Ethics AMC Flashcards
1
Q
- A 25-year old mother refused immunization for her 2-month old son.
A
Immunization should be given for the benefit of the child.
- immunisation is not by force
2
Q
- A 30-year old mother refused surgery for suspected appendicitis for her 6-year old daughter.
A
Surgical removal of the appendix should be performed for the benefit of the child.
3
Q
- A 16-year old boy diagnosed with osteosarcoma refuses amputation despite it being life-saving.
A
Amputation should NOT be performed.
4
Q
- A 17-year old Jehovah’s Witness girl refuses a lifesaving blood transfusion.
A
Blood transfusion should NOT be given because she is competent to make the decision.
5
Q
- A 5-year old Jehovah’s Witness girl needs emergency blood transfusion, mother refuses.
A
Blood transfusion should be given because the patient is not competent; mother cannot refuse treatment.
6
Q
- A 2-year old boy is diagnosed with child abuse, parents request confidentiality.
A
The case should be reported to Child Welfare Agency (CWA); children should be removed from parents.
7
Q
- A 15-year old boy with STD asks physician not to tell parents.
A
Physician should treat patient, notify appropriate health authority, but not tell parents.
8
Q
- A 16-year old boy requests condoms without informing parents.
A
Condoms should be given; physician should not inform parents.
9
Q
- A 30-year old man with HIV requests physician not to tell his wife.
A
Physician should notify appropriate authority for safety, urge patient to disclose to wife.
10
Q
- A newborn is not resuscitated per mother’s decision; she understands implications.
A
Physician is not liable for newborn’s death; no liability for withholding life-sustaining treatment.
11
Q
- Physician picks up car accident victim, resulting in quadriplegia.
A
Physician is liable for consequences due to inadequate neck protection.
12
Q
- Policeman asks physician to insert nasogastric tube against patient’s refusal.
A
Nasogastric tube should not be inserted; blood alcohol level should be tested.
13
Q
- 60-year old man with myocardial infarction needs resuscitation by another department’s physician.
A
Physician must resuscitate patient; cannot refuse treatment based on department.
14
Q
- 15-year old homosexual boy seeks help, asks physician not to tell parents.
A
Physician should help avoid homosexual activities; should not inform parents.
15
Q
- 15-year old homosexual boy brought by parents who do not accept orientation.
A
Physician should inform parents of sexual orientation as an alternative lifestyle; should not force change.
16
Q
- 16-year old girl becomes pregnant against mother’s wishes; wants to continue.
A
Physician should advise continuation of pregnancy; girl is competent to decide.
17
Q
- 15-year old girl seeks abortion without parental notification.
A
Abortion should be done without notifying parents; strict requirements may deter seeking care.
18
Q
- Physician provides sterile needles to intravenous drug abusers.
A
Yes, to reduce HIV or hepatitis risk; refer to appropriate health facilities.
19
Q
- Pregnant woman refuses fetal blood transfusion for erythroblastosis fetalis.
A
Physician should seek court order for procedure benefitting fetus.
20
Q
- 20-year old man threatens girlfriend; physician alerts university, no action taken.
A
Responsibility lies with the man for the killing; university also accountable for negligence.
21
Q
- 20-year old pregnant woman refuses cesarean section for placenta previa.
A
Physician can seek court permission for cesarean section for fetal benefit.
22
Q
- 30-year old pregnant woman abuses alcohol and drugs harmful to fetus.
A
Report to CWA if fetal urine toxicology positive; suggest separate custody if necessary.
23
Q
- Physician wants to study 10-12 year olds; one child refuses participation.
A
Child can refuse participation in research study.
24
Q
- 40-year old schizophrenic patient needs hernia repair; understands procedure.
A
Yes, patient can consent if understands procedure despite psychiatric condition.
25
25. 65-year old schizophrenic patient needs coronary angiography; does not understand.
Relative can consent; obtain court order if no available relative.
26
26. Postpartum woman consents to newborn's cardiac surgery for congenital heart disease.
Yes, mother can consent if understands procedure.
27
27. Parents request surgical repair for newborn with trisomy 18 or 13; non-viable condition.
Surgeon should refuse surgery; consider gastrostomy tube for nutrition if patient survives.
28
28. Terminally ill patient requests medication to expedite death due to constant pain.
Physician cannot expedite death but can prescribe appropriate pain relief medication.
29
29. Patient diagnosed with metastatic prostate cancer; physician must disclose diagnosis.
Yes, physician must disclose diagnosis to patient.
30
30. Surgeon unsure of patient's decision-making capacity for cholecystectomy.
Consult psychiatrist or neurologist; consider ethics committees or court involvement for complex cases.
