Clinical Goverance

Option List
A. Check advance directive
B. Sister can sign consent form
C. Don't do the procedure give pain relief and send her home.
D. Respect autonomy and document all the discussion and monitor.
E. Inform named consultant, FGM midwife and place immediately.
F. Issue a contraceptive and involve the Safeguarding team.
G. Proceed in the best interest of the patient.
H. Mother can't give consent on her behalf
I. Respect religious views
J. Do only the procedure what is consented
K. No one can sign on behalf of her as she has capacity
L. Respect autonomy
M. Respect religious views
N. Cannot be done as it's against law
O. Montgomery ruling
P. Involve safeguarding team immediately
Each of the following clinical scenarios below relate to various ethical principles. For each patient select the single most appropriate Option from the list above. Each option may be used once, more than once or not at all.

1.14-year-old Katie, presented with severe right sided abdomen pain, her pain score is 7/10. On further imaging she has twisted right ovarian cyst, probably dermoid. Katie has a capacity to make decision. She has passed Gillick test. She is refusing to undergo surgery, she wants some medicines. Her mother who accompanied her is willing for surgery, what would you do now?

2. Ms. Marsha, 34years old, is a yoga teacher and she has been referred from Midwife unit for abnormal CTG with thick meconium stained liquor.On examination - she is 4 cm dilated, occipto posterior with grade 1 meconium stained liquor. Minimal caput noted.CTG -pathological with prolonged bradycardia now lasting for 3minutes.You decide for Emergency LSCS in view of fetal distress.
You spoke to Marsha; she wants natural delivery without any intervention. She has capacity to make decision. She is firm with her decision after understanding the pros and cons of it. What would you do?

3. A 32-year-old is undergoing laparoscopic sterilisation, you note right ovarian dermoid cyst measuring 4x4cm. Your scrub nurse asks whether you should be doing cystectomy as patient can avoid second operation to do it.

4. Ms. Zumba, 16years old, presented with excessive bleeding. On further evaluation she is 9weeks pregnant with retained products of conception. She needs to undergo dilatation and evacuation. Ms. Zumba has a capacity to make the decision, she agrees for the procedure, but she want her sister Mariam, who is 17 year old to sign the consent form.

5. Mr and Mrs.Lewis have 3 daughters. Now they are her to discuss Preimplantation genetic diagnosis (PGD). When explored further, they want IVF and PGD for gender selection as they want a male child. Both have capacity to make a decision and they can pay if IVF not funded from NHS.

6. Mrs. SahaDamba, para2 from Nigeria has undergone circumcision as a child. She has FGM type 3 which was defibulated during labour, she has delivered a baby girl. You are seeing her in regular postnatal visit, she says that she is flying to Nigeria today as she can get her elder daughters circumcision planned tomorrow. She tells you to keep this confidential as she trusts you and asks you to keep it as a secret.

7. Ms.Saki, 11 year old girl, has visited your clinic requesting for contraception. She is having sex with 16 old boyfriend, she doesn’t feel she is doing anything wrong, so she requests you not to involve safe guarding team as she knows what she is doing. She is having consensual sex, no grooming involved.

Option List
A. Abandon operative procedure and reschedule
B. Defer the operative procedure
C. Fraser competence must be demonstrable before obtaining consent
D. Obtain legal advice on individuals who withhold consent for treatment 16
E. Obtain legal advice on interpretation on the Abortion Act 1967
F. Discuss with the consultant and proceed forclwprotmy
G. Obtain legal advice on interpretation as she doesn’t have the Mental Capacity
H. Parental consent must be obtained before proceeding
I. Paternal consent need not be obtained before proceeding
J. Perform additional procedure without explicit consent to do so
K. Proceed without consent in order to save the fetus life
L. Proceed without consent in order to save the woman’s life
M. Respect the rights of the putative father of the fetus to withhold consent
N. Respect the rights of the unborn fetus and proceed to delivery
O. Respect the rights of the woman to withhold consent for treatment
P. Verbal consent of patient alone is acceptable
Q. Verbal consent with witness and case note documentation
R. Written consent must be obtained
For each of the scenarios described choose the single most appropriate statement concerning the obtaining of patient consent with respect to the law in England. Each option may be used once, more than once, or not at all

8.Ms.X, 35-year-old suffering from Down syndrome, is diagnosed to have sued ted borderline ovarian tumour. She lives in-home care, and she has no relatives. She has been accompanied by home care nurse .she needs laparotomy as per MDT S opinion.

9. You are about to start seeing Ms Briganza in urogynecology clinic who has been referred by GP for prolapse uterus. Your junior colleague wants to sit with you during the consultation of Ms Braganza

10. Mrs.Suzi is 34 years old is in the surgical unit for Laparoscopic sterilisation which she consented for a week before in the outpatient clinic. She now appears somewhat upset and anxious, and she is refusing to undergo the procedure.