Ethics Brief

Question 1

Describe the first step when dealing with suspected child abuse according to medical ethics.

Answer 1

The first step is to take photographs for documentation.

Question 2

What is the importance of reporting child abuse to Child Protective Services, even if just suspected?

Answer 2

Reporting child abuse is crucial to protect the child and ensure proper investigation and intervention.

Question 3

Define the types of child abuse and provide examples of physical abuse.

Answer 3

Types include emotional, neglect, and physical abuse. Examples of physical abuse are bruises of different colors, fractures (especially spiral fracture of the humerus), cigarette burns, head trauma, retinal hemorrhage, and abdominal injuries.

Question 4

How is Munchausen syndrome by proxy characterized in medical ethics?

Answer 4

It involves a parent, usually the mother, fabricating or inducing illness in the child.

Question 5

Describe the common offender and type of incest in cases of sexual abuse according to medical ethics.

Answer 5

The most common offender is the father, and the most common type of incest is brother-sister.

Question 6

What are the signs that may lead to suspecting sexual abuse in a child according to medical ethics?

Answer 6

Signs include vaginal, penile, or rectal pain, discharge, bruising, erythema, bleeding, presence of STDs in prepubertal child, and bite marks on the genitals or inner thigh.

Question 7

Define the types of elder abuse and mention the most common type according to medical ethics.

Answer 7

Types include neglect, physical, psychological, and financial abuse. Neglect is the most common type of elder abuse.

Question 8

How can healthcare professionals identify individuals at high risk of elder abuse according to medical ethics?

Answer 8

Individuals at high risk may be male, have memory problems, physical disabilities, depression, loneliness, lack of social support, substance abuse issues, be verbally or physically combative with caregivers, or have a shared living situation.

Question 9

Describe the types of spouse violence (domestic violence) and the most common type according to medical ethics.

Answer 9

Types include physical, psychological, financial, and sexual violence. Physical violence is the most common type of spouse violence.

Question 10

What steps should be taken when dealing with a woman experiencing domestic violence according to medical ethics?

Answer 10

Encourage the woman to talk about her bruises, explain that domestic violence is unacceptable, suggest accessing specialist support services, and discuss options for safe temporary accommodation if needed.

Question 11

Define the conditions that may render a driver unable to drive according to medical ethics.

Answer 11

Conditions such as seizure disorder, vision impairment, and syncope can impair a driver’s ability to drive safely.

Question 12

Describe the actions to be taken by RTA when encountering an impaired driver.

Answer 12

Encourage self-refraining from driving, using alternate transportation, and informing RTA; if refusal, inform authorities.

Question 13

What are the guidelines regarding accepting gifts from pharmaceutical companies?

Answer 13

Accept if related to education or medical purposes; sponsorship for educational presentations allowed if no interference with content; meals accepted at educational conferences; cannot accept if there is a hidden agenda or entertainment items like movie or sports tickets.

Question 14

Define autonomy in healthcare.

Answer 14

The freedom to choose one’s own form of healthcare, follow pre-planned patient wishes even if unconscious, and prioritize patient autonomy over beneficence.

Question 15

How is competence and capacity to understand determined in healthcare settings?

Answer 15

Competence decided by the court, all adults considered competent; physicians assess ability to understand, may involve a psychiatrist if needed; minors under 16 require consent from parents or legal guardian, except in emergency situations.

Question 16

Describe the concept of informed consent in healthcare.

Answer 16

Informing patients about all treatment options and consequences of not receiving treatment; following the patient’s last known wishes if they lose the capacity to understand or communicate.

Question 17

What are the considerations regarding consent in emergency situations in healthcare?

Answer 17

In emergencies, consent may be given by appropriate surrogates if the patient is unable; minors may have partial emancipation for certain healthcare decisions; parents cannot refuse life-saving treatment for their child.

Question 18

Explain the decision-making autonomy of pregnant mothers in healthcare.

Answer 18

Pregnant mothers have the right to refuse or allow treatments even if it affects the fetus; the fetus is not considered a separate individual with rights.