31
31. Comatose patient's substitute decision-maker designated by written advance directive.
50-year old neighbor should make substitute decision based on advance directive.
32
32. Patient's right to refuse medical intervention, including life-sustaining treatment.
Patient can refuse treatment, not considered suicide; physician participation not assisted suicide.
33
33. Medical student identifying as 'doctor' to patient.
No, patient can refuse procedures by medical student; procedures only with patient's consent and appropriate supervision.
34
34. Bus driver hides epilepsy from employer fearing job loss.
No, physician should encourage notifying employer; if not, notify appropriate authority for community safety.
35
35. Patient requests physician not to tell wife about stomach cancer diagnosis.
Physician should encourage patient to disclose diagnosis to wife.
36
36. Presymptomatic Huntington's disease patient refuses to disclose diagnosis to wife.
Patient should seek genetic counseling and discuss with wife due to risk to future children.
37
37. Meningitis patient refuses therapy and returns to college dormitory.
Physician should report to college authority; recommend isolation during illness.
38
38. Nurse with hepatitis B antigen-positive does not disclose to hospital authority.
Physician should encourage nurse to disclose condition to hospital authority; if refusal, notify for patient safety.
39
39. Patient needs neurosurgical intervention not accepted due to lack of medical insurance.
University hospital must accept patient regardless of insurance status.
40
40. Patient needs second prosthetic valve; surgeon reluctant due to patient's drug addiction.
Surgery should be performed if medically indicated, regardless of patient's lifestyle.
41
41. Anencephalic newborn's kidney requested for transplant to sibling with renal failure.
Surgeon should perform kidney transplant if medically viable.
42
42. Patient in persistent vegetative state; physician discontinues nutrition and hydration.
Yes, this is ethically acceptable in most states with appropriate evidence of patient's wishes.
43
43. Medical student requests pelvic examination on anaesthetized patient without consent.
No, procedure cannot be performed without patient's consent.
44
44. Unconscious patient brought to ER after wrist slashing; psychiatric and social evaluation needed.
Physician should provide care, evaluate psychiatric state with social worker involvement.
45
45. Alzheimer's patient with recurrent aspiration pneumonia; family decides against intervention.
Physician should respect family's decision after discussion.
46
46. Infant diagnosed with hypoplastic left heart syndrome; prostaglandin used to stabilize.
Parents can choose staged surgical repair, heart transplantation if available, or palliative care.
47
47. Developmentally disabled woman with breast cancer; family declines intervention.
Discuss with hospital ethics committee; consensus often to refrain from intervention due to severe disability.
48
48. Cervical cancer patient with history of noncompliance; surgeon wants to force chemotherapy.
No, patient must decide on treatment; physician can only educate and advise.
49
49. Diabetic patient unhappy with management seeks another physician.
Physician should refer to another specialist who may better manage patient's condition.
50
50. Internist refuses to see patient due to rudeness; patient seeks records from new physician.
Internist should provide patient's medical records to new physician upon request.
51
51. An internist refused to see a complicated hypertensive patient who he has seen for the last 10 years...
yes. The legal charge of abandonment can arise when the physician without giving timely notice, ceases to provide care for a patient who is still in need of medical attention. Internist is not obligated to find him another physician. However, patient should have sufficient time to arrange for another physician.
52
52. A physician went on vacation for 2 weeks. He did not find another physician to cover him...
yes. The physician has a legal obligation to arrange for coverage by another physician.
53
53. An ophthalmologist performed a cataract surgery on a patient who went home after the operation...
yes. Ophthalmologist failed to judge the patient’s condition seriously enough to warrant attention.
54
54. A 70-year old Chinese man is diagnosed with severe osteoarthritis...
The doctor should suggest to discontinue the herbal product which may be causing the dizzy spells.
55
55. A 35-year old woman is diagnosed with chronic throat infection...
The patient can continue an alternative homeopathic medicine. Alternative medicine therapy is accepted in society and is also used along with conventional therapy.
56
56. A 45-year old woman is diagnosed with UTI (urinary tract infection)...
The patient should discontinue the herbal medicine immediately and should start antibiotics as soon as possible.
57
57. A 13-year old boy with suspected meningitis refuses therapy...
The patient should be admitted and treated in the hospital. If they refuse, legal action should be taken.
58
58. A 2-year old girl is admitted with the diagnosis of intestinal obstruction...
Legal steps may be taken to provide a surrogate decision-maker.
59
59. A 67-year old widow has been using hypnotics for the last 5 years...
No. The physician cannot use placebos because his decision is deceptive. The problem of addiction should be discussed directly with the patient.
