Medical Ethics

Question 1

Medical Ethics

What are the four bedrock principles of medical ethics?

Answer 1

Autonomy

Beneficence

Nonmaleficence

Justice

Question 2

Medical Ethics

Assuming a patient has full decision-making capacity, what is the ethical difference between withholding life-saving care that the patient has refused and removing life-saving care that the patient has requested be discontinued?

Answer 2

There is no ethical difference between withholding and removing life-saving treatment.

(Patient autonomy is paramount.)

Question 3

Medical Ethics

What are the three main components of the hierarchy of substitute decision makers in cases of medical care?

Answer 3

1. Legally appointed SDMs
2. Automatic family member SDMS
3. SDM of last resort

Question 4

Medical Ethics

Describe the hierarchy of substitute decision makers who are legally appointed in cases of medical care.

Answer 4

(Yellow category)

Question 5

Medical Ethics

Describe the family hierarchy of substitute decision makers in cases of medical care.

Answer 5

(Green category)

Question 6

Medical Ethics

In what order do parents, children, spouses, and siblings fit into the hierarchy of substitute decision makers (in terms of medical care)?

Answer 6

Spouse >

Parents or children >

Siblings

Question 7

Medical Ethics

Describe the last resort in the hierarchy of substitute decision makers in cases of medical care.

Answer 7

(Blue category)

Question 8

Medical Ethics

What is palliative sedation (as an alternative to euthanasia)?

Answer 8

Prescribing high doses of opiates or other medications to the point of producing unconsciousness in order to treat refractory physical pain

Question 9

Medical Ethics

The doctrine of double effect distinguishes effects that are intended from those that are foreseen but unintended.

What is an example of this?

Answer 9

Opiates are used to relieve pain, but they also have the side effect of causing respiratory depression and hastening death

Question 10

Medical Ethics

What are some basics regarding medical disputes over minors?

Answer 10

Question 11

Medical Ethics

How would you describe the difference between medical negligence and battery?

Answer 11

Question 12

Medical Ethics

Can a patient’s next of kin override their living will?

Answer 12

No. Only the patient can modify the living will.

Question 13

Medical Ethics

What is the difference between consent and assent?

Answer 13

1. Assent is the non-legal affirmation that children must give.
2. Consent is the legal affirmation that parents, legal guardians, and emancipated minors give.

Question 14

Medical Ethics

In what situations should a physician treat a minor without parental consent?

Answer 14

Emancipated minors; treatment for STDs, substance abuse, birth control, and emergency situations

Question 15

Medical Ethics

Depressed patients who are suicidal and want to withdraw treatment should not have their wishes honored until this happens (2):

Answer 15

1) Assessment of competence
2) No honoring of decisions until depression resolves

Question 16

Medical Ethics

What should a physician do if a patient makes sexual advances?

Should a physician have sexual or romantic relationships with past patients?

Answer 16

Immediately terminate the doctor-patient relationship.

No (the power differential is too large).

Question 17

Medical Ethics

How long must a physician continue to provide treatment after termination of the doctor-patient relationship?

Answer 17

30 days (So the patient has time to find a new provider)

Question 18

Medical Ethics

Case 1

Answer 18

D

1. Personal diagnoses are not to be divulged (Even to partners) against the patient’s will.
2. Certain diseases must be reported to the CDC:

Hepatitis A, B, C;

HIV, AIDS;

Syphilis, gonorrhea;

MMR;

TB;

Salmonella, Shigella, E. coli;

Varicella;

Meningitis.

Question 19

Medical Ethics

Case 2

Answer 19

C

The first step in controversial, difficult situations is to attempt to understand the alternate party’s point of view.

Question 20

Medical Ethics

Case 3

Answer 20

E

1. As a parent, this patient is an emancipated minor that can consent to her own treatments and make her own decisions.

Question 21

Medical Ethics

Case 4

Answer 21

A

1. The mother has full control and precedence over the child.

Question 22

Medical Ethics

Case 5

Answer 22

A

1. HIPPA - “I am not allowed to say whether or not…”

Question 23

Medical Ethics

Case 6

Answer 23

D

1. Gifts should always be refused.

Question 24

Medical Ethics

Case 7

Answer 24

B

1. The physician failed to obtain informed consent.

No words were exchanged, no benefits or risks were explained, and no alternative options given.

2. There were no damages due to a breach of duty; so, there is no case of negligence here.

Question 25

# Medical Ethics Case 8

Answer 25

**A** 1. Res ipsa loquitor - Literally means 'the thing speaks for itself.' 2. Anything extremely obvious as your mistake and liability.

