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  1. Understanding PLAB 2: The Foundation Course
  2. /
  3. Module 4: Ethics and Professionalism

Understanding PLAB 2: The Foundation Course

Course Progress
0 of 45 lessons completed (0%)
Module 1: Understanding PLAB 2
4
Module 2: The Consultation Toolkit
9
Module 3: Difficult Conversations
6
Module 4: Ethics and Professionalism
9
Module 4 Introduction
Lesson 4.1 : Ethical Foundations and Good Medical Practice
Lesson 4.2 : Consent and Capacity
Lesson 4.3 : Confidentiality
Lesson 4.4 : Safeguarding Children and Adults
Lesson 4.5: End-of-Life Care, DNAR, and Advance Care Planning
Lesson 4.6 : Fitness to Drive, Medical Errors, and Duty of Candour
Lesson 4.7: Colleague Concerns and Professionalism
Lesson 4.8: Other Ethical Dilemmas
Module 5: Examination Stations
8
Module 6: Procedures, Emergencies, and Prescribing
9

Lesson 4.8: Other Ethical Dilemmas

Module 4: Ethics and Professionalism

Lesson 4.8: Other Ethical Dilemmas

Jehovah's Witnesses and Blood Transfusion

SituationUK Approach
Competent adult refusing transfusionAbsolute right to refuse. Confirm capacity. Check for coercion. Offer alternatives (iron, cell salvage, volume expanders). Document extensively. Respect the decision, do not transfuse against their wishes.
Parent refusing transfusion for their childParental religious beliefs do NOT override the child's best interests. If transfusion is necessary to preserve life, apply for emergency court authorisation. In a life-threatening emergency with no time to seek a court order, treat in the child's best interests.
Unconscious patient who previously refusedCheck for a valid ADRT refusing blood. If valid, respect it. If there is no valid ADRT and the outcome is uncertain, act in best interests, this may mean giving blood.

Resource Allocation

If a patient demands a treatment the NHS does not fund:

  • Acknowledge their wish and their frustration.
  • Explain that prescribing is guided by NHS funding decisions (e.g. NICE technology appraisals) and is not at your personal discretion.
  • Offer the best available funded alternatives.
  • Explain they may access treatments privately if they wish.
  • Document the conversation. Do not promise treatments you cannot deliver.

Treating Family Members and Colleagues

GMC guidance strongly advises against treating family members, and in most circumstances, colleagues. Objectivity is compromised, you may over- or under-investigate, or miss diagnoses because of emotional involvement.

In PLAB 2: if a role-player presents as your 'colleague' asking you to prescribe for them, decline to prescribe anything significant, explain why, and direct them to register with their own GP.

Non-Evidence-Based Treatment Requests

Respect patient autonomy, but do not prescribe treatments that are not supported by evidence simply because the patient asks. Be honest, non-dismissive, and offer what is available:

"I completely understand you're looking for every possible option, and I respect that. I have to be honest with you: the evidence for that treatment isn't strong enough for us to offer it on the NHS. What I can do is make sure your current plan is the best it can be, and refer you to our specialist team to discuss all your options."

Transgender Health — 2026 MLA Content Map

Transgender health was added as a distinct topic area in the 2026 MLA content map. The following principles apply to any consultation with a transgender or gender-diverse patient.

AreaWhat to Know
Language and identityAsk at the start of the consultation: 'What name and pronouns would you like me to use?' Use these consistently. Do not question or require justification for a patient's gender identity.
History takingTake a respectful, patient-centred history. Ask about gender dysphoria, mental health support, and current medications (including gender-affirming hormones). Screen sensitively for depression and anxiety, these are more prevalent in this group.
Referral pathwayReferral to a Gender Identity Clinic (GIC) is via GP. NHS waiting lists are currently very long, acknowledge this sensitively and explore current support in the meantime.
Prescribing in primary careGPs may be asked to continue hormones initiated by a gender clinic under a shared care protocol. Do not initiate independently without specialist guidance.
Key principleTransgender identity is not a mental illness. Never conflate gender identity with psychiatric pathology. Provide the same quality of care you would give to any other patient.