60
60. A 50-year old man is diagnosed with multiple sclerosis...
No. The patient has impaired capacity.
61
61. A 55-year old woman with diabetes is diagnosed with gangrene on both feet...
No. The appointment of a surrogate should be sought to get the consent for the surgery.
62
62. A 17-year old boy came to a surgeon for bilateral vasectomy...
Surgeon should not perform bilateral vasectomy and should offer him less radical alternatives. A mature minor may not comprehend the implications of this procedure.
63
63. A 16-year old girl came to a doctor for bilateral tubal ligation...
OB/GYN doctor should not perform bilateral tubal ligation and should offer her less radical alternatives.
64
64. A 16-year old boy wants to donate one of his kidneys to his friend...
The physician cannot accept his kidney. However, he can donate one of his kidneys if his parents agree.
65
65. A 15-year old boy wants to participate in a research study...
No. The boy needs consent from his parents to participate in a research study.
66
66. A 17-year old boy lives independently...
No. He is an emancipated minor who lives independently from his parents physically and financially.
67
67. A 70-year old man is diagnosed with terminal esophageal cancer...
Attending physician, surgeons, and the patient or surrogate should discuss the matter and either affirm or suspend the order in anticipation of surgery.
68
68. An infant, born at 30 weeks gestation...
Physician must resuscitate the patient in the delivery room because the diagnosis is uncertain.
69
69. A 60-year old man is diagnosed with terminally ill colon cancer...
No. A performance of ‘slow code’ or ‘show code’ is not acceptable to the patient.
70
70. A 20-year old man is diagnosed with suspected bacteremia and meningitis...
The physician should resuscitate the patient despite the patient’s refusal to antibiotic therapy.
71
71. A 50-year old woman is diagnosed with severe aortic stenosis...
In severe aortic stenosis, vigorous resuscitation is highly unlikely to restore adequate cardiac output.
72
72. A 14-year old boy is diagnosed with terminally ill cancer...
The boy’s decision should be respected because the treatment is futile.
73
73. A surrogate pregnant mother made a surrogacy contract with a couple...
Yes. If her life or health becomes threatened from continuing the pregnancy, she should retain her right to abortion.
74
74. A physician became sexually involved with a current patient...
No. The physician should discuss with a colleague or other professional before becoming sexually involved with a former patient.
75
75. A physician decided to take care of his own family members and relatives...
No. The physician should encourage all friends and family members to have their own personal physician.
76
76. A male patient wants to have a copy of his medical records...
The physician should retain the original of the chart. Information should only be released with the written permission of the patient or the patient’s legally authorized representative (e.g., attorney).
77
77. A 30-year old female wants to have an abortion...
Physician should not offer advice to the patient.
78
78. A physician sees patients at a reduced fee...
No. The physician is not providing optimal care.
79
79. A surrogate pregnant mother signed a surrogacy contract with a couple...
Yes. Surrogate contracts should grant the birth mother the right to void the contract within a reasonable period after the birth of the child.
80
80. A surrogate pregnant mother signed a surrogacy contract with a couple...
No. Genetic parents have exclusive custody and parental rights.
81
81. A surrogate pregnant mother signed a surrogacy contract with a couple...
The couple is genetically related to the fetus. They have the right not to continue with this pregnancy.
82
82. A surrogate pregnant mother signed a surrogacy contract with a couple...
Female partner has no right to terminate this pregnancy because she has no genetic relation. Surrogate mother has genetic relation and she has the right to continue this pregnancy even if the male partner disagrees.
83
83. A 3-year old girl is diagnosed with blood cancer...
Physician should obtain an informed consent of the risks of donation and should follow the normal umbilical cord clamping protocol. Physician should protect both the children.
84
84. A 31-year old man has decided to donate one of his kidneys for a large amount of money...
No. Only the potential donor, not the donor’s family or another third party, may accept financial incentive. Payment should occur only after the organs have been retrieved and judged medically suitable for transplantation.
85
85. A couple has decided to have a child through artificial insemination...
Physician should not participate in sex selection for reasons of gender preference. However, sex selection of sperm for the purpose of avoiding a sex-linked inheritable disease is appropriate.
86
86. A 30-year old man has donated his sperms which were kept frozen...
The donor’s wife can use the semen for artificial insemination but not to donate it to someone else. The donor should give clear instructions at the time of donation.
87
87. The donor and recipient of sperms are not married...
The recipient. Except in cases where both donor and recipient agree to recognize a paternity right.
