MCCQE - Medical Council of Canada Qualifying Examination Medical Ethics and Legal Duties Questions and Answers 1 — Questions and Answers
Question 1: A 15-year-old female patient, who appears insightful and articulate, requests a prescription for oral contraceptives. She understands the risks, benefits, and alternatives, but explicitly asks you not to inform her parents. What is the most appropriate course of action for a physician in Canada?
- Refuse to prescribe until parental consent is obtained, as she is a minor.
- Inform the parents of her request, respecting their role as legal guardians.
- Assess her capacity to consent; if she is deemed a 'mature minor', provide the prescription without notifying her parents. (Correct answer)
- Provide the prescription but insist on booking a follow-up appointment with the patient and her parents together.
Correct answer: Assess her capacity to consent; if she is deemed a 'mature minor', provide the prescription without notifying her parents.
In Canada, the legal principle of the 'mature minor' doctrine applies. This common law doctrine, upheld by the Supreme Court of Canada, states that if a minor is capable of understanding the nature of a proposed treatment and its consequences, they can provide valid consent. [6, 18] Age is not the determining factor; capacity is. Therefore, the physician's primary duty is to assess the 15-year-old's capacity. [3] If she demonstrates sufficient understanding (i.e., is a mature minor), her consent is valid, and her request for confidentiality should be respected. [6] Insisting on parental consent or breaching her confidentiality against her wishes would be inappropriate.
Question 2: A psychiatrist is treating a patient who reveals a credible and detailed plan to cause serious physical harm to his former supervisor. The patient has a history of violent outbursts. According to Canadian legal and ethical principles, the psychiatrist's primary duty is to:
- Maintain absolute patient confidentiality to preserve the therapeutic relationship.
- Immediately discharge the patient from care to sever professional responsibility.
- Take reasonable steps to protect the potential victim, which may include warning them and/or notifying the police. (Correct answer)
- Document the threat thoroughly in the patient's chart and increase the frequency of therapy sessions.
Correct answer: Take reasonable steps to protect the potential victim, which may include warning them and/or notifying the police.
While patient confidentiality is a cornerstone of medical ethics, it is not absolute. The Supreme Court of Canada decision in Smith v. Jones established a 'public safety' exception. [19] When there is a clear, serious, and imminent risk of harm to an identifiable person or group, the physician's duty to protect the public outweighs the duty of confidentiality. [5, 12, 19] The physician has a duty to take reasonable steps to prevent the harm, which can include warning the potential victim and/or contacting the police. [19] Simply documenting the threat is insufficient, and discharging the patient is an abdication of responsibility. Maintaining absolute confidentiality in this scenario would be a breach of the duty to protect.
Question 3: A 75-year-old patient has been deemed incapable of making medical decisions due to advanced dementia. He does not have a power of attorney for personal care or an advance directive. According to the typical hierarchy of substitute decision-makers (SDMs) in most Canadian provinces, who should the medical team approach first for consent?
- The patient's eldest adult child.
- A close friend who has known the patient for 40 years.
- A court-appointed guardian.
- The patient's spouse. (Correct answer)
Correct answer: The patient's spouse.
Most provinces and territories in Canada have legislation that specifies a ranked hierarchy of automatic substitute decision-makers (SDMs) for patients who are incapable of consenting to treatment and have not legally appointed someone. [2, 20] While the exact order can vary slightly, the spouse or partner is consistently ranked at or near the top of the list, above adult children, parents, or siblings. [8, 20] A court-appointed guardian would only be sought if no one higher on the list is available or willing to act. A close friend is typically much lower on the hierarchy, if included at all. [8]
Question 4: A physician prescribes a beta-blocker to a patient with a known and clearly documented allergy to this class of medication. The pharmacy's computer system flags the error before the medication is dispensed, and the patient suffers no physical harm. What is the physician's primary ethical obligation in this situation?
- Disclose the near miss to the patient, apologize, and explain the corrective measures being implemented. (Correct answer)
- Do not inform the patient, as no harm occurred and disclosure would only cause unnecessary anxiety.
- Only document the event in the hospital's internal incident reporting system.
- Thank the pharmacist for their diligence but take no further action regarding the patient.
Correct answer: Disclose the near miss to the patient, apologize, and explain the corrective measures being implemented.
Ethical guidelines from the Canadian Medical Association and provincial colleges emphasize a duty of candour and transparency with patients. This includes the disclosure of medical errors, even when they do not result in harm (i.e., 'near misses'). The physician has an ethical obligation to inform the patient about what happened, apologize for the error, and explain what steps will be taken to prevent it from happening again. This approach respects patient autonomy and helps to maintain trust in the patient-physician relationship. Relying solely on internal reporting is insufficient as it omits the crucial step of communicating with the patient.
Question 5: Which of the following is a mandatory eligibility criterion for a person to receive Medical Assistance in Dying (MAID) under current federal legislation in Canada?
- The person's natural death must be reasonably foreseeable.
- The person must have a grievous and irremediable medical condition. (Correct answer)
- The request must be co-signed and approved by their substitute decision-maker.
- The person's sole underlying medical condition can be a mental illness.
Correct answer: The person must have a grievous and irremediable medical condition.
Under Canada's federal legislation, a core eligibility criterion for MAID is that the person must have a 'grievous and irremediable medical condition'. [7] This is defined as a serious and incurable illness, disease, or disability, being in an advanced state of irreversible decline in capability, and experiencing enduring and intolerable suffering. While there are different procedural safeguards depending on whether natural death is reasonably foreseeable, a foreseeable death is not a universal eligibility requirement. [1, 7] The request for MAID must be made by a capable person for themselves, not by a substitute decision-maker. [7] As of early 2026, persons suffering solely from a mental illness are not eligible for MAID. [1, 21, 23]
Question 6: Which of the following statements best reflects the guidance from the Canadian Medical Association (CMA) and provincial regulatory bodies regarding physicians providing ongoing medical care to their close family members?
- It is encouraged, as it improves access to care and convenience for the family.
- It is permissible without restriction, provided the family member gives explicit consent.
- It should be strictly limited to minor conditions or emergencies when no other physician is available. (Correct answer)
- It is only prohibited for prescribing controlled substances, but is acceptable for all other care.
Correct answer: It should be strictly limited to minor conditions or emergencies when no other physician is available.
The CMA Code of Ethics and Professionalism, along with standards from provincial colleges, strongly advises against physicians treating themselves or close family members. [4, 9, 11] The rationale is that personal relationships can compromise professional objectivity, affect clinical judgment, and create difficulties in areas like taking a sensitive history or performing intimate examinations. [4, 15] The explicit exception is for minor problems or in an emergency situation where another physician is not readily available. [4, 16] Even in these cases, care should be transferred to another physician as soon as practical. This guidance extends beyond just prescribing controlled substances and applies to routine and ongoing care in general. [15]
MCCQE - Medical Council of Canada Qualifying Examination Medical Ethics and Legal Duties Questions and Answers 1
A 15-year-old female patient, who appears insightful and articulate, requests a prescription for oral contraceptives.
She understands the risks, benefits, and alternatives, but explicitly asks you not to inform her parents.
What is the most appropriate course of action for a physician in Canada?