Question 19

Describe the approach to handling healthcare decisions for minors in different age categories.

Answer 19

Minors under 16 require consent from parents or legal guardians, except in emergencies; mature minors (14-16 years) may have more decision-making autonomy; minors can consent if independent, military, married, or living alone.

Question 20

How is autonomy prioritized in healthcare decisions over beneficence?

Answer 20

Patients have the right to make choices, even if they are not in their best interest; autonomy allows patients to refuse treatments that may be beneficial.

Question 21

Explain the role of informed consent when a patient loses the capacity to understand.

Answer 21

Healthcare providers should follow the patient’s last known wishes, whether verbal or written, if the patient becomes unable to understand or communicate.

Question 22

Describe the consent process for individuals with Down Syndrome.

Answer 22

Consent by parent or guardian is required, with substituted judgment by someone who knows the patient if not available. The weakest consent method is the best interest of the patient, with the court appointing a guardian or Medical Director if needed.

Question 23

How is confidentiality maintained in healthcare settings?

Answer 23

Patient information is kept confidential except in cases of harm to a third party, court orders/subpoenas/search warrants, or when the patient gives consent.

Question 24

Define Advance Directive in healthcare.

Answer 24

Advance Directive is when a patient communicates their wishes in advance of becoming unable to communicate, typically through a Living Will or Health Care Proxy.

Question 25

What is the role of a Health Care Proxy in medical decision-making?

Answer 25

The Health Care Proxy, also known as Medical Power of Attorney or Durable Proxy, speaks for the patient and overrules other decision-makers based on the patient’s wishes.

Question 26

Describe the decision-making hierarchy in the absence of an Advance Directive.

Answer 26

In the absence of an Advance Directive, decision-making falls to the normal family, followed by the wife, parents, adult children, siblings, and friends. In cases of split families, a family meeting, Ethics Committee, or Court Order may be involved.

Question 27

How are End of Life Issues handled in healthcare settings?

Answer 27

Patients with capacity can refuse treatment at any time, even after starting it. Different scenarios like refusing dialysis, mechanical ventilation, or transfusions are respected. If a patient lacks capacity due to depression, psychiatric consultation or behavior Rx may be considered.

Question 28

Describe the process when a government employee requests patient information.

Answer 28

Patient information can only be shared with a government employee if they have a subpoena, court order, or search warrant. Otherwise, the request should be refused.

Question 29

What should healthcare providers do if a patient with a psychiatric disorder shows intent to harm others?

Answer 29

In cases where a psychiatric patient shows intent to harm others, the police and potential victims should be informed to protect everyone.

Question 30

How should healthcare providers handle requests for patient information from friends or family members?

Answer 30

Healthcare providers should always maintain patient confidentiality and refrain from sharing information, stating that they are not authorized to do so. If a patient is conscious and a family member asks for information, permission should be sought from the patient first.

Question 31

Describe the decision-making process when a patient has Depression and lacks capacity to understand.

Answer 31

In cases where a patient has Depression and lacks capacity to understand, psychiatric consultation, a trial of behavior Rx, or anti-depressants may be considered to address the situation.

Question 32

Describe the hierarchy of decision-making in the absence of an Advanced Directive for a patient with conflicting family opinions.

Answer 32

Patient decision > Advanced Directive (Proxy, Living will) > Oral Advanced Directive > United Family Decision > Resolution through discussion or ethics committee > Court Order.

Question 33

Do Not Resuscitate (DNR) order specifies limitations on medical interventions; what does it entail?

Answer 33

DNR means no chest compressions, cardioversion, or acute anti-arrhythmics in case of cardiac arrest, but other medical procedures like surgery, biopsy, and medication administration are permissible.

Question 34

How does the decision on intubation vary for a patient with a DNR order based on their condition?

Answer 34

If the patient is stable with a respiratory disease, intubation may be appropriate; however, if the patient is unstable, intubation is generally avoided as it is part of resuscitation.

