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Jehovah's Witness Consent — FRCA Final MCQ

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HardMedicolegal & EthicsJehovah's Witness ConsentFRCA Final

In England, a 45-year-old Jehovah's Witness is scheduled for major hepatobiliary surgery with a substantial risk of fatal haemorrhage. In a private consultation she demonstrates decision-specific capacity and confirms that she refuses allogeneic blood components and intraoperative cell salvage, even if refusal results in her death. She completes a written, signed and witnessed advance decision that is valid and applicable to these interventions. The multidisciplinary team considers surgery clinically appropriate, and the responsible surgeon and anaesthetist agree to undertake it using a documented blood-conservation plan. What is the legally and ethically correct course of action?

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

Reveal the answer and explanation

Correct answer: D — Proceed using the agreed blood-conservation plan and withhold every specifically refused intervention, including after she loses capacity

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

A is correct. An adult with decision-specific capacity may refuse treatment even when refusal is likely to cause death. Once she loses capacity under anaesthesia, her valid and applicable advance decision has the same effect as a contemporaneous refusal and must be followed. The Court of Protection may determine whether an advance decision exists, is valid or is applicable, but cannot overrule one that meets those requirements; therefore B is incorrect. The doctrine of necessity does not authorise treatment that has been specifically and validly refused, excluding E. An ethics committee may advise but cannot provide legal authority to disregard the refusal, excluding D. Although clinicians are not compelled to offer clinically inappropriate elective surgery, the stem establishes that the responsible team considers surgery appropriate and has agreed to proceed, so C does not apply.

Reference: Department for Constitutional Affairs, Mental Capacity Act 2005 Code of Practice, Chapter 9: Advance decisions to refuse treatment, 2007. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/497253/Mental-capacity-act-code-of-practice.pdf