The Four-Box Method to Application of Ethics in Clinical Practice Medical Indications Flashcards
Question 1: Ethics in Medical Indications
Clinical Vignette: A 65-year-old male patient presents with acute onset renal colic. Upon evaluation, it is clear that he will need surgical intervention. You consider his medical history, diagnosis, and prognosis before moving forward.
A) What is the most important factor to consider before proceeding?
A) The patient’s current diagnosis
B) The goals of treatment
C) The patient’s medical history
D) The probability of treatment success
Correct Answer: B) The goals of treatment
Explanation: Understanding the goals of treatment is vital for choosing an appropriate intervention.
Memory Tool: “Goal-Oriented Treatment” is the GOT-to-have before proceeding.
Reference Citation: TABLE 7.1, Medical Indications section, point 3
Rationale: It emphasizes the importance of treatment goals in ethical medical practice.
Question 2: Ethics in Patient Preferences
Clinical Vignette: A 40-year-old female presents with recurrent UTIs. She states that she is allergic to certain antibiotics and prefers not to take them.
A) What should be your next step?
A) Proceed with alternative treatment
B) Evaluate her understanding and get consent
C) Confirm the allergy with tests
D) Override the patient’s preference due to the recurrent nature of UTIs
Correct Answer: B) Evaluate her understanding and get consent
Explanation: It is crucial to confirm that the patient understands the benefits and risks before proceeding.
Memory Tool: “Informed Consent is Paramount” - ICP
Reference Citation: TABLE 7.1, Patient Preferences section, point 2
Rationale: It highlights the significance of informed consent in respecting patient preferences.
Question 3: Ethics in Quality of Life
Clinical Vignette: A 55-year-old male patient with BPH is facing surgical options. He is also a professional soccer coach.
A) What should be considered while evaluating treatment options?
A) His current state of health
B) The economic burden of treatment
C) The effect on his professional life
D) Religious beliefs of the patient
Correct Answer: C) The effect on his professional life
Explanation: Given his profession, any treatment’s impact on his quality of life is crucial.
Memory Tool: “Vocation Affects Life Quality” - VALQ
Reference Citation: TABLE 7.1, Quality of Life section, point 1
Rationale: Quality of life extends beyond just medical outcomes and may include career impacts.
Question 4: Ethics in Contextual Features
Clinical Vignette: A 30-year-old woman is undergoing evaluation for a kidney transplant. Her husband works for the pharmaceutical company that manufactures immunosuppressants.
A) What ethical issue is most directly raised here?
A) Financial and economic factors
B) Provider conflicts of interest
C) Legal implications of treatment decisions
D) Resource allocation
Correct Answer: B) Provider conflicts of interest
Explanation: The husband’s employment could be seen as a conflict of interest.
Memory Tool: “Conflicting Interests Create Ethical Stickiness” - CICES
Reference Citation: TABLE 7.1, Contextual Features section, point 9
Rationale: Addresses the complexities of conflicts of interest in ethical decision-making.
Question 5: Integrated Ethics in Medical Indications and Patient Preferences
Clinical Vignette: A 70-year-old male with a history of hypertension comes to the ER with severe back pain and is diagnosed with an aortic aneurysm requiring emergency surgery. The patient is anxious and reluctant to proceed with the surgery.
A) What should be your first two ethical considerations before proceeding?
A) Assess the probability of treatment success and get the patient’s consent
B) Identify goals of treatment and ensure patient’s mental capability
C) Assess the patient’s acute condition and prior expressed preferences
D) Evaluate the problem’s critical nature and the patient’s quality of life post-surgery
Correct Answer: B) Identify goals of treatment and ensure the patient’s mental capability
Explanation: Both the goals of treatment (Medical Indications, point 3) and the patient’s mental capacity to understand and consent (Patient Preferences, point 3) are critical before proceeding.
Memory Tool: “Goal & Mind Check” - GMC
Reference Citation: TABLE 7.1, Medical Indications point 3 & Patient Preferences point 3
Rationale: Highlights the intertwined considerations of treatment goals and patient mental capacity in clinical ethics.
