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Doctrine of Necessity in Emergency Treatment — SCE Palliative Medicine MCQ

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HardLegal & Ethical FrameworkDoctrine of Necessity in Emergency TreatmentSCE Palliative Medicine

An unconscious adult requires immediate surgery for a ruptured abdominal aneurysm. No proxy is contactable, but the record contains a valid applicable advance decision refusing blood transfusion. Which legal approach is correct?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Proceed with surgery using blood-conservation methods that respect the advance refusal

Explanation lettering: C = shown as A · A = shown as B · B = shown as C

A is correct. Emergency treatment for a person lacking capacity is authorised through best interests, but a valid and applicable advance decision to refuse specified treatment must be respected. The team can undertake indicated surgery using available blood-conservation strategies and senior legal/ethical support without assuming that refusal of transfusion equals refusal of all care. Relatives do not provide consent unless legally empowered, court delay may be unsafe, and necessity is not a blanket power to override autonomous refusals.

Reference: Mental Capacity Act Code of Practice: https://www.gov.uk/government/publications/mental-capacity-act-code-of-practice