Ethics, law and professional practice in Ireland for PRES Level 2

You are an intern in an Irish hospital. You realise that yesterday you prescribed a dose of gentamicin ten times higher than intended. The nurse noticed and did not administer it, so the patient came to no harm. What is the most appropriate action?

1. Report it through the hospital incident reporting system and inform your supervising consultant correct Correct. Near misses are reported precisely because no harm occurred. They reveal the system weakness at no cost to a patient. Openness with your supervisor is a professional duty, not a career-ending admission.
2. Report it only if the nurse raises it formally Wrong. The duty rests with you and does not depend on whether someone else acts first.
3. Discuss it informally with a peer and move on Insufficient. Peer support matters, but it does not produce the system learning that formal reporting does.
4. Correct the prescription chart quietly and say nothing Wrong, and considerably worse than the original error. Altering documentation to conceal an incident is a probity issue regulators treat far more seriously than a prescribing mistake.
5. Take no action, since the patient came to no harm Wrong. Unreported near misses are how the same error reaches the next patient, who may not have an alert nurse.

The point: Near misses are reportable. Candour, incident reporting and early escalation are examined behaviours in every licensing exam in this catalogue, and concealment is what ends careers rather than the error itself.

Source: Medical Council of Ireland — Guide to Professional Conduct and Ethics Medical Council of Ireland · tier 0, exam blueprint / regulator

A 79-year-old man with advanced dementia is admitted with aspiration pneumonia. He is unable to communicate. His daughter, who holds no formal legal authority, insists that he would never have wanted artificial feeding. There is no advance healthcare directive. What is the correct basis for the decision about clinically assisted nutrition?

1. Ask the daughter to sign a consent form on his behalf Wrong. Proxy consent by a relative without legal authority has no standing, and asking for it misrepresents her role and burdens her with a decision that is not hers.
2. Apply to the courts before making any decision Disproportionate as a first step. Court involvement is for genuinely finely balanced or disputed cases that cannot be resolved through the usual process.
3. A best-interests decision by the treating team, informed by the family's account of his previously expressed wishes and values correct Correct. Without capacity and without a valid advance directive or a legally appointed decision-maker, the decision rests with the clinical team acting in his best interests. The family are consulted as an essential source of evidence about what he would have wanted, not as the decision-makers.
4. Proceed with artificial feeding regardless, since preserving life always takes precedence Wrong. There is no absolute duty to provide a treatment that is not in the patient's best interests, and clinically assisted nutrition in advanced dementia carries limited benefit and real burden.
5. The daughter's instruction is legally binding and must be followed Wrong. A relative without formal legal authority cannot consent to or refuse treatment on an adult's behalf. Their view is important evidence, not a decision.

The point: Under Irish law the Assisted Decision-Making (Capacity) Act framework emphasises supported decision-making and, where capacity is absent, decisions guided by the person's will and preferences. Family are consulted; only a validly appointed representative or a valid advance healthcare directive is binding. Document the reasoning, not just the outcome.

Source: Medical Council of Ireland — Guide to Professional Conduct and Ethics; Assisted Decision-Making (Capacity) Act Medical Council of Ireland · tier 0, exam blueprint / regulator