Question 6: Comprehensive Ethics in Quality of Life and Contextual Features
Clinical Vignette: A 45-year-old female diagnosed with a complex cyst on her left kidney. The patient is a single mother of two, and her religious beliefs discourage surgical interventions.
A) Which two ethical aspects are most crucial to consider?
A) Impact of treatment on her role as a mother and her religious beliefs
B) Prospects of her returning to normal life and financial aspects
C) Physical deficits post-treatment and provider issues affecting decisions
D) Comfort/palliative care options and legal implications
Correct Answer: A) Impact of treatment on her role as a mother and her religious beliefs
Explanation: Consideration of the patient’s role as a mother (Contextual Features, point 1) and her religious beliefs (Contextual Features, point 4) are pivotal in this case.
Memory Tool: “Mother & Faith First” - MFF
Reference Citation: TABLE 7.1, Contextual Features point 1 & 4
Rationale: Addresses the essential aspects of the patient’s life that can greatly influence treatment choices.
Question 7: Integrated Ethics in All Four Categories
Clinical Vignette: A 55-year-old male patient has been diagnosed with metastatic prostate cancer. He is an avid runner and wishes to preserve his quality of life. He’s also a prominent community leader, and the local hospital receives significant donations from his organization.
A) What are the top three ethical considerations?
A) Goals of treatment, patient’s quality of life, and institutional conflicts of interest
B) Acute vs. chronic condition, patient’s role in the community, and financial factors
C) Therapeutic failure plans, patient’s prior preferences, and legal implications
D) Probability of treatment success, patient’s normal life prospects, and justification for breaching confidentiality
Correct Answer: A) Goals of treatment, patient’s quality of life, and institutional conflicts of interest
Explanation: In this complicated scenario, the ethical priorities include treatment goals (Medical Indications, point 3), maintaining the patient’s quality of life (Quality of Life, point 1), and acknowledging institutional conflicts of interest (Contextual Features, point 9).
Memory Tool: “Treatment Goals, Quality Life, Don’t Conflict” - TGQLDC
Reference Citation: TABLE 7.1, Medical Indications point 3, Quality of Life point 1, Contextual Features point 9
Rationale: This question highlights the multifaceted ethical considerations that can arise in complex clinical cases.
Question 8: Integrating Medical Indications and Quality of Life
Clinical Vignette: A 62-year-old man presents with acute urinary retention. He has a history of obstructive sleep apnea and obesity. The most effective treatment could result in impotence, which the patient strongly wishes to avoid.
A) What are the top two considerations before making a treatment decision?
A) Assess probabilities of treatment success and the patient’s normal life prospects
B) Goals of treatment and the patient’s quality of life post-surgery
C) Therapeutic failure plans and the patient’s mental state
D) Acuteness of the problem and patient’s present condition
Correct Answer: B) Goals of treatment and the patient’s quality of life post-surgery
Explanation: Given the potential for impotence, it is vital to weigh the goals of treatment (Medical Indications, point 3) against the patient’s post-treatment quality of life (Quality of Life, point 1).
Memory Tool: “Aim for Goals but Gauge Life Quality” - AGGLQ
Reference Citation: TABLE 7.1, Medical Indications point 3, Quality of Life point 1
Rationale: This question underscores the tension between medical efficacy and quality of life.
Question 9: Complex Ethical Considerations Involving Patient Preferences and Contextual Features
Clinical Vignette: A 27-year-old woman diagnosed with advanced bladder cancer declines chemotherapy due to her plans to conceive. She comes from a community that highly values fertility.
A) What are the most pressing ethical issues?
A) Assessing the patient’s understanding and evaluating community influence
B) Prior expressed preferences and provider issues that might influence treatment decisions
C) Evidence of the patient’s incapacity and legal implications
D) The patient’s right to choose and religious or cultural factors
Correct Answer: D) The patient’s right to choose and religious or cultural factors
Explanation: Respecting the patient’s autonomy (Patient Preferences, point 7) and considering her cultural background (Contextual Features, point 4) are the foremost considerations.
