Ethical, legal + organizational medicine

Question 1

Responsibility for indigenous people’s services: federal or provincial?

Answer 1

Federal

Question 2

Responsibility for licensing professionals: federal or provincial?

Answer 2

Provincial

Question 3

Responsibility for public health investigations: federal or provincial?

Answer 3

Federal

Question 4

What is autonomy?

Answer 4

The right that patients have to make decisions according to their beliefs and preferences

Question 5

What is competence?

Answer 5

The ability to make a specific decision for oneself as determined legally by the courts

Question 6

What is capacity?

Answer 6

The ability to make a specific decision for oneself as determined by clinicians

Question 7

Reasons to breach confidentiality

Answer 7

Child abuse (report to local child welfare authorities (e.g. Children’s Aid Society)

Fitness to drive or fly a plane (report to provincial Ministry of Transportation)

Communicable disease

Coroner report

Duty to inform/warn

Question 8

Statutory reporting responsibilities

Answer 8

1. suspected child abuse or neglect – report to local child welfare authorities (e.g. Children’s Aid Society)
2. Fitness to drive a vehicle or fly an airplane – report to provincial Ministry of Transportation
3. communicable diseases – report to local public health authority
4. i_mproper conduct of other physicians or health professionals_ – report to College or regulatory body of the health professional (sexual impropriety by physicians is required reporting in some provinces)
5. vital statistics must be reported; reporting varies by province (e.g. in Ontario, births are required to be reported within 30 d to Office of Registrar General or local municipality; death certificates mustbe completed by a MD then forwarded to municipal authorities)
6. reporting to coroners

Question 9

The duty to protect/ warn is based on which case?

Answer 9

Tarasoff

Question 10

Duty to protect/ warn applies when?

Answer 10

1. there is an imminent risk
2. to an identiable person or group
3. of serious bodily harm or death

Question 11

What is the principle of assent?

Answer 11

Patients found incapable to make a specic decision should still be involved in that decision as much as possible

Question 12

What are the four basic elements of consent?

Answer 12

• Voluntary
• Capable
• Specific
• Informed

Question 13

Criteria For Administration of Treatment for an Incapable Patient in Emergency Situations

Answer 13

• Patient is experiencing extreme suffering
• Patient is at risk of sustaining serious bodily harm if treatment is not administered promptly (loss of life or limb)

Question 14

Treatment without consent is what in law?

Answer 14

Treatment without consent is battery (an offense in tort), even if the treatment is life-saving (excluding situations outlined in exceptions to Consent)

Question 15

If a patient has an advanced directive saying they refuse artificial nutrition, can they be given iv fluids?

Answer 15

No according to Canada Q Bank

Question 16

Is there a minimum age to prescribe contraception in Canada?

Answer 16

No

Question 17

Do you have to be specific about what role a resident surgeon will play in surgery in Canada when obtaining informed consent?

Answer 17

No, you just need to say the resident will play a role

Question 18

Are you protected in Canada if you respond to an emergency on a plane?

Answer 18

Yes by Good Samaritan laws. These apply in circumstances where you have no obligation to provide care.

Question 19

If a lawyer asks you for medical records as part of a complaint are you allowed to charge a fee to make copies?

Answer 19

Yes

Question 20

Landed immigrants have to wait a maximum of how long to get publicly funded coverage for health insurance?

Answer 20

Three months

Question 21

What are Living Wills for?

Answer 21

Specifying end of life care

Question 22

What type of advanced directive specifies a surrogate decision maker?

Answer 22

A durable power of attorney for health care

Question 23

When does a fetus have legal rights?

Answer 23

The fetus does not have legal rights until it is born alive and with complete delivery from the body of the woman

Question 24

Can a pregnant woman addicted to teratogenic substances be detained to protect the fetus?

Answer 24

No. Winnipeg Child and Family Services (Northwest Area) v. G. (D.F.), [1997] 3 S.C.R. 925)

Question 25

If a woman is competent and refuses medical advice, her decision must be respected even if the fetus will suffer- true or false?

Answer 25

True

Question 26

Can surrogate mothers receive payment in Canada?

Answer 26

Assisted Human Reproduction Act, 2004 Surrogate mothers cannot be paid or offered compensation beyond a reimbursement of their expenses

Question 27

What gave Canadian adults who are mentally competent and suffering intolerably and enduringly the right to a doctor's assistance in dying?

Answer 27

Carter v Canada 2015

Question 28

Notifications to the coroner

Answer 28

* Violence, negligence, misconduct * Pregnancy * Sudden or unexpected causes * Disease not treated * Cause other than disease * Suspicious circumstances * MAID

Question 29

What is CPSO Policy for Ending the Physician-Patient Relationship?

Answer 29

Discontinuing services that are needed is an act of professional misconduct unless done by patient request, alternative services are arranged, or adequate notice has been given

Question 30

When can a physician have a relationship with a patient in Canada? And which specialty is a complete exclusion?

Answer 30

In specified situations, physicians may have a personal relationship with a patient *provided a year has passed since the last therapeutic contact* Physicians are permanently prohibited from personal relationships with patients whom they saw for psychotherapy

Question 31

CPSO Policy: Treating Self and Family Members

Answer 31

Physicians will not diagnose or treat themselves or family members except for _minor conditions or in emergencies_ and then only if no other physician is readily available

Question 32

Can parents refuse life saving treatment for their children in Canada?

Answer 32

No

Question 33

Who is responsible for local sanitation, monitoring communicable disease notifications, water and food safety enforcement and local environmental risk assessment?

Answer 33

The Public Health Unit

Question 34

Basic Activities of Daily Living refer to what?

Answer 34

Self care

Question 35

When should you discuss DNR orders with patients?

Answer 35

When they are still in good health, according to Canada Q Bank.

Question 36

What are instrumental ADLs? Give some examples

Answer 36

ADLs that are not fundamentally essential for living but allow an individual to live independently Making a phone call Doing home repairs Making meals Doing laundry Taking medications Managing finances Driving using public transport Shopping for groceries Doing housework

Question 37

What is the leading cause of cancer death in Canada?

Answer 37

Lung cancer. 25% of all cancers. Then colorectal, then breast

Question 38

Best evidence for smoking cessation

Answer 38

Counselling + pharmacotherapy

Question 39

Reporting obligations for Live Births, Stillbirths, and Deaths

Answer 39

All live and stillbirths must be reported within _2 business days_ Physicians must report if pt is suspected to have deceased from violence, misadventure, negligence, misconduct or malpractice or any cause other than disease; by unfair means; during pregnancy or postpartum from circumstances reasonably attributed to the pregnancy; suddenly and unexpectedly; from an illness not treated by a legally qualified medical practitioner; or under circumstances that may require investigation • physicians must report all medically assisted deaths to the coroner