Question 35

Define Euthanasia and explain its legal status in the United States.

Answer 35

Euthanasia involves a person administering a lethal drug to end another’s life upon their request, which is illegal in every state in the U.S.

Question 36

Describe the Law of Double Effect and provide an example.

Answer 36

The Law of Double Effect states that if the intention is to do good, an action can be taken even if it may have a harmful effect; however, if the intention is to cause harm, the action should not be carried out.

Question 37

Explain the concept of Brain Death and its implications.

Answer 37

Brain Death is considered actual or legal death even if the heart is still beating, as it signifies the irreversible loss of brainstem reflexes and functions.

Question 38

Discuss the ethical considerations surrounding abortion in different trimesters.

Answer 38

Abortion is generally more permissible in the 1st trimester, less clear in the 2nd, and more restricted in the 3rd trimester in some states; consent is solely required from the mother, and gender selection for abortion is deemed unethical.

Question 39

What are the guidelines regarding gender selection and abortion based on fetal gender?

Answer 39

Gender selection and subsequent abortion based on the fetus’s gender are considered unethical practices.

Question 40

How is contraception viewed in terms of availability and ethical considerations?

Answer 40

Contraception is widely available and considered ethically acceptable for family planning purposes.

Question 41

Describe the consent requirements for sterilization procedures.

Answer 41

Freely available with only patient consent, no consent needed from spouse.

Question 42

Define the ethical status of sperm donation and selling.

Answer 42

Completely ethical.

Question 43

How are organ donations handled in terms of consent and who can request donation?

Answer 43

Consent is obtained by the Organ Donor Network; only they can ask for donation, not the treating physician.

Question 44

Do organ donors need to have family consent even if they have an organ donor card?

Answer 44

Yes, family consent is still required even with an organ donor card.

Question 45

Describe the approach to reportable diseases like Meningococcemia.

Answer 45

Always report to interrupt spread without revealing the patient’s identity.

Question 46

Define the autonomy boundary in cases of TB patients for safety reasons.

Answer 46

Autonomy ends where safety of others begins, leading to isolation or incarceration if necessary to prevent spread.

Question 47

How should healthcare providers handle HIV testing consent for pregnant women with STDs?

Answer 47

Separate consent is needed for HIV testing; if the patient refuses, testing cannot be done.

Question 48

Describe the ethical approach to treating HIV-positive pregnant women who refuse treatment.

Answer 48

Autonomy of the mother is prioritized over the safety of the child, so treatment cannot be given against the mother’s consent.

Treating HIV-positive pregnant women who refuse treatment involves navigating complex ethical principles, including respect for autonomy, beneficence, non-maleficence, and justice. Here is an ethical approach based on RACGP and broader medical ethics guidelines:

1. Respect for Autonomy:
   
   • Informed Consent: Ensure the patient is fully informed about the risks and benefits of treatment for herself and her unborn child. Provide comprehensive information about the implications of untreated HIV, including the risk of mother-to-child transmission.
   • Respect Decision: Respect the patient’s autonomy and her right to make decisions about her own health care, even if those decisions are not in line with medical recommendations.
2. Beneficence and Non-Maleficence:
   
   • Best Interests of the Patient and Fetus: Advocate for treatment that benefits both the mother and the fetus. Emphasize the reduction of mother-to-child transmission risk with antiretroviral therapy (ART).
   • Harm Reduction: If the patient refuses ART, explore other harm reduction strategies, such as safer delivery practices and avoidance of breastfeeding to minimize transmission risks.
3. Communication and Counseling:
   
   • Open Dialogue: Engage in open, non-judgmental dialogue to understand the reasons for refusal. Address any misconceptions, fears, or cultural beliefs that may influence the decision.
   • Support Systems: Offer psychological and social support. Involve counselors, social workers, and support groups to provide additional perspectives and support.
4. Legal and Ethical Frameworks:
   
   • Confidentiality: Maintain patient confidentiality, especially in sensitive cases involving HIV.
   • Legal Obligations: Be aware of legal obligations regarding the reporting of HIV and protecting public health while balancing the patient’s rights.
5. Collaborative Decision-Making:
   
   • Multidisciplinary Team: Work with a multidisciplinary team, including obstetricians, infectious disease specialists, and ethicists, to provide comprehensive care and explore all possible options.
   • Alternative Solutions: Consider and respect alternative health beliefs and practices, working with the patient to find mutually acceptable solutions.

