Master Ethics & Law (GMC Guidelines)
for PLAB 1

What the PLAB 1 Tests in Ethics & Law (GMC Guidelines)

PLAB 1 tests your ability to apply GMC Good Medical Practice (2013, updated 2024) to realistic clinical scenarios. You must demonstrate knowledge of consent (Gillick competence, Mental Capacity Act 2005), confidentiality (disclosure without consent for serious crime or child protection), and end-of-life decisions (DNACPR, Advance Decisions, the Mental Capacity Act 2005). Questions often present a dilemma (e.g., patient refusing life-saving treatment, a child requesting contraception without parental knowledge, a colleague with impaired fitness to practise) and require you to choose the legally and ethically correct action. You are expected to know the GMC's stance on honesty, probity, and raising concerns. Do not confuse legal principles with personal opinion; the exam tests the GMC framework and UK law, not your moral views.

High-Yield Concepts

• Consent and Gillick Competence: Children under 16 can consent to treatment if they have sufficient understanding and intelligence (Gillick competence). For contraception, the Fraser guidelines apply: the child must understand the advice, cannot be persuaded to inform parents, and is likely to begin or continue sexual activity without contraception. If Gillick competent, their refusal can be overridden by a court or person with parental responsibility (though rarely done).
• Mental Capacity Act 2005 (MCA): Assume capacity unless proven otherwise. Capacity is decision-specific: the patient must understand, retain, weigh, and communicate their decision. If lacking capacity, act in their best interests (consider past wishes, values, and consult relevant others). A valid Advance Decision to refuse treatment (ADRT) is legally binding if it applies to the current situation and is in writing, signed, and witnessed. Lasting Power of Attorney (LPA) for health and welfare can make decisions if the patient lacks capacity.
• Confidentiality and Disclosure: Disclosure without consent is permitted only in exceptional circumstances: to prevent serious harm (e.g., gunshot wound, child abuse, notifiable disease), for court order, or for public interest (e.g., DVLA notification if the patient continues to drive with uncontrolled epilepsy). The GMC says you must disclose to an appropriate person (e.g., police, social services) and document your reasoning. Do not disclose for routine insurance or employer requests without explicit consent.
• End-of-Life Decisions: DNACPR and Euthanasia: DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders must be discussed with the patient (if capacitated) or their family/representative (if lacking capacity) unless doing so would cause significant harm. Euthanasia and assisted suicide remain illegal in the UK (Suicide Act 1961). Palliative sedation (e.g., midazolam for terminal agitation) is permissible under the doctrine of double effect if the primary aim is symptom relief, not death. The Liverpool Care Pathway is no longer used; use an individualised care plan.
• Raising Concerns (Whistleblowing): You have a duty to raise concerns about patient safety, poor practice, or impaired colleagues (e.g., a surgeon with alcohol dependency). First, raise internally (e.g., clinical lead, medical director). If unresolved, escalate to the GMC or CQC. The GMC's 'Good Medical Practice' states you must act promptly and maintain confidentiality of the concern only to those who need to know. Protection from detriment is provided under the Public Interest Disclosure Act 1998.
• Prescribing and Managing Conflicts of Interest: Do not prescribe for yourself or close family (except for minor, short-term conditions like paracetamol for headache). Accepting gifts from pharmaceutical companies is limited: only low-cost items (e.g., pens, notepads) related to professional practice; no cash or hospitality beyond modest refreshments. Declare any financial or non-financial interests in research or private practice. The BNF and GMC guidelines prohibit prescribing unlicensed medicines without proper justification and patient consent.
• Fitness to Practise and Health Issues: If you are ill or impaired (e.g., by alcohol, drugs, or mental health), you must not treat patients until you are fit. You must seek appropriate medical help and inform the GMC if your fitness to practise is seriously impaired. The GMC's 'Good Medical Practice' requires you to be registered with a GP and follow their advice. Colleagues with similar issues should be supported but reported if they pose a risk.
• Children and Safeguarding: If you suspect child abuse or neglect (e.g., unexplained fractures, failure to thrive), you must share information with social services or the NSPCC without parental consent if necessary to protect the child. The GMC advises that child protection overrides confidentiality. For non-accidental injury (e.g., subdural haematoma in a shaken baby), you must document findings, involve the safeguarding lead, and consider a child protection plan. The same applies to vulnerable adults under the Care Act 2014.

Common Traps in Ethics & Law (GMC Guidelines) Questions

• Confusing Gillick competence with Fraser guidelines: Fraser applies only to contraception; Gillick applies to all treatment decisions for under-16s.
• Thinking that a patient's refusal of life-saving treatment (e.g., blood transfusion for a Jehovah's Witness) can be overridden if they have capacity — it cannot.
• Believing you must always inform the police of a crime (e.g., a patient confessing to theft) — disclosure requires serious harm, not any crime.
• Assuming an Advance Decision to refuse treatment is valid if it was made verbally and not witnessed — it must be in writing, signed, and witnessed for life-sustaining treatment.
• Mistaking 'best interests' for 'what the doctor thinks is best' — it must include the patient's past wishes, beliefs, and consultation with family and other professionals.
• Thinking you can prescribe antibiotics for a family member's sore throat over the phone — you must not prescribe for yourself or close family except for minor, short-term conditions.

How to Revise Ethics & Law (GMC Guidelines) for the PLAB 1

Focus on the GMC's 'Good Medical Practice' 2013 (the core document) and the Mental Capacity Act 2005. Questions are clinical vignettes (e.g., a 14-year-old requesting the Pill, a demented patient refusing hip surgery, a colleague you suspect is drunk). The answer is rarely 'do nothing'; it is always an active step within the GMC framework. Prioritise: consent (especially Gillick), capacity assessment, confidentiality exceptions, and end-of-life law. Practise distinguishing between ethical principles (autonomy, beneficence) and legal duties (disclosure, capacity). Use past PLAB 1 papers to see how they frame 'what would you do next?' — often the answer is 'discuss with the patient' or 'seek a second opinion' rather than immediate action. Do not overthink: if the patient has capacity, their decision stands, even if it leads to death.

Practise it: MedLumen has 50 Ethics & Law (GMC Guidelines) questions for the PLAB 1, each with a full explanation and references.