Consent scenarios appear in both stations, and they are the ones where candidates most often give a confident wrong answer. The law here is settled and worth knowing precisely.

What standard applies?

Montgomery. The test is no longer what a responsible body of anaesthetists would disclose — it is whether a reasonable person in this patient's position would attach significance to the risk, or whether this particular patient would. That shifts the conversation from a recited list to finding out what matters to them.

  • Discuss material risks and the reasonable alternatives, including regional versus general where both are options
  • Give it enough time. Consent taken on the trolley outside theatre is hard to defend
  • Record the discussion, not just the signature

How do you assess capacity?

The Mental Capacity Act test is decision-specific and has four parts. All four must be present for capacity; failing any one means it is absent for that decision.

  • Understand the information relevant to the decision
  • Retain it long enough to make the decision
  • Weigh it as part of making the decision
  • Communicate the decision

Two principles catch candidates out. Capacity is presumed unless shown otherwise, and an unwise decision is not evidence of incapacity — a patient may refuse for reasons you think are poor and still have capacity to refuse.

What if they lack capacity?

Act in their best interests, taking account of their past wishes and beliefs and consulting those close to them. Check for a valid advance decision or a lasting power of attorney for health and welfare — an attorney can consent, family alone cannot. In an emergency, treat what is immediately necessary to save life or prevent serious deterioration and no more.

The scenario that usually comes up

A patient arrives on the day and something makes you uneasy — they have not understood, or the list is running and there is pressure to proceed. The answer is to say clearly that you would not anaesthetise a patient who has not given valid consent, that you would discuss it with the surgeon and your consultant, and that delaying a case is a smaller harm than proceeding without it. Being able to say that to a senior colleague is the professionalism being marked.