Ethics

Question 1

True or False

Competent pts have the right to refuse knowledge of their own medical information and diagnoses

Answer 1

True

• ensure pt is well informed before they make their decision and find out from the pt who their surrogate decision maker should be

Question 2

What does capacity mean?

Answer 2

pt can communicate rationally and demonstrate comprehension of proposed tx, alternatives, and consequences of their decision

MMSE is NOT used to judge capacity

Question 3

True or False

If pt is intellectually disabled or has cognitive impairment, it means the pt has lack of decision making capacity

Answer 3

False

Question 4

True or False

Physician should respect refusal of tx from a pt who is SUICIDAL

Answer 4

False

Question 5

True or False

Physician should respect refusal of tx from a pt who is DEPRESSED but NOT SUICIDAL

Answer 5

True

Question 6

Criteria of Emancipated Minor

Answer 6

Living independently
Married
In military
Self-supporting

Question 7

Criteria of Partially Emancipated Minor

Answer 7

Contraception
STDs/ HIV
Substance use
Prenatal care

Question 8

True or False

Parents CANNOT refuse lifesaving therapy for minors

Answer 8

True

Question 9

True or False

Jehovah’s witness may refuse therapy for himself AND his child

Answer 9

False

• they CAN’T refuse tx for their children but can refuse tx for themselves

Question 10

True or False

Consent obtained via telephone is considered valid

Answer 10

True

Question 11

True or False

Pregnant women can refuse therapy even if the life of the fetus is at risk

Answer 11

True

Question 12

True or False

If pt has transmissible disease (eg. HIV, TB, syphilis, gonorrhea), physician can violate the pt’s confidentiality to protect innocent third parties

Answer 12

True

Physicians are NOT universally req’d to disclose HIV status of pts to involved third parties BUT need to report all NEW cases of HIV to local department of health

Question 13

True or False

Oral advance directive CAN be honored if pt is dx w/ terminal or irreversible condition AND pt’s wishes were declared to the attending physician + 2 other witnesses

Answer 13

True

No witnesses = not valid oral directive

Question 14

True or False

Ethics committee can be used if family members are in disagreement about care of pt

Answer 14

True

Question 15

True or False

Physician needs consent to stop tx for brain dead pt

Answer 15

False

Question 16

True or False

Family can refuse organ donation even if pt has organ donation card

Answer 16

True

• ONLY organ donation network can ask for consent for the organs NOT the physician

Question 17

True or False

Tx of family members and friends is unethical and only acceptable in emergency situations where no other doctor available

Answer 17

True

Question 18

True or False

Sexual contact b/w psychiatrist and pt (current or former) is acceptable no matter how much time has elapsed since ending physician-pt relationship

Answer 18

False

NEVER acceptable!

Question 19

True or False

Sexual contact b/w a physician (who is NOT psychiatrist) and pt (current or former) is acceptable if there is written letter outlining termination of physician-pt relationship

Answer 19

True

Question 20

Medicare vs Medicaid

Answer 20

Medicare - for elderly (≥ 65 yoa)

Medicaid - don’t have money

• -> disabled
• -> children of low income adults (50% of all medicaid pts but LOWEST expenditure compared to all other grps)
• -> low income adults
• -> elderly

Question 21

Hospice

Answer 21

requires survival prognosis of ≤ 6 months
focus is on quality of life NOT cure/prolongation of life
sx control offerred
interdisciplinary team
services provided at home, hospital, or assisted living facility
pts can leave hospice at any time to pursue curative tx and return later

Question 22

True or False

The following are CIs to hospice care:

• full code status
• co-morbid medical conditions
• inability to provide informed consent

Answer 22

False

Question 23

Palliative Care

Answer 23

focus is on quality of life
can occur even if pt receiving life prolonging tx (vs. hospice where no tx allowed)
pts have better outcomes in mental health, satisfaction and quality of life