Ethics

Question 1

….. refers to an adult with the capacity to understand his/ her medical problems can refuse any therapy/ test

Answer 1

Autonomy (most important ethical concept)

Question 2

Trying to do the right thing for the patient is called …

Answer 2

Beneficence (less important than autonomy)

Question 3

What is the next best step in management of an adult pt with capacity who is refusing therapy/ test?

Answer 3

discuss/ meet/ confer with patient

Question 4

Who determines a patient’s capacity?

Answer 4

physicians

Question 5

When should a psychiatric consultation be performed when managing a patient who is refusing treatment?

Answer 5

if patient’s capacity to understand is unclear

Question 6

What factors determine whether a patient is an emancipate minor (

Answer 6

1. living independently
2. self-supporting
3. married
4. in the military

Question 7

What categories of medical care are minors considered to be partially emancipated?

Answer 7

1. sex (contraception)
2. reproductive health (STDs, HIV, prenatal care)
3. substance abuse

Question 8

Are minors partially emancipated with regards to abortion?

Answer 8

not in 36 states that require parental notification (therefore recommend that the pt inform parents)

Question 9

True or False. Parents can refuse lifesaving therapy for minors.

Answer 9

false (i.e. Jehovah’s Witnesses can refuse blood transfusion for themselves but not for their child)

Question 10

What are the 5 criteria that must be true in order for consent for a procedure/ therapy to be informed consent?

Answer 10

1. benefits of procedure/ therapy
2. risks of procedure/ therapy
3. alternatives to procedure/ therapy
4. in language pt can understand
5. must be given for each procedure

Question 11

True or False. Consent is implied in an emergency.

Answer 11

True (however if prior wishes are fully known, then the wishes take precedence)

Question 12

True or False. Pregnant women can refuse therapy, even if the life of the fetus is at risk.

Answer 12

True

Question 13

What are the two exceptions to the privacy/ confidentiality rule?

Answer 13

1. transmissible diseases (HIV, syphillis, gonorrhea, tuberculosis)
2. have psychiatric illness and planning to harm others

Question 14

What is the strongest form of advance directive in case a patient loses the ability to have capacity?

Answer 14

Health Care proxy (include documentation of desires and/ or appointment of an agent)

Question 15

What is the importance of a DNR order?

Answer 15

refusal of endotracheal intubation and cardiopulmonary resuscitation in the event that one loses the ability to breath or heart stops

Question 16

What is the initial best step of management for a pt with no capacity and no advanced directives (proxy or living will)?

Answer 16

obtain best possible understanding of clearly expressed wishes from family and friends

Question 17

When is an ethics committee indicated in the case of a patient with no capacity and no advance directive (proxy or living will)?

Answer 17

1. no clearly stated wishes on the part of the pt

2. caregivers (family) are split or in disagreement about the nature of care

Question 18

When is a court order indicated in the case of a pt with no capacity and no advance directive (proxy or living will)?

Answer 18

when all other options have not given clarity (friends and family conflicted, ethics committee conflicted)

Question 19

True or False. An adult pt with capacity may refuse all forms of nutrition.

Answer 19

True

Question 20

True or False. In the absence of clearly stated wishes on the issues of fluids and nutrition, they should not be given to a pt without capacity.

Answer 20

False (should be given unless clearly stated wish not to have)

Question 21

True or False. There is no obligation on the part of the physician to provide care that will not work.

Answer 21

True

Question 22

True or False. You need the consent of the father for an abortion.

Answer 22

False

Question 23

At point is elective abortion an unrestricted right of a pregnant woman?

Answer 23

first trimester only (second trimester is questionable and third is no accessible)

Question 24

True or False. Physicians have the legal right to refuse to treat any patient.

Answer 24

True (although it may be unethical)

Question 25

True or False. HIV positive health care workers are obligated to disclose their HIV status.

Answer 25

False

Question 26

What gifts are ethically acceptable?

Answer 26

small gifts not tied to specific treatment/ tests

gifts with intent of getting specific prescription is not acceptable

Question 27

True or False. A physician can certify a tortured patient as dead.

Answer 27

False (physicians can not participate in torture on any level)

Question 28

Who should you report an imparied (potentially dangerous to medical care) practicing physician to?

Answer 28

state medical board