language or otherwise. Under section 2 the inability must be because of an impairment of, or a disturbance in the functioning of, the mind or brain, and it is judged for the specific decision at the time it needs to be made. Retaining the information for a short period only does not prevent a person being regarded as able to decide (section 3(3)), so a 24-hour recall test sets the bar too high. Agreement with the clinician is not required, and a person is not to be treated as unable to decide merely because the decision is unwise (section 1(4)). A written, reasoned explanation is not required either. Best interests (section 4) governs what is done once capacity has been found to be lacking; it is not a test the person must pass.
Mental Capacity Act 2005 Code of PracticeDepartment for Constitutional Affairs, issued by the Lord Chancellor, April 2007·Chapter 4, para 4.14: inability to make a decision“A person is unable to make a decision if they cannot:”Open PDF at page 49
Oxford Handbook of Pre-Hospital Carepp. 30–31Ch. 1 An approach to pre-hospital care · The law and pre-hospital care: consent and capacity, Mental Capacity Act 2005“use or weigh that information as part of the process of making the decision;”
ABC of Prehospital Emergency Medicinep. 203Ch. 37 Medicolegal and Ethical Aspects of Prehospital Emergency Medicine · Consent: decision-making ability“a person is able to make a specific decision at a particular time.”
law-001 · Law, Ethics & Human Factors · Law & Ethics · Easy · v4
Question 2 · Law, Ethics & Human Factors · Moderate
For an advance decision to refuse life-sustaining treatment to be valid, which condition must be met?
AIt must be in writing and signed, and be countersigned by the patient's GP or a hospital doctor
BIt may be spoken, provided a relative witnessed it and confirms it applies even if life is at risk
CIt must be in writing, signed and witnessed, and state that it applies even if life is at risk
DIt must be in writing, signed and witnessed, and have been made or reviewed in the last 12 months
EIt must be in writing, signed and witnessed, and registered with the Office of the Public Guardian
Show answer
Answer: C
It must be in writing, signed and witnessed, and state that it applies even if life is at risk
Section 25(5) and (6) of the Mental Capacity Act 2005: an advance decision is not applicable to life-sustaining treatment unless it is verified by a statement that it is to apply to that treatment even if life is at risk, and the decision and statement are in writing, signed by the person (or by another person in their presence and by their direction), with the signature made or acknowledged in the presence of a witness who also signs. There is no requirement for a doctor's countersignature, for a review date, or for registration with the Office of the Public Guardian, which applies to lasting powers of attorney. A spoken refusal reported by a relative cannot meet the written requirements for life-sustaining treatment, and the Oxford Handbook warns that such statements from a relative or friend have no legal validity. The person must have been 18 or over, with capacity, when making the decision.
Mental Capacity Act 2005 Code of PracticeDepartment for Constitutional Affairs, issued by the Lord Chancellor, April 2007·Chapter 9, quick summary: advance decisions refusing life-sustaining treatment“state clearly that the decision applies even if life is at risk.”Open PDF at page 163
Mental Capacity Act 2005 Code of PracticeDepartment for Constitutional Affairs, issued by the Lord Chancellor, April 2007·Chapter 9, quick summary: who can make an advance decision“People can only make an advance decision under the Act if they are 18”Open PDF at page 163
Oxford Handbook of Pre-Hospital Carep. 33Ch. 1 An approach to pre-hospital care · The law and pre-hospital care: advance directives“to receive a certain treatment or to be resuscitated have no legal validity”
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Question 3 · Law, Ethics & Human Factors · Easy
Which statement about section 136 of the Mental Health Act 1983 is correct?
AA registered paramedic may detain a person who appears mentally disordered for up to 24 hours
BA constable may remove a person who appears mentally disordered from any place but a dwelling
CA constable may remove a person who appears mentally disordered only from a public place
DA constable may enter a home without a warrant to remove a person who appears mentally disordered
EA constable may hold a person who appears mentally disordered for 72 hours' treatment without consent
Show answer
Answer: B
A constable may remove a person who appears mentally disordered from any place but a dwelling
Section 136 of the Mental Health Act 1983 is a police power: if a person appears to a constable to be suffering from mental disorder and to be in immediate need of care or control, the constable may remove them to a place of safety. Under subsection (1A) the power may be exercised at any place other than a house, flat or room where that person or anyone else is living, or a yard, garden, garage or outhouse used with it, so it is no longer limited to a public place; entering a home requires a warrant under section 135. Before acting the constable must, if practicable, consult a registered medical practitioner, a registered nurse, an approved mental health professional or another specified person. The permitted period of detention is 24 hours from arrival at the place of safety, extendable only by authorisation under section 136B, and its purpose is examination by a doctor and interview by an approved mental health professional, not treatment. Paramedics hold no power under section 136. The Oxford Handbook's 'public place' and 72-hour wording reflects the law before the 2017 amendments.
Ch. 7 Acute psychiatric emergencies · Section 135: removal to a place of safety · pp. 470–471“Section 135 allows access into the patient’s home.”
Ch. 7 Acute psychiatric emergencies · Section 136: removal from a public place · pp. 470–471“An individual found in a public place who appears to be suffering”
Ch. 7 Acute psychiatric emergencies · Section 136: removal from a public place · pp. 470–471“a formal psychiatric assessment must be carried out within a maximum of 72 hours”
law-003 · Law, Ethics & Human Factors · Law & Ethics · Easy · v5