88
88. The residents and medical students were asked by an attending to follow certain orders for a patient...
The residents and medical students should not follow those orders. They should discuss with the attending issuing those orders and seek advice from a senior attending physician, chief of staff, or chief resident.
89
89. A physician used a newly prescribed drug to his patient...
Yes. FDA should be notified only if the drug causes serious adverse events such as those resulting in death, hospitalization, or medical or surgical intervention.
90
90. A 39-year old female has been suffering from chronic cholecystitis...
The second surgeon should accept the patient’s decision. First surgeon should accept the patient’s decision.
91
91. A 45-year old male was admitted to the hospital with mild chest pain...
The patient is asked to sign a statement that he is leaving against medical advice (AMA). The patient may however leave without signing that statement.
92
92. A 55-year old man requested his physician to misrepresent his medical condition...
The physician must refuse that request.
93
93. What is the responsibility of a fellow physician who is aware of drug abuse, alcohol abuse, or psychiatric illness of his colleagues or of a medical condition that is harmful to patients?
The physician should protect the patients and report to the appropriate authority (e.g., hospital authority, Dean for medical student’s problem).
94
94. A 60-year old male has been suffering from severe pain due to terminal prostate cancer...
The physician should increase the dosage of narcotics and sedatives up to the maximum recommended amount.
95
95. A 25-year old female medical student or resident noticed a mistake made by a junior attending physician during rounds. She is afraid of that attending physician. What is the appropriate way to handle the situation? (Important)
She should discuss the situation with a more senior attending physician for appropriate interpretation, advice, and assistance.
96
96. A 26-year old male medical student or resident made a mistake during patient care. He is afraid of what might result. What is the appropriate way to handle the situation?
He should disclose the mistake to the attending physician and try to learn from that mistake. The patient should be notified as well.
97
97. A 63-year old female health care worker is concerned about taking care of patients with HIV infection or multidrug-resistant tuberculosis. What is the appropriate way to handle the situation? (Important)
The physician should provide appropriate care to patients despite personal risk. Institutions should reduce the risk of infection by appropriate equipment, supervision, and training. Her concern should be taken seriously.
98
98. A 30-year old male physician has an opportunity for financial incentive if he sees more patients and refers them unnecessarily. What is your opinion about this?
The physician should provide only care that is in the patient’s best interest.
99
99. Two physicians are discussing a case inside the elevator of a hospital. What is your opinion about this?
They should not do that because they have to maintain the patient’s confidentiality.
100
101. A physician is experiencing a very difficult ethical issue regarding a complicated case. He is confused. What should be the next step?
He should discuss the matter with other faculty members in his health care team, colleagues, or hospital ethics committee.
101
102. What is the final plan of action in an ethical issue?
Both patient and physician should agree regarding final management. The patient should be well-informed about the medical condition. The physician should be sympathetic and knowledgeable regarding the relevant medical condition.
102
103. DNR (do not resuscitate) order. When is this appropriate?
This is appropriate if the patient or surrogate signed that order or if CPR would be futile. Physicians should write DNR orders and the reason for them in the chart. "Slow" or "show" codes are not acceptable.
103
104. Brain death (adult): What are the criteria?
- Definition: Irreversible cessation of circulation and respiratory functions or irreversible cessation of all functions of the entire brain and brain stem.
- Criteria: Absence of all signs of receptivity, responsivity, and all brainstem reflexes, with isoelectric EEG. Must be confirmed by another physician.
- Criteria: Absence of all signs of receptivity, responsivity, and all brainstem reflexes, with isoelectric EEG. Must be confirmed by another physician.
104
105. Practice guidelines for physicians: What role do they play?
They help select appropriate diagnostic techniques and therapeutic measures for specific patients and conditions, potentially reducing healthcare costs while improving patient care.
105
106. What is the major goal of therapy for a patient with an incurable disease?
Enhancing the quality of life should be the major goal.
106
107. What happens to patients who do not have decision-making capacity about their medical care?
They usually arrange for surrogates to make decisions based on their values. Advanced directives can also guide care.
107
108. Down syndrome with different medical conditions: How should these be managed?
Each condition should be managed based on regular surgical or medical protocols, discussed with parents, and in the best interest of the patient.
108
109. Can a healthy male patient with Down syndrome make his own medical decisions?
Yes, if he understands the procedure and consequences, especially if he lives independently.
109
110. How should a doctor handle a patient who is rambling during a medical consultation?
Direct the patient to focus on specific problems related to their health concern.
110
111. How should a doctor handle a patient who is not providing enough information about their symptoms?
The doctor should ask detailed questions to gather sufficient information for an accurate diagnosis.
111
112. What should a doctor do if a noncompliant patient with ulcerative colitis presents with acute abdominal pain after a prolonged absence?