Question 26

# Medical Ethics Case 9

Answer 26

**B** 1. The Good Samaritan Law protects HCPs that provide 'reasonable intervention' in an unexpected emergency outside usual medical practice in a clinic or hospital.

Question 27

# Medical Ethics Case 10

Answer 27

**E** 1. All three parties are liable

Question 28

# Medical Ethics Case 11

Answer 28

**C** 1. Autonomy trumps beneficence if the patient is competent. 2. The religious beliefs are not the determining factor here; it is the patient's decision that counts.

Question 29

# Medical Ethics Case 12

Answer 29

**B** 1. Life-saving treatment overrides religious beliefs for children. 2. Religious beliefs do not give parents the right to deny treatment to their child.

Question 30

# Medical Ethics Case 13

Answer 30

**C** 1. Passive euthanasia is the allowance of a patient to make their own decision about your providing or withholding treatment. 2. Active euthanasia is physician-assisted suicide - This is not allowed.

Question 31

# Medical Ethics Case 14

Answer 31

**E** 1. The patient should always be in charge of the flow of information.

Question 32

# Medical Ethics Case 15

Answer 32

**A** 1. The patient's decisions override the family's wishes.

Question 33

# Medical Ethics Case 16

Answer 33

**A** 1. The spouse makes the call in the absence of a living will. 2. If the spouse is unavailable and the adult children disagree, you go to the ethics committee. 3. If the spouse is unavailable and the adult children agree, you follow the children's wishes.

Question 34

# Medical Ethics Case 17

Answer 34

**B** 1. The Good Samaritan Law allows for reasonable, life-saving measures while waiting for EMS to arrive. 2. The physician is easily being unreasonable because we can assume the physician did nothing to stabilize the patient's spine.

Question 35

# Medical Ethics Case 18

Answer 35

**A** 1. Certain cases regarding minors (E.g. drugs, STDs, abortion) do not need to be reported to the patient's parent(s).

Question 36

# Medical Ethics Case 19

Answer 36

**B** 1. Assent is the non-legal affirmation that children must give. 2. Minors have to assent to clinical trials. 3. Consent is the legal affirmation that parents, legal guardians, and emancipated minors give.

Question 37

# Medical Ethics Case 20

Answer 37

**A** 1. Strange case and this probably should not be asked by the student or physician, but if the family gives consent, then it is technically allowable.

Question 38

# Medical Ethics Case 21

Answer 38

**E** 1. Brain death must be confirmed before removing mechanical ventilation. 2. No brainstem reflexes (Pupillary or corneal - Must rule out other toxic causes) + neurologic exam.

Question 39

# Medical Ethics Case 22

Answer 39

**A** 1. Physicians must arrange for someone else to cover their patients while they're gone. 2. It does not matter that the patient was non-compliant, the physician is still first in line for blame as he did not make alternate arrangements for the patient.

Question 40

# Medical Ethics Case 23

Answer 40

**B** 1. The patient is clearly not competent to make decisions as she is deluded to her situation. 2. Only a surrogate decision maker's consent is needed.

Question 41

# Medical Ethics Case 24

Answer 41

**B** 1. In almost every state, the genetic mother has the right to change her mind and keep the child, regardless of any signed contract.

Question 42

# Medical Ethics Case 25

Answer 42

**D** 1. Impaired healthcare providers must ALWAYS be reported. 2. You need to get someone else in to help as soon as possible. 3. Allowing the intoxicated physician to assist or attempting the case alone are both inappropriate decisions.

Question 43

# Medical Ethics Case 26

Answer 43

**D** 1. Living alone legally implies consent.

Question 44

# Medical Ethics Case 27

Answer 44

**E** 1. Any sensitive work with a patient of the opposite sex is a time when a chaperone should be called.

Question 45

# Medical Ethics Case 28

Answer 45

**E** 1. There is a moral obligation to tell the child as we do not know how capable the child is of understanding. 2. However, there is no legal obligation.

Question 46

# Medical Ethics Case 29

Answer 46

**D** 1. There is no binding legal obligation that arises from organ donor cards. 2. The next-of-kin can refuse the donation unless there is some other living will involved (Which organ donor cards are not).

Question 47

# Medical Ethics Case 30

Answer 47

**E** 1. The student has meningitis. 2. Although he is contagious, the student cannot be held against his will. 3. The CDC should be notified as this is a reportable disease, and the college needs to be notified that they have a contagious student on campus with a dangerous disease.