Consent, parental responsibility and mature-minor frameworks — viva

Stem

Examiner-led viva on a high-stakes adolescent consent scenario. ^[10]

Examiner: She is drowsy. How does that change your consent approach? ^[3]

Strong answer: Drowsiness is a red flag for transient incapacity. Before I treat her refusal as informed, I check reversible causes — oxygenation, perfusion, pain, glucose and evolving shock — because impaired consciousness can erode the four capacity domains. A refusal given in shock is not a valid refusal. ^[3]

Examiner: Assume she is now alert and oriented. What do you assess? ^[3]

Strong answer: I assess decision-making capacity for this specific, high-stakes, potentially irreversible decision across the four Appelbaum domains: does she understand the transfusion, appreciate that she could die without it, reason through the trade-off, and communicate a stable choice? I assess voluntariness and coercion, and I recognise that capacity for an irreversible life-saving refusal is a higher bar than for a low-risk decision. ^{[3] [6]}

Examiner: She is capable and refuses. Parents support her. What now? ^[10]

Strong answer: This is a genuine legal-ethical crisis, not a solo registrar override. I escalate immediately to the senior clinician on call and request an ethics consultation and legal input, because courts internationally have moved toward overriding refusal of life-saving treatment in minors under defined conditions. I treat the reversible threats now, document the capacity assessment, and pursue urgent judicial review. ^{[10] [8]}

Examiner: How does the harm principle fit here? ^[8]