The doctor should assess the abdominal pain thoroughly before making any decisions, ensuring responsible care for the patient.
112
113. How should a doctor approach discussing prognosis with a terminally ill pancreatic cancer patient?
The doctor should discuss the patient's condition honestly and compassionately with both the patient and their family.
113
114. How should a doctor gently inform a nervous patient recently diagnosed with cancer about their medical condition?
The doctor should gently inform the patient about their diagnosis, providing support and answering questions truthfully.
114
115. How should a doctor communicate with a patient who has had a previous nervous breakdown and values open communication with their family?
The doctor should involve the patient's family in discussions about the medical condition, maintaining open and honest communication.
115
116. What should a doctor tell a critically ill patient once stabilized in the ICU about their medical condition?
The doctor should gently inform the patient about their condition, ensuring they understand the situation.
116
117. A mother wants to hold her premature baby admitted to the NICU on a ventilator. What should the doctor do?
The doctor should allow the mother to hold her baby, promoting bonding and comforting both the baby and the mother.
117
118. Should a doctor ask about a male patient's sexual orientation when diagnosing HIV?
Yes, the doctor should ask directly but respectfully about the patient's sexual orientation to provide appropriate care and counseling.
118
119. Why should a doctor ask specific questions about sexual practices when diagnosing HIV in a patient whose partner has HIV?
The doctor should determine the risk of HIV transmission based on sexual practices, as certain practices may carry higher transmission risks.
119
120. How should a doctor deliver the news to family members when a child dies in the ER after drowning?
The doctor should provide clear and compassionate information to the family, ensuring they understand everything was done to save the child.
120
121. How should a physician respond when a pregnant Rh(-)ve woman, who has had induced abortions, is sensitized and her husband wants to know how she became sensitized?
The physician should advise the husband to discuss this with his wife directly and avoid mentioning her history of abortions.
121
122. What should a physician do if a mother brings her infant to the ER and old rib fractures are discovered on radiological tests, which she claims not to know about?
This is a case of suspected child abuse and should be reported to the appropriate child welfare agency.
122
123. How should a physician handle a child's mother becoming anxious during the examination for respiratory distress?
The physician should ensure the management plan is discussed with the parents, always prioritizing the child's best interests.
123
124. A mentally retarded patient is pregnant, and her mother and husband want an abortion while she does not. What should the physician do?
The physician should not perform an abortion and should base decisions on the patient's best interests, considering all perspectives and involving an ethics committee if needed.
124
125. When examining an adolescent or adult female patient, what precaution should a physician take?
A chaperone should be present during the physical examination to ensure patient comfort and ethical standards are maintained.
125
126. Should a chaperone be present when a female physician examines an adolescent or adult male patient?
No, a chaperone is not typically required during such examinations unless requested by the patient or deemed necessary by the physician for ethical reasons.
126
127. What should a physician do if a suspected HIV-positive patient who signed an organ donation consent form dies in a car accident?
Organs should be preserved until the HIV status is confirmed. If positive, the organs should be discarded.
127
128. If a deceased patient signed an organ donation consent form but their driver's license has expired, what should the physician do?
Organs cannot be accepted because the consent form is no longer valid.
128
129. A nurse receives a complaint from a female patient about sexual harassment by a male physician during a physical examination. What should the nurse advise the patient to do?
The nurse should advise the patient to make an official report to the hospital authority or an appropriate agency for investigation.
129
130. How should a physician approach advising a chronic male smoker with heart problems to quit smoking?
The physician should strongly advise the patient to quit smoking immediately, offering support and assistance to help him achieve this goal.
130
131. What should a physician do if a terminally ill patient has signed a DNR but not a DNI (do not intubate) order and now requires intubation?
The physician should intubate the patient but not resuscitate them in line with their wishes.
131
132. If a terminally ill patient has signed a DNR but wants to be intubated without resuscitation, what should a physician do?
The physician should intubate the patient as requested, ensuring their wishes are respected.
132
133. An unconscious adolescent car accident victim needs immediate surgery, but no family members can be contacted for consent. What should a surgeon do?
The surgeon should proceed with surgery without waiting for consent, acting in the best interest of the patient's health and safety.
133
134. Should an OB/GYN doctor disclose their HIV status to patients and colleagues?
No, the doctor is not obligated to disclose their HIV status to patients or colleagues but must take appropriate infection control precautions and inform hospital authorities.
134
135. Can a physician refuse to see an HIV-positive patient with an open wound?
While ethically questionable, a physician can legally refuse to see a patient, though it is generally considered unethical to do so.
