The PLAB 2 Ethics Scenarios That Keep Coming Back
Four ethics themes show up again and again in PLAB 2 stations: confidentiality, capacity, consent in young people, and fitness to drive. None of them needs a legal essay. The examiner wants to see that you recognise the issue, apply the right principle in plain words, stay kind to the patient, and finish with a safe plan. For each theme below you get the principle, a phrase you can adapt, and the trap candidates fall into.
A note on sources: the principles follow GMC guidance and, for capacity, the Mental Capacity Act 2005 (England and Wales). If you are preparing for PRES 3 in Ireland, read the Medical Council's guide as well, because the framework differs in places.
Confidentiality
Principle. Patient information is confidential, but not absolutely. You can disclose without consent when the law requires it, or when it is justified in the public interest, for example to prevent serious harm to someone else. Even then, share only what is necessary, and tell the patient first where that is practical and safe.
A phrase to adapt. "I understand you'd rather I didn't tell anyone, and I want to respect that. I'll only share what is necessary. Can I explain what I'm worried about, and then we can decide the next step together?"
The trap. Two opposite mistakes. One is promising total secrecy in the first minute ("I won't tell anyone"), which you may not be able to keep. The other is jumping straight to disclosure without exploring the patient's reasons or offering them the chance to share the information themselves.
Capacity
Principle. Assume the patient has capacity unless shown otherwise. Capacity is specific to one decision at one time. Under the Mental Capacity Act, a person can make the decision if they can understand the relevant information, retain it long enough to decide, weigh it up, and communicate their choice. An unwise decision does not on its own mean they lack capacity.
A phrase to adapt. "Can you tell me in your own words what the treatment involves, and what might happen if you don't have it?" Then ask what matters most to them and how they are weighing things up.
The trap. Deciding someone lacks capacity because you disagree with their choice. The second trap is skipping the support step: before concluding anything, do what you can to help them decide, with simpler language, a quieter room, a relative present if they want one, or coming back later if the problem may pass. Only if they still cannot decide is the decision made in their best interests, involving the people close to them.
Consent in young people
Principle. A young person under 16 can consent to their own treatment if they have enough maturity and understanding to grasp what is involved (Gillick competence). The Fraser guidelines apply this thinking to contraception advice. In a typical station, a teenager asks for contraception and does not want their parents told. Assess their understanding, encourage them to involve a parent or trusted adult without making it a condition, and explain the limits of confidentiality.
A phrase to adapt. "I can see you've thought about this carefully. I'd encourage you to talk to a parent or someone you trust, but that's your choice. What you tell me stays between us unless I thought you or someone else was at risk of serious harm, and if that happened I would tell you first."
The trap. Refusing to go on because a parent is not in the room, or missing the safeguarding side. Ask gently about the partner's age, pressure, and whether the relationship feels safe. If you suspect abuse or exploitation, protecting the young person comes first and information may need to be shared.
Fitness to drive
Principle. It is the patient's legal responsibility to tell the DVLA about a medical condition that may affect safe driving. Your part is to advise them, including to stop driving if they are not fit, and to tell them to inform the DVLA. If they will not stop, or you learn they are still driving against advice, GMC guidance expects you to try to persuade them first, and then to contact the DVLA medical adviser, because disclosure in the public interest is justified. Tell the patient before you do it, and document the conversation.
A phrase to adapt. "I know this is a big thing to hear, especially with your job. Driving isn't safe for you at the moment, and the DVLA need to be told. I can help you with that. If you carried on driving, I would have to contact the DVLA myself, and I'd tell you before I did."
The trap. Saying "I have a legal obligation to report you". The legal duty to inform the DVLA sits with the patient. Yours is professional: advise, persuade, and disclose in the public interest if they will not act. The other trap is forgetting the human side, such as how they will get to work.
Putting it together in 8 minutes
Station time is short, so keep the same order every time: acknowledge how the patient feels, explore their ideas, concerns and expectations, say the principle in one or two plain sentences, agree a plan, check they have understood, and safety-net. Do not recite the name of the guidance. Say what it means.
Practising
These stations are easy to read about and hard to say aloud under pressure. Practise the phrases out loud until they sound like you. OSCEPilot has AI patients for ethics and communication stations if you want a realistic partner at any hour.
FAQ
Do I need to quote the GMC guidance in the station? No. Examiners mark what you do and say. State the principle in plain language and apply it to the patient in front of you.
What if the patient asks me to keep something secret and I think they are at risk? Explain the limits of confidentiality early, explore their reasons, and share only the minimum necessary with the right person. Tell the patient first where it is safe to do so.
Is this the same for PRES 3? The principles overlap, but the legal framework and the Irish Medical Council's guide differ, so check them before you sit PRES 3.