MRCS PART A · PAPER 2 · PRINCIPLES OF SURGERY
Surgical consent: priorities and refusal
Two fictional encounters, two concept trees and two original five-option questions. GMC primary guidance checked and platform owner reviewed. No procedure-specific risk estimates, legal advice or calibrated difficulty. Not a complete consent or capacity course.
2 topics · 2 original SBAs
1 · Relate risk to the patient's priorities
Your task: Identify patient-specific significance without a universal disclosure cutoff.
Why discuss an uncommon risk?
Its consequence may matter particularly to this patient. Frequency alone does not settle relevance.
Are patient-specific concerns the only risks to discuss?
No. Also address recognised risks, expected harms and serious harm even when unlikely.
What else belongs in the decision?
Benefits, uncertainty and reasonable alternatives, including no intervention. Explore priorities rather than assuming them.
Does a signature replace that discussion?
No. Consent depends on supported decision-making, not merely completion of a form.
2 · Separate disagreement from incapacity
Your task: Respond to voluntary informed refusal without treating disagreement as failed capacity.
Does declining the recommended operation prove incapacity?
No. Capacity concerns this particular decision at this time, not agreement with the clinician.
What if understanding becomes uncertain?
Offer suitable support and assess under the applicable national law. Do not diagnose incapacity from the outcome alone.
Does the supplied informed refusal permit surgery?
No. This adult has capacity and is deciding freely. Continue appropriate care without proceeding against that decision.
What changes if pressure compromises free choice?
That is a separate problem requiring support and appropriate advice; neither automatic surgery nor an assumption of incapacity follows.