GP KFPs / SAQs · core-skills
Consent, capacity, and confidentiality — KFP-style written assessment
KFP-style staged scenarios on consent, capacity and confidentiality: Gillick competence, four-ability capacity assessment, emergency necessity doctrine, notifiable disease disclosure, and SPIKES for delivering bad news.
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RACGP KFPRACGP AKTMRCGP AKT
Prompt
Three pillars, four abilities, and the exceptions that matter
KFP 1 (10 marks)
A 15-year-old girl attends alone requesting oral contraception. She is mature, understands the risks and benefits, and does not want her parents to know. [2]
- Can she consent to contraception? Name the legal principle. (3) [2]
- Can you keep the consultation confidential from her parents? (3) [2]
- Under what circumstances would you breach that confidentiality? (4)
Model answers
- Yes - Gillick competence applies. A child under 16 can consent if they demonstrate sufficient maturity and understanding to fully comprehend the proposed treatment. The test is decision-specific. [2]
- Yes - a Gillick-competent child has the same right to confidentiality as an adult. Parental consent is not required once competence is established. [2]
- Breach confidentiality only if: there is a safeguarding concern (abuse, exploitation), the patient is at risk of serious harm, or there is a legal requirement (notifiable disease, court order). Explain to the patient why you must breach before doing so.
References3ShowHide
- [1]Baile WF, Buckman R, Lenzi R, et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer Oncologist, 2000.PMID 10964998
- [2]Wheeler R Gillick or Fraser? A plea for consistency over competence in children BMJ, 2006.PMID 16601020
- [3]Moskop JC Informed consent and refusal of treatment: challenges for emergency physicians Emerg Med Clin North Am, 2006.PMID 16877132