Ethics/other Flashcards
A quality assurance program should include all the following features EXCEPT:
a) identify who is your customer (patient)
b) identify what services are required by the customer (patient)
c) identify how services are provided to the customer (patient)
d) identify the cost of the services to the customer (patient) compared to other institutions
e) identify processes by which services to the customer (patient) may be improved
c) identify how services are provided to the customer (patient)
* CHECK as M answer says D
Effective risk management is paramount in the day-to-day life of any medical practitioner. Typically, there are three strategies practitioners utilise to manage risk: transfer, mitigate or avoid the risk. When managing risk, in which order would you implement the aforementioned strategies?
a. Transfer, avoid, then mitigate the risk
b. Mitigate, transfer, then avoid the risk
c. Avoid, mitigate, then transfer the risk
d. Avoid, transfer, then mitigate the risk
d. Avoid, transfer, then mitigate the risk
Which of the following is NOT a reason, identified by the literature, for patient’s expression of dissatisfaction while being told their diagnosis?
a. Doctors perceive their breaking bad news skills to be inadequate
b. Most patients do not wish to be told their diagnosis
c. Doctors fear that breaking bad news will cause long term harmful consequences
d. Patients may not be asking questions for which they desire more information
b. Most patients do not wish to be told their diagnosis
O
A 22 year old nulliparous woman was referred by her GP for colposcopy in view of persistent LSIL on Pap smear. The colposcopy and a guided biopsy results confirmed LSIL with presence of HPV infection. She requests treatment with LLETZ.
On what principle would the clinician DECLINE the request?
A. Non-maleficence
B. Patient autonomy
C. Beneficence
D. Justice
A. Non-maleficence
O
DO NO HARM!
A 14 year old competent adolescent presents requesting a termination of pregnancy of 8 week gestation. She has not told her parents that she is pregnant and is not intending to do so. She is concerned that if they find out, they will make her
leave home.
What is the course of action that BEST addresses the needs of this young woman?
A. Counsel her appropriately and schedule the procedure
B. Refuse to perform the procedure due to her age and because she has not told her parents
C. Counsel her appropriately, advise her to tell her parents, as in the event of an emergency her next of kin would be notified, and schedule the procedure
D. Inform the parents
C. Counsel her appropriately, advise her to tell her parents, as in the event of an emergency her next of kin would be notified, and schedule the procedure
O
A 31 year old had an ultrasound to assess fetal morphology at 21 weeks pregnant. The ultrasound showed a moderate VSD. She was counselled for an
amniocentesis the results of which showed no karyotypic abnormality. A detailed discussion about fetal prognosis followed with the obstetrician and paediatric cardiologist and they recommended against a termination of pregnancy. However, the patient requests a termination of pregnancy.
What will be the MOST relevant guiding principle to assist in decision making?
A. Non-maleficence
B. Maternal autonomy
C. Fetal rights
D. Justice
B. Maternal autonomy
O
The doctor has just diagnosed a woman as being HIV positive. She does not wish to inform her partner. Apart from notification, what is the doctor’s LEGAL OBLIGATION to her partner?
A. The partner can only be told with her permission
B. The partner has a right to know irrespective of her wishes
C. The partner only needs to be informed if the couple are not using barrier contraception
D. The partner should be offered testing without being told that she is positive
B. The partner has a right to know irrespective of her wishes
O
A 14 year old girl presents to a gynaecology clinic to discuss contraception options. She is a non-smoker. On further questioning it appears she is in a consensual relationship with her 15 year old boyfriend and the doctor is satisfied that she is able to understand the potential risks and benefits of taking the combined contraceptive pill (COCP). The doctor should counsel her about the potential risks of early sexual activity but is convinced that she will continue to be sexually active and she is adamant she does not wish to discuss this with her parents.
In this situation, RANZCOG would recommend that
the doctor should:
A. Agree and prescribe the COCP only with parental agreement
B. Encourage her to talk to her parents but agree to prescribe the COCP in any case
C. As she is 14years old, you request a second opinion
D. You report her to Child Protective Services under mandatory reporting legislation
B. Encourage her to talk to her parents but agree to prescribe the COCP in any case
O
A 14 year old presents to the Gynaecology clinic with her mother for investigation of pelvic pain. During examination she asks if the doctor would be able to prescribe the oral contraceptive pill as she is sexually active. On further questioning it appears she is in a consensual relationship with the 34 year old mother’s partner. She is adamant that the doctor must not discuss this with anyone and that the only reason she has raised this issue was because she was afraid of becoming pregnant.
Which of the following would be MOST APPROPRIATE?
A. Inform her that this will need to be reported to child protective services
B. Inform the mother
C. Refer her to the social work department
D. Ask her to talk to the mother’s partner
A. Inform her that this will need to be reported to child protective services
O
A mother brings her daughter, who is severely intellectually disabled to see the doctor. The 15 year old teenager is unable to undertake any self care activities, is not toilet trained, requires assistance with feeding, and is wheelchair dependant. The mother is requesting a hysterectomy as her daughter will clearly never be able to have a pregnancy or care for a baby.
What is the MOST APPROPRIATE management of this case?
A. The doctor agrees and offers to undertake a hysterectomy with parental consent
B. The doctor refuses, as no sterilising procedures in minors are permitted under Australian law
C. The doctor seeks approval from the Family Law Court of Australia/Guardianship Board to undertake the procedure
D. The doctor suggests alternative menstrual management approaches
D. The doctor suggests alternative menstrual management approaches
O
i.e. Mirena
A 20 year old severely disabled woman is brought to the gynaecology clinic by her parents. She is 18 weeks pregnant. What is the MOST APPROPRIATE first action?
A. Apply to the Guardianship Board to obtain consent for TOP
B. Termination of pregnancy can be arranged with parental consent
C. Notify the police
D. Arrange social work involvement
C. Notify the police
O
The doctor is phoned by a father who has discovered a packet of the combined contraceptive pill (COCP) in his 16 year old daughter’s room with the doctors name on it as a prescriber. He wants to know what is going on.
What is the MOST APPROPRIATE response to him over the telephone?
A. The doctor denies ever seeing his daughter
B. The doctor says he is unable to discuss details of his daughter’s care with him
C. The doctor explains that his daughter was prescribed the COCP as she is sexually active and did not want to get pregnant
D. The doctor explains that the COCP was prescribed for period pain
B. The doctor says he is unable to discuss details of his daughter’s care with him
O
Which of the following actions and activities in the physician/patient relationship is NOT an example of sexual misconduct
a. The patient and physician mutually consent to the sexual relationship
b. A romantic relationship between a physician and current patient in which emotional counselling has taken place
c. A romantic relationship between a physician and a former patient in which emotional counselling has taken place
d. None of the above
d. None of the above
O
Of the following applications to Artificial Reproductive Technology the LEAST justified on ethical grounds is:
A. reanastamosis of the fallopian tubes in a 41-year old woman
B. donor insemination of an unmarried woman
C. ovulation induction in a woman where both husband and wife are not employed
D. surrogate motherhood for an married professional with mild endometriosis who does not wish to stop her depo provera as her endometriosis may flare
E. IVF for a 27year old woman with blocked fallopian tubes whose father has Huntington’s chorea
D. surrogate motherhood for an married professional with mild endometriosis who does not wish to stop her depo provera as her endometriosis may flare
O
Which of the following are NOT common reasons, as reported in current literature, for non compliance to medical advice/treatment?
A. Low levels of patient satisfaction
B. Patient age
C. Complex treatment regime
D. Doctor’s gender
D. Doctor’s gender
O
