Medical Ethics & Professionalism Flashcards

A competent adult patient with end-stage renal disease refuses dialysis, knowing this decision will lead to death within weeks. His family begs you to override his refusal and start treatment. Which ethical principle MOST directly supports honoring the patient's refusal?

Answer: Respect for autonomy, because a competent adult's informed refusal of treatment is legally and ethically binding

Respect for autonomy is the cornerstone principle here. A competent adult who has been fully informed and understands the consequences of refusing dialysis has an absolute right to decline treatment, even life-sustaining treatment. Beneficence and non-maleficence support treatment, but they do not override a competent patient's informed refusal. Justice concerns resource allocation and is not the primary principle governing this individual decision.

During a busy clinic, a physician discovers that a colleague has been submitting insurance claims for procedures not actually performed. The colleague is a close friend and an otherwise excellent clinician. According to professional ethics, what is the physician's PRIMARY obligation?

Answer: Report the fraudulent billing to the appropriate institutional or regulatory authority, regardless of the personal relationship

Physicians have a professional and ethical duty to report colleagues engaged in fraud, as this harms the healthcare system, other patients, and the integrity of the profession. While private confrontation may seem humane, it does not fulfill the physician's obligation to protect the public and the system. Delaying or only documenting is ethically insufficient. The ethics committee is not the reporting mechanism for fraud — the appropriate authority (compliance officer, regulatory body) must be notified.

A 14-year-old presents alone requesting treatment for a sexually transmitted infection. She specifically asks that her parents not be informed. Under the ethical framework governing adolescent confidentiality, which approach is MOST appropriate?

Answer: Treat the infection and maintain confidentiality, as disclosure would deter adolescents from seeking care for sensitive conditions

Most ethical and legal frameworks recognize that adolescents have the right to confidential treatment for sensitive conditions such as STIs, contraception, and mental health, precisely because mandatory disclosure would deter them from seeking care — leading to worse public health outcomes. The concept of the 'mature minor' and specific statutory exceptions allow treatment without parental consent in these circumstances. Refusing treatment or notifying parents against the patient's wishes would cause harm and undermine trust in the healthcare system.

A surgeon is scheduled to perform an elective procedure but realizes the morning of surgery that she consumed alcohol the previous evening and feels mildly impaired. The patient is already prepped and waiting. What is the MOST ethically defensible course of action?

Answer: Postpone the surgery, disclose the impairment to the appropriate supervisor or department head, and arrange for a qualified colleague to take over

Patient safety is paramount, and even mild impairment compromises the duty of non-maleficence. The surgeon must not operate while impaired, regardless of the elective nature of the case or the patient's willingness to proceed. Disclosing to a supervisor and arranging coverage fulfills both the safety obligation and the professional accountability obligation. Relying on a legal driving threshold is inappropriate in a surgical context; standards of medical practice are far more stringent than road safety limits.

A terminally ill patient with capacity has completed a valid advance directive refusing cardiopulmonary resuscitation (DNR order). During a routine procedure, the patient experiences cardiac arrest. A family member present insists the team 'do everything.' What should the medical team do?

Answer: Honor the DNR order as written, since a valid advance directive by a competent patient supersedes surrogate decision-making

A valid advance directive completed by a competent patient represents the patient's autonomous decision about their own care and is legally and ethically binding. Family members, even well-intentioned ones, cannot override a competent patient's prior documented wishes. Initiating CPR against a valid DNR violates patient autonomy and constitutes unwanted treatment. A time-limited compromise resuscitation attempt and emergency ethics consultation are both inappropriate when a valid directive clearly governs the situation.

A pharmaceutical company offers a physician an all-expenses-paid trip to a medical conference where the physician will present research funded by that company. The research favors the company's product. Which statement BEST describes the ethical concern and appropriate response?

Answer: The concern is conflict of interest; the physician must disclose the funding source and the sponsored travel to the audience and in any publications

This scenario illustrates a conflict of interest — the physician's financial relationship with the company may consciously or unconsciously bias the presentation and undermine research integrity. The appropriate response is full disclosure of the funding source and sponsored travel, not outright refusal (which may deprive the medical community of valid research) nor dismissal of the concern (data accuracy alone does not eliminate COI). Transparency allows the audience to apply appropriate scrutiny. 'Donating the trip cost' does not address the fundamental bias concern.