A patient who has been assessed in the ED and advised that they need admission is refusing to stay. They want to self-discharge. How do you manage this?
- A patient with capacity has the absolute right to refuse treatment, even if that decision seems unwise
- Mental Capacity Act 2005: capacity is presumed unless there is reason to doubt it
- Capacity assessment: understand, retain, weigh up, communicate
- Factors that may impair capacity: intoxication, head injury, sepsis, acute psychiatric illness, severe pain
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How to approach this Emergency Medicine interview question
This ethics question is common in Emergency Medicine NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "A patient who has been assessed in the ED and advised that they need admission is..." as the anchor for a concise answer with a clear opening, a clinical or professional structure, and a reflective close.
What the panel is testing
A strong ethics answer makes the competing duties visible. Name the principle or legal issue, then describe the practical steps you would take in the hospital: gather facts, assess capacity where relevant, seek advice, document, and protect the patient. For emergency medicine, keep the answer time-aware. Panels expect prioritisation, early senior involvement, concise handover, and awareness of department flow without losing sight of the individual patient.
- Identify the ethical tension before jumping to a decision: capacity, consent, confidentiality, best interests, or law.
- Use local policy and senior advice, and be explicit about safeguarding or immediate patient-safety concerns.
- Balance respect for autonomy with professional duties, documentation, and clear communication.
How to structure your answer
For a ethics prompt, aim for a short opening sentence, then two or three evidence-led points, then a final reflection. If you use STAR, keep the result and reflection as strong as the situation. If it is a clinical scenario, say what you would do now, what you would do next, and how you would keep the patient safe while help is coming.
- Open by naming the main issue in the question.
- Give a structured response rather than a memorised script.
- End with escalation, documentation, learning, or follow-up.
Common mistakes to avoid
The weakest answers usually stay too vague, ignore the specific role, or miss the safety issue hidden in the question. Do not use this page to memorise a perfect paragraph. Use it to rehearse the shape of a safe answer, then adapt it to your own experience and the post you are applying for.
- A patient with capacity has the absolute right to refuse treatment, even if that decision seems unwise
- Mental Capacity Act 2005: capacity is presumed unless there is reason to doubt it
- Capacity assessment: understand, retain, weigh up, communicate