When every available option carries risk, how do you choose the least harmful, most defensible path? This episode teaches the essential “least-harm trio” approach — a structured, GMC-aligned method for navigating the grey zone of clinical practice, where autonomy, safety, confidentiality and equity collide. Using three high-pressure scenarios, you’ll learn how to act decisively and transparently, escalate early, and document in a way that protects both patients and professionals.

0:00 Why high-stakes decisions feel paralysing
00:20 Ethical tensions & conflicting duties
00:48 The “least harm trio” (safety • honesty • fairness)
01:16 Act + escalate + document
02:00 Why passive waiting is unsafe
02:40 Scenario 1 — Sepsis, unclear capacity
03:10 Trio = A-B-G (Assess capacity fast → Best-interest action → Good documentation)
04:20 What protects you legally when treating without clear consent
05:40 Common traps (unsafe delay, restraint, over-escalation)
06:10 Scenario 2 — Domestic abuse, privacy & danger
06:40 Trio = A-B-D (Access privacy → Begin skilled inquiry → Document lawful information-sharing)
07:50 Creating safety without confrontation
09:30 Scenario 3 — Late arrival, learning disability, complex consent
10:10 Trio = B-F-A (Book longer slot → Find adjustments today → Avoid rushed consent)
11:20 Health equity and avoiding invalid consent
12:20 Universal “tie-breaker rules”
12:40 Act now + escalate
13:00 Transparency > perfection
13:20 Documentation as defensive practice
13:50 Systems-level pressures and documentation burden
14:10 Final reflections and practical mindset

• In high-stakes decisions, do something and escalate, never freeze.
• “Least harm trio” = safety → transparency → fairness.
• Capacity-uncertain emergencies require fast capacity optimisation + best-interest action + contemporaneous notes.
• Domestic abuse needs privacy creation first, not confrontation.
• Rushed consent is invalid — equity demands adjustments, even if late.
• Documentation is your legal and professional protection.

High-Yield Mnemonics
A-B-G (Assess capacity → Best-interest action → Good documentation)
A-B-D (Access privacy → Begin inquiry → Document lawful sharing)
B-F-A (Book longer slot → Find safe adjustments → Avoid rushed consent)

Links:
• passthemsra.com – Complete MSRA revision, notes, mocks, flashcards
• freemsra.com – Free podcasts, threads and rapid-learning guides
• msra.io – Smart MSRA Qbank with analytics

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