• RACGP Guidelines: RACGP Clinical Resources
• World Health Organization (WHO): HIV/AIDS Guidelines
• Ethical Frameworks: Beauchamp, T. L., & Childress, J. F. (2001). Principles of Biomedical Ethics.

By integrating these ethical principles and frameworks, healthcare providers can navigate the delicate balance of respecting patient autonomy while advocating for the health and well-being of both the mother and the child.

Question 49

What is the recommended action if an HIV-positive patient refuses to notify their partner?

Answer 49

Discuss with the patient, encourage partner notification, and if refused, inform the Health Department to ensure partner notification.

If an HIV-positive patient refuses to notify their partner, the recommended actions according to the RACGP guidelines include:

1. Counsel the Patient: Engage in a detailed discussion to explain the importance of notifying partners for their health and to prevent further transmission of HIV.
2. Support Patient Referral: Encourage the patient to inform their partners themselves, providing verbal and written information to facilitate this process.
3. Provider Referral: If the patient still refuses, you can refer the case to local sexual health services. These services can assist with partner notification confidentially and ensure that the partners are informed and tested.
4. Legal Obligations: Inform the patient that public health authorities may be notified if they refuse to disclose their HIV status to their partners, as part of mandatory case notification protocols.
5. Documentation and Follow-Up: Document the discussions and steps taken in the patient’s medical records. Arrange for follow-up appointments to reassess the situation and provide ongoing support.

For more information, you can refer to the RACGP guidelines on contact tracing for STIs and the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) resources.

Question 50

How should healthcare providers handle refusal to treat HIV-positive patients?

Answer 50

Refusal to treat is unethical, but a physician cannot be forced to treat; the best choice is to refer the patient to another physician.

Question 51

Describe the process for handling STD cases involving partner notification and contact tracing.

Answer 51

Encourage the patient to inform their partner first; if they refuse, the healthcare provider should take the responsibility to notify the partner. Contact tracing, reporting, and notifying are essential steps.

Question 52

Define malpractice in healthcare and outline the three rules that determine it.

Answer 52

Malpractice is an error in care with evidence and harm to the patient. If all three criteria are not met, it is not considered malpractice.

Question 53

How should doctors handle gifts from patients in the healthcare setting?

Answer 53

Doctors should not accept gifts if there is any intent behind them or if they are of significant value.

Question 54

What are the guidelines regarding doctor-patient relationships and sexual contact?

Answer 54

Doctor-patient sexual contact is unethical regardless of who initiates it. Both parties should mutually terminate the relationship if such a situation arises.

Question 55

Describe the protocol for physician disagreement in a medical setting.

Answer 55

If there is a disagreement between attending and resident physicians, the attending’s decision prevails. If residents disagree, they should discuss and try to reach a consensus based on evidence-based medicine.

Question 56

What are the rules regarding experimentation on patients in healthcare settings?

Answer 56

Experimentation should only be voluntary and with informed consent. Children require consent from a parent or guardian. The same rules apply to prisoners, and any study causing definite harm is unethical and not approved.

Question 57

Explain the reporting protocol for impaired healthcare professionals.

Answer 57

Impaired healthcare professionals due to various conditions must be reported to the medical board. If patient care is not affected, certain behaviors may not require reporting.

Question 58

How should healthcare professionals handle doctor-doctor relationships in terms of disagreements?

Answer 58

In cases of disagreement between attending and resident doctors, the attending’s decision takes precedence. If residents disagree, they should attempt to resolve the issue through discussion or escalate to a higher authority if needed.