Ethics · Advanced · Ethics

Request for Hastened Death in Terminal Illness

Practise this PLAB 2 ethics station on End-Stage Pancreatic Cancer. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor on the palliative care team. You meet with Nour Mansour, a 68-year-old woman with advanced pancreatic cancer who is now end-stage. She has explicitly requested that you help her to die, saying her suffering is unbearable. Her son is present and supports her request. Please take a sensitive history, explore her wishes and concerns, and discuss the appropriate management.

Background notes: PMH: Advanced pancreatic cancer, Hypertension, Type 2 diabetes, Osteoarthritis

What this station tests

  • Exploring the request before responding legally: what is driving it determines the intervention
  • Euthanasia and assisted suicide are illegal in the UK: stated with compassion, not judgment
  • Offering what you CAN do: symptom control, dignity, advance care planning, psychological support
  • Addressing the suffering behind the request: uncontrolled pain, fear, burden, or depression each have solutions
  • Not judging the patient for asking: the request comes from suffering, not moral failure

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself. Establish the ethical issue and your role.
  • 1-3 min — Explore Perspective: Listen to patient/relative perspective. Understand their reasoning and concerns.
  • 3-5 min — Ethical Framework: Apply ethical principles: autonomy, beneficence, non-maleficence, justice. Reference relevant guidelines (GMC, Mental Capacity Act).
  • 5-7 min — Negotiate and Plan: Find common ground. Explain your professional obligations. Involve MDT where appropriate. Document plan.
  • 7-8 min — Closing: Summarise agreed position. Outline next steps. Offer further discussion.

Consultation approach

The opening

A terminally ill patient asking for help to die is one of the most emotionally challenging PLAB 2 stations. The candidate must explore the request with compassion, explain the legal position, and address the suffering that prompted it. Mrs Mansour is 68, end-stage pancreatic cancer, asking you to help her die. Open with: 'Mrs Mansour, I can hear how much you are suffering. Tell me what has brought you to ask this.'

Core approach

Explore the request before responding legally. What is driving it? Uncontrolled pain? Fear of future suffering? Loss of dignity? Feeling like a burden? Depression? Each has a different intervention. If pain is uncontrolled: palliative care can almost always achieve comfort. If fear of the future: advance care planning gives her control. If burden: address with family and support services. If depression: treat it.

Explain the legal position with compassion. 'I understand why you are asking, and I respect the thought behind it. Under UK law, I am not able to help end your life. Euthanasia and assisted suicide are not legal in this country.' Do not judge her for asking. Do not lecture about the law.

Offer what you CAN do. 'What I can promise is that we will do everything possible to make sure you are comfortable, pain-free, and treated with dignity. Palliative care is not about giving up: it is about living as well as possible for as long as possible.'

Closing and safety netting

Practical actions. Optimise symptom control (pain, nausea, breathlessness). Palliative care team involvement if not already. Advance care planning: preferred place of death, what interventions she does and does not want. Lasting power of attorney. Psychological support for existential distress. Family support.

Address the underlying suffering rather than the legal question. 'The fact that you are asking tells me we need to do more to address your suffering. Let me work with the palliative care team to make things better.' Safety net: palliative care is available 24/7. Follow-up: regular review of symptoms and wishes.

How examiners mark this station

Examiners will assess your ethical reasoning and interpersonal skills. Domain 2 (Clinical Management) is primary: marks for applying an ethical framework, referencing relevant legislation and guidelines, and reaching a reasoned position. Domain 3 (Interpersonal Skills) is equally weighted: marks for non-judgmental exploration, empathic communication, and negotiation skills. Domain 1 (Data Gathering) assesses your ability to fully explore the situation before forming a view.

Domain 1 (Primary focus)

Scores well: Underlying drivers explored (pain, fear, burden, depression). Current symptom control assessed. Psychological state evaluated. Family dynamics understood.

Costs marks: Not exploring drivers. Responding only with the law.

Domain 2 (Primary focus)

Scores well: Legal position stated with compassion. Symptom optimisation planned. Palliative care involved. ACP. Psychological support. What you CAN do clearly stated.

Costs marks: Not knowing the law. No palliative care. No ACP. No alternatives offered.

Domain 3 (Primary focus)

Scores well: Empathic throughout. Not judging. Exploring suffering. Providing hope through palliative care. Genuine compassion for her distress.

Costs marks: Judgmental. Lecturing about the law. Cold or clinical. Not acknowledging suffering.

Common examiner feedback (and how to fix it)

Did not demonstrate adequate ethical reasoning or application of relevant guidelines

Fix: Structure your response around the four ethical pillars (autonomy, beneficence, non-maleficence, justice). Reference specific guidelines (GMC, Mental Capacity Act) where relevant.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Acknowledge the emotional weight of the situation early. Show that you understand why this is difficult before applying ethical reasoning.

Common mistakes in this station

  1. Responding with the law before exploring the suffering: she needs empathy before information
  2. Being judgmental: she is suffering, not making a moral statement
  3. Not offering alternatives: palliative care can address most of what drives the request

Resitting PLAB 2?

If you have found ethics stations difficult, focus on learning a clear ethical framework (the four pillars) and practising how to apply it conversationally rather than reciting principles. Examiners reward candidates who can explore the tension between competing ethical principles while remaining empathic and non-judgmental.

Example opening

Thank you for coming in to speak with me. My name is Dr [Name]. I understand there is something important we need to discuss. Could you tell me your understanding of the situation?

Frequently asked questions

How should I approach this end-Stage pancreatic cancer ethics station in PLAB 2?

A terminally ill patient asking for help to die is one of the most emotionally challenging PLAB 2 stations. The candidate must explore the request with compassion, explain the legal position, and address the suffering that prompted it. Mrs Mansour is 68, end-stage pancreatic cancer, asking you to help her die.

What are examiners marking in this end-Stage pancreatic cancer station?

Marks are won for: Underlying drivers explored (pain, fear, burden, depression). Current symptom control assessed. Psychological state evaluated. Family dynamics understood. Marks are lost for: Not exploring drivers. Responding only with the law.

What is the most common mistake candidates make in this end-Stage pancreatic cancer station?

Responding with the law before exploring the suffering: she needs empathy before information. Another frequent error: Being judgmental: she is suffering, not making a moral statement.

How do I prepare for this station if I have not managed end-Stage pancreatic cancer in clinical practice?

This station rewards process over personal experience. The skill being assessed: Euthanasia and assisted suicide are illegal in the UK: stated with compassion, not judgment. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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