Medical Ethics & Professionalism Flashcards

A physician discovers that a colleague has been falsifying patient records to meet hospital performance metrics. The colleague is otherwise an excellent clinician with no history of patient harm. The physician confronts the colleague privately, who promises to stop. What is the physician's primary professional obligation at this point?

Answer: Report the conduct to the appropriate hospital authority or medical regulatory body regardless of the promise

Professional integrity obligations require that falsification of medical records be reported to appropriate authorities regardless of private assurances. Record falsification undermines patient safety, institutional trust, and regulatory oversight. A private promise does not fulfill the physician's duty to the profession and the public; self-regulation through informal channels is insufficient for conduct that constitutes fraud.

A terminally ill patient with full decision-making capacity explicitly refuses a blood transfusion on religious grounds. The patient loses consciousness, and the family urgently consents to the transfusion, arguing the patient 'would want to live.' The treating physician has no advance directive on file. What is the ethically correct course of action?

Answer: Honor the patient's previously expressed refusal, as a competent patient's autonomous decision remains binding after loss of consciousness

A competent adult's informed refusal of treatment remains ethically and legally binding even after the patient loses capacity, provided the refusal was clearly expressed and pertained to the current clinical situation. Family members do not have the authority to override a known competent refusal; their role as surrogates is to represent the patient's known wishes, not substitute their own. The emergency exception applies only when the patient's prior wishes are unknown.

During a clinical trial, a researcher discovers an interim analysis strongly suggesting the experimental drug is causing unexpected cardiac harm in a subgroup. The trial sponsor requests the researcher delay disclosure to investigators pending their internal review, arguing premature reporting could bias the trial. What must the researcher do?

Answer: Immediately report the safety signal to the Data Safety Monitoring Board and relevant ethics committee regardless of sponsor preferences

Researchers have a non-delegable duty to promptly report serious adverse events to the Data Safety Monitoring Board (DSMB) and ethics committee. Sponsor interests cannot override participant safety. Delays in reporting safety signals violate research ethics principles, including beneficence and respect for participants, and may constitute research misconduct. The DSMB exists precisely to make independent safety determinations that supersede sponsor preferences.

A physician in a small community is the only specialist available for a patient who is also a personal friend. The patient requests the physician manage their care and explicitly waives any concerns about the dual relationship. Which statement best reflects the appropriate ethical response?

Answer: The physician may provide necessary care given access constraints, but should maintain professional boundaries, document the dual relationship, and transfer care as soon as a suitable alternative becomes available

Dual relationships (physician-friend) introduce bias risk, compromise objectivity, and may inhibit the patient from disclosing sensitive information. However, in resource-limited settings, abandonment of a patient in need is also an ethical violation. The appropriate approach balances access to care against the risks of the dual relationship by providing necessary care, maintaining strict professional conduct, documenting the situation, and transitioning care at the earliest appropriate opportunity. A patient waiver reduces but does not eliminate the ethical concern.

A healthcare institution proposes a policy requiring physicians to disclose their personal religious beliefs to patients who request 'values-concordant care.' A physician objects, arguing disclosure violates their privacy. Which ethical principle most directly governs how this conflict should be resolved?

Answer: Patient autonomy and the duty to facilitate informed decision-making, balanced against the physician's right to reasonable privacy

This conflict sits at the intersection of patient autonomy (the right to make informed choices about one's care team, including value alignment) and physician privacy (the right not to disclose personal beliefs). Neither right is absolute. Ethical resolution requires balancing: patients may reasonably request information to exercise autonomous choice, but institutions must also protect reasonable physician privacy expectations. The key governing tension is between facilitating autonomous patient decision-making and recognizing the limits of mandated personal disclosure.

A senior physician in a teaching hospital observes a resident perform a procedure independently that the resident is not yet credentialed for, with a favorable outcome and no patient harm. The senior physician is aware the resident did this to avoid waking the attending at 3 AM. What is the most ethically complete response?

Answer: Report the credentialing violation through appropriate channels, address the systemic issue of inadequate overnight attending availability, and ensure the incident is documented

A credentialing violation represents a systemic patient safety issue independent of outcome — the absence of harm does not retroactively legitimize an unauthorized procedure. Ethically complete responses address both the individual breach (documentation and reporting per institutional policy) and the underlying systemic factor (inadequate overnight supervision) that created the conditions for the violation. Outcome-based reasoning ('no harm, no foul') is a recognized ethical fallacy in patient safety. Private counseling alone fails to fulfill institutional safety obligations.