Memory Tool: “Respect Choices and Cultural Context” - RCCC
Reference Citation: TABLE 7.1, Patient Preferences point 7, Contextual Features point 4
Rationale: This question highlights the ethical importance of patient autonomy and cultural respect in medical treatment.
Clinical Vignette: A 50-year-old man presents with symptoms suggestive of prostate cancer. He is uninsured and is concerned about the costs of diagnostic procedures and treatment.
A) What are the two key ethical concerns?
A) Financial factors and probabilities of treatment success
B) Treatment goals and problems of resource allocation
C) Patient’s informed consent and the legal implications
D) Treatment failure plans and family issues affecting decisions
Correct Answer: B) Treatment goals and problems of resource allocation
Explanation: The ethical considerations include aligning the treatment with the goals (Medical Indications, point 3) while being mindful of the financial limitations and resource allocation (Contextual Features, point 6).
Memory Tool: “Goal Aligned Yet Resource-Considerate” - GAYRC
Reference Citation: TABLE 7.1, Medical Indications point 3, Contextual Features point 6
Rationale: This question draws attention to the challenge of providing effective treatment in a resource-limited setting.
Question 11: Ethical Decision-Making in Acute Versus Chronic Conditions
Clinical Vignette: A 38-year-old woman presents with recurrent UTIs. Antibiotics provide short-term relief but do not prevent recurrence. She’s open to exploring treatment options but fears long-term antibiotic use.
A) What are the two most pertinent ethical issues in her case?
A) Nature of the problem (acute or chronic) and the patient’s expressed treatment preferences
B) Probability of treatment success and goals of treatment
C) Quality of life prospects and potential therapeutic failure
D) Patient’s capacity to understand risks and patient’s right to choose
Correct Answer: A) Nature of the problem (acute or chronic) and the patient’s expressed treatment preferences
Explanation: In this case, assessing whether the problem is chronic (Medical Indications, point 2) and considering the patient’s wishes (Patient Preferences, point 1) are crucial.
Memory Tool: “Chronic or Not, Patient’s Thought” - CNPT
Reference Citation: TABLE 7.1, Medical Indications point 2, Patient Preferences point 1
Rationale: This question emphasizes the importance of understanding the chronic nature of a problem alongside the patient’s wishes.
Question 12: Privacy and Legality in Medical Decisions
Clinical Vignette: A 21-year-old male patient tested positive for chlamydia. He has multiple sexual partners and is reluctant to inform them about his diagnosis.
A) What ethical principles should guide the treatment decision?
A) Breach of confidentiality and legal implications
B) Patient’s right to choose and quality of life
C) Resource allocation and religious or cultural factors
D) Provider issues affecting decisions and prospects of return to normal life
Correct Answer: A) Breach of confidentiality and legal implications
Explanation: Ethical concerns involve breaching confidentiality for the public good (Contextual Features, point 5) and legal implications like mandatory reporting (Contextual Features, point 7).
Memory Tool: “Can’t Keep Silent, Must Report” - CKSMR
Reference Citation: TABLE 7.1, Contextual Features point 5 & 7
Rationale: Focuses on ethical considerations in cases that have broader societal implications.
Question 13: Ethics in Clinical Research Context
Clinical Vignette: A 67-year-old man with advanced renal cancer is offered a chance to participate in a clinical trial for a new immunotherapy drug. He has no family or friends to consult.
A) What are the key ethical considerations?
A) Goals of treatment and clinical research involvement
B) Consent and probability of success
C) Provider or institutional conflicts of interest and patient preferences
D) Prospects for a return to normal life and financial factors
Correct Answer: A) Goals of treatment and clinical research involvement
Explanation: Ethical concerns should focus on the goals of treatment (Medical Indications, point 3) and the involvement of clinical research (Contextual Features, point 8).
Memory Tool: “Aiming for Cure but Trial in Picture” - ACTIP
Reference Citation: TABLE 7.1, Medical Indications point 3, Contextual Features point 8
Rationale: This question explores the ethics of introducing experimental treatments, especially when the patient lacks a support system.
