A patient with dementia is refusing to be discharged to a care home. Her family and the team believe she cannot manage at home safely. How do you approach this?
- Start with the presumption of capacity - do not assume a patient with dementia lacks capacity
- Capacity must be assessed for the specific decision: "where to live after discharge"
- If the patient has capacity, their decision must be respected even if others disagree
- If the patient lacks capacity, the best interests process must be followed (Section 4 MCA)
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How to approach this Psychiatry interview question
This ethics question is common in Psychiatry NHS interviews because it reveals how you think under interview pressure, not just what facts you can recall. Use "A patient with dementia is refusing to be discharged to a care home. Her family and the..." 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 psychiatry, risk assessment, capacity, legislation, rapport, and multidisciplinary planning are usually central. Keep the answer humane, structured, and legally aware.
- 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.
- Start with the presumption of capacity - do not assume a patient with dementia lacks capacity
- Capacity must be assessed for the specific decision: "where to live after discharge"
- If the patient has capacity, their decision must be respected even if others disagree