Two consents and a signature

Correct answer: B. Only the patient herself

• A. Contacting the parents would breach the confidentiality that emancipation is designed to protect.
• B. Correct. Emancipation confers adult legal status for healthcare decisions. She consents for herself, and no relative can consent on her behalf. The sister has no legal standing here whatever her age, and telling the patient otherwise would undermine a right she has already been granted.
• C. This is the trap. Adding an adult relative does not strengthen a consent that is already valid, and accepting the sister's signature instead would render the consent defective.
• D. The sister has no authority. Being over 18 does not make someone a legal guardian.

Correct answer: B. Contact the parent or legal guardian to obtain consent

• A. A child's assent is ethically important and should always be sought, but a minor cannot give legally valid consent for treatment.
• B. Correct. Consent for a minor rests with the parent or legal guardian. A grandmother has no automatic authority unless she holds documented guardianship or a written authorisation to consent. Reaching the parent, even by telephone with a witness and contemporaneous documentation, is the correct first step.
• C. Relatives who accompany a child cannot consent by virtue of relationship alone. Practices should keep documented authorisation on file for anyone who regularly brings a child.
• D. Rescheduling is reasonable if the parent cannot be reached, but simply discharging the patient with no attempt to contact them skips the necessary step.

Note: This is routine care. In a true emergency, care needed to relieve pain or address a threat to health may proceed under implied or emergency consent, with contemporaneous documentation of the attempts made to reach the guardian.

Correct answer: D. Obtain and document written informed consent for the procedure

• A. Clinical photography is good documentation practice, but consent is the requirement that must come first.
• B. Routine prophylaxis is not indicated for a soft tissue biopsy in a healthy patient and would not be the next step in any event.
• C. Blood work is ordered only when the medical history indicates it, such as a bleeding disorder or anticoagulation.
• D. Correct. Informed consent precedes any invasive procedure. The discussion covers diagnosis, the nature of the procedure, its risks and benefits, reasonable alternatives including no treatment, and the opportunity to ask questions, and it is documented before the scalpel is picked up.