ECFMG Professionalism & Ethics 4 — Questions and Answers
Question 1: A physician caring for a VIP patient is pressured by hospital administrators to expedite discharge prematurely to free a suite. The physician's ethical obligation is to:
- Comply to maintain hospital relationships and patient satisfaction scores
- Discharge based on clinical readiness, not administrative or social pressure (Correct answer)
- Consult the ethics committee before making any discharge decision
- Transfer the patient to another service to avoid the conflict
Correct answer: Discharge based on clinical readiness, not administrative or social pressure
Clinical decisions must be based on medical need; discharge decisions driven by privilege or administrative convenience violate the principle of justice and patient welfare.
Question 2: A physician who personally opposes abortion on moral grounds is asked to provide pregnancy termination services. Which option best balances the physician's conscience with professional obligations?
- Refuse without explanation and refer to a specialist
- Decline to perform the procedure but provide timely referral to a willing provider (Correct answer)
- Perform the procedure despite personal objections to avoid abandonment
- Ask the hospital ethics board to make the decision for the patient
Correct answer: Decline to perform the procedure but provide timely referral to a willing provider
Conscientious objection is recognized, but physicians must provide timely referral to ensure patients can access legal medical care.
Question 3: During a research study, an enrolled participant develops a serious adverse event possibly related to the intervention. The principal investigator must first:
- Complete the study and then report the event in the final publication
- Report the event to the IRB and sponsor according to protocol-defined timelines (Correct answer)
- Inform only the participant's family and continue the study
- Withdraw the participant and destroy their data to protect confidentiality
Correct answer: Report the event to the IRB and sponsor according to protocol-defined timelines
Serious adverse events must be promptly reported to the IRB and sponsor per federal regulations and study protocol; participant safety is paramount.
Question 4: A physician is asked by a defense attorney to provide expert testimony exaggerating the plaintiff's injuries for compensation. Providing such testimony would violate:
- Procedural justice only, since expert opinions are protected speech
- Medical ethics and potentially constitute perjury (Correct answer)
- Hospital bylaws but not broader ethical codes
- No rule as long as the physician is paid as a consultant
Correct answer: Medical ethics and potentially constitute perjury
Expert witnesses have an ethical duty to provide honest, evidence-based opinions; fabricating or exaggerating findings constitutes perjury and professional misconduct.
Question 5: An intern is unsure about a medication dose but is afraid to ask the attending at 3 AM. She administers what she believes is correct and a patient error occurs. This scenario best illustrates the risk of:
- Scope of practice violation
- Hierarchy-induced communication failure (Correct answer)
- Negligent credentialing by the hospital
- Autonomous clinical decision-making
Correct answer: Hierarchy-induced communication failure
Fear of hierarchical reprisal discourages speaking up, a known patient safety threat that professional culture should actively counter.
Question 6: A patient signs an advance directive designating a healthcare proxy but later develops capacity and verbally contradicts the directive. Which statement is correct?
- The advance directive always takes legal precedence over verbal statements
- The patient's current verbal wishes take precedence when they have decision-making capacity (Correct answer)
- The healthcare proxy's decisions take precedence since they were legally designated
- The physician must defer to both and cannot proceed until they agree
Correct answer: The patient's current verbal wishes take precedence when they have decision-making capacity
Advance directives apply only when a patient lacks decision-making capacity; a capacitated patient's current wishes always govern.
Question 7: Which of the following is the best example of the ethical principle of justice in clinical practice?
- Ordering every available diagnostic test for a patient who can pay out-of-pocket
- Allocating scarce ICU beds based on ability to pay
- Distributing scarce ventilators using objective, clinically-based triage criteria (Correct answer)
- Providing additional services to patients who are kind to the healthcare team
Correct answer: Distributing scarce ventilators using objective, clinically-based triage criteria
Justice requires fair allocation of resources using objective, non-discriminatory criteria rather than wealth, social status, or personal favoritism.
ECFMG Professionalism & Ethics 4
A physician caring for a VIP patient is pressured by hospital administrators to expedite discharge prematurely to free a suite.
The physician's ethical obligation is to: