Medical Ethics Board Review Questions
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Questions and Answers

What should a physician do when disclosing a medical error to a patient?

  • Notify the patient’s family about the error.
  • Offer financial restitution for the error.
  • Explain how the mistake has been corrected. (correct)
  • Only inform the patient about the mistake without any details.

    • What is one potential benefit of disclosing a medical error to a patient?

  • It can lead to immediate financial restitution.
  • Patients are always satisfied with the explanation given.
  • It may reduce the likelihood of lawsuits. (correct)
  • Patients will definitely not want an apology.

    • In a situation where a minor seeks vaccines and consultation on contraception without parental consent, what is the most appropriate action?

  • Provide contraception information but defer the vaccine. (correct)
  • Give the vaccine and discuss contraception immediately.
  • Administer the vaccine after seeking phone consent from a guardian.
  • Defer all discussions until the minor’s guardian is present.

    • What should be done after notifying the risk management service about a medical error?

    <p>Work on problem-solving to mitigate the impact of the error. (A)</p> Signup and view all the answers

    Why might a physician choose not to offer financial restitution upon disclosing a medical error?

    <p>Offering restitution can complicate legal matters. (B)</p> Signup and view all the answers

    Which of the following is the MOST important ethical principle to consider when a patient declines recommended treatment?

    <p>Respect for patient autonomy (D)</p> Signup and view all the answers

    A 56-year-old patient with metastatic renal cell carcinoma declines immunotherapy and requests palliative care. Which action is MOST appropriate?

    <p>Honor the patient's request and initiate palliative care. (B)</p> Signup and view all the answers

    In the United States, what is the legal emphasis regarding patient preferences in medical decision-making?

    <p>Patient choice is paramount, upheld by the US Supreme Court. (C)</p> Signup and view all the answers

    A 56-year old patient with metastatic renal cell carcinoma declines treatment. What should you do FIRST?

    <p>Assess the patient's understanding of their diagnosis and prognosis. (A)</p> Signup and view all the answers

    What are the 4 essential topics that should be considered in medical ethics?

    <p>Medical Indications, Patient Preferences, Quality of Life, Contextual Features (C)</p> Signup and view all the answers

    A 17-year-old is capable of verbally expressing their own desires and preferences in medical decisions. According to the content, what should be done?

    <p>The child's preferences should be taken into account and respected as much as possible. (A)</p> Signup and view all the answers

    In a case where a competent adult patient refuses a potentially life-saving treatment, the physician's primary ethical obligation is to:

    <p>Respect the patient's autonomy and explore the reasons behind the refusal. (A)</p> Signup and view all the answers

    A 21-year-old college student presents to the ED with acute headache and stiff neck. Initial lab results show a WBC count of 24,000. After immediate stabilization, what is the MOST important next step from an ethical standpoint before initiating treatment?

    <p>Explain the risks and benefits of the proposed treatment to the patient and obtain informed consent. (C)</p> Signup and view all the answers

    Under what circumstances is it ethically permissible for a physician to withhold relevant health information from a patient?

    <p>In unusual situations where disclosure may cause a serious psychological threat (therapeutic privilege). (C)</p> Signup and view all the answers

    According to the provided information, what is the stance of the American Medical Association (AMA) Code of Ethics on the concept of therapeutic privilege?

    <p>It considers therapeutic privilege to be ethically unjustified. (C)</p> Signup and view all the answers

    What is the primary concern raised by the American College of Physicians (ACP) regarding therapeutic privilege?

    <p>It threatens the principle of informed consent. (D)</p> Signup and view all the answers

    In the case presented, a patient receives 100 units of long-acting insulin instead of the prescribed 10 units. What is the most appropriate first step in addressing this medical error?

    <p>Inform the patient of the error and implement measures to prevent low blood sugar, such as administering a glucose drip. (C)</p> Signup and view all the answers

    According to the provided information, what is the primary ethical obligation of healthcare professionals regarding medical errors?

    <p>To disclose healthcare injuries and errors to patients. (D)</p> Signup and view all the answers

    When should a physician disclose a medical error to a patient?

    <p>If the physician suspects or knows it has an actual or potential impact on the patient's health, well-being or medical decision making. (D)</p> Signup and view all the answers

    What is the general patient sentiment regarding the disclosure of medical errors, even minor ones?

    <p>Patients want physicians to acknowledge even minor errors. (A)</p> Signup and view all the answers

    What does the provided information suggest about the relationship between medical errors and ethical behavior?

    <p>Errors themselves do not necessarily imply negligent or unethical behavior, but failure to disclose them may. (A)</p> Signup and view all the answers

    According to the presentation, what is the definition of beneficence?

    <p>Action taken in the best interest of others. (D)</p> Signup and view all the answers

    A surgeon suspects that a colleague has signs of alcohol withdrawal and Wernicke’s encephalopathy after a surgery on your patient. According to the presentation, what is the most appropriate first step?

    <p>Speak directly to the surgeon and encourage them to seek counseling. (C)</p> Signup and view all the answers

    A patient with advanced lung and cardiovascular disease wants to be 'Do Not Resuscitate (DNR)' if they 'will be on a ventilator forever' or if they have a tumor. They now present with pulmonary symptoms and pneumonia on chest x-ray. What is the most appropriate code status for this patient?

    <p>Full code, since the patient has a potentially reversible condition. (C)</p> Signup and view all the answers

    According to the presentation, what is the purpose of an ethics consult?

    <p>To clarify ethical issues, delve into conflicts, and assess advance directives. (A)</p> Signup and view all the answers

    What ethical principle is potentially challenged when a provider's self-interest conflicts with a patient's care?

    <p>Nonmaleficence. (D)</p> Signup and view all the answers

    According to the presentation, what should clinicians remember about withdrawal of care?

    <p>Courts view withdrawal and withholding of care the same way. (D)</p> Signup and view all the answers

    When should clinicians consider obtaining advice from a hospital attorney or risk management, according to the presentation?

    <p>When an ethical dilemma cannot be resolved through other means. (B)</p> Signup and view all the answers

    According to the presentation, what action takes place as the 'last resort' when ethical dilemmas cannot be resolved?

    <p>A court decision. (A)</p> Signup and view all the answers

    What is considered the 5th vital sign in the context of pain management?

    <p>Pain (C)</p> Signup and view all the answers

    In which scenario should opioids be used judiciously according to the guidelines?

    <p>Only for advanced malignancy or hospice care (D)</p> Signup and view all the answers

    What is the recommended approach when opioids must be prescribed?

    <p>Assess risks and document informed consent (C)</p> Signup and view all the answers

    Why should dual prescriptions of opioids and benzodiazepines be avoided?

    <p>They can significantly increase the risk of respiratory depression (B)</p> Signup and view all the answers

    What is the first step a healthcare provider should take when caring for a patient with progressive dementia regarding treatment decisions?

    <p>Discuss treatment options with the durable power of attorney (A)</p> Signup and view all the answers

    What is generally required for minors to receive vaccinations?

    <p>Parental consent in most states (D)</p> Signup and view all the answers

    What is the purpose of the Mature Minor Doctrine?

    <p>To permit minors to receive immunizations without parental consent (C)</p> Signup and view all the answers

    What should be considered before extending a prescription for opioids post-dental procedure?

    <p>Potential for a long-term opioid dependence (B)</p> Signup and view all the answers

    What is a significant concern regarding pain management with opioids for opioid-naive patients?

    <p>Patients may require opioids for an extended period post-procedure (C)</p> Signup and view all the answers

    What is a common exception to guardian consent laws for minors?

    <p>Emergency situations (B)</p> Signup and view all the answers

    Which analgesic is recommended based on the patient's reported symptoms after dental extractions?

    <p>Acetaminophen (D)</p> Signup and view all the answers

    Which practice is discouraged according to updated guidelines for opioid prescriptions post-surgery?

    <p>Extending opioid prescriptions beyond 3 days (D)</p> Signup and view all the answers

    What might be a factor in determining if a minor can act as their own guardian for healthcare decisions?

    <p>The minor's age and maturity level (D)</p> Signup and view all the answers

    Flashcards

    Medical Ethics

    The study of moral values and judgments in medicine.

    4 Essential Ethical Topics

    Medical indications, patient preferences, quality of life, contextual features.

    Patient Autonomy

    Respect for the patient's right to make their own medical decisions.

    Palliative Care

    Medical care that focuses on providing relief from symptoms, pain, and stress.

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    Informed Consent

    The process of obtaining permission from a patient before conducting a healthcare intervention.

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    Ethical Decision-Making

    Process of making decisions by evaluating moral principles and patient needs.

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    Family Communication

    Importance of discussing treatment options with family members when appropriate.

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    Legal Features in Ethics

    Social and legal contexts that influence ethical medical decisions.

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    Medical Error Disclosure

    The communication of a medical mistake to a patient.

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    Risk Management Service

    Institutional service that helps manage medical errors and costs.

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    Mature Minor Statute

    Legal provision allowing minors to consent to certain medical care.

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    Informed Consent for Vaccination

    Patient’s understanding and agreement prior to receiving a vaccine.

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    Emancipated Minor Care

    Medical provisions for minors who are legally independent.

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    Therapeutic Privilege

    A situation where a physician may withhold full disclosure of patient information if it could harm the patient's psychological well-being.

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    Disclosure of Medical Information

    The obligation of healthcare professionals to share relevant health information with patients.

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    Patient Trust

    The confidence a patient has in their healthcare provider's ability to act in their best interest.

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    Ethical Obligation

    Moral responsibilities that healthcare professionals have towards patients, including honesty about errors.

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    Communication Sensitivity

    The care taken when conveying health information to ensure it is understood and received well.

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    Case Disclosure Example

    Describing a specific incident where a medical error occurred and how it should be communicated to the patient.

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    Tetanus Booster

    A vaccination given to prevent tetanus; may delay discussions about contraception until mother is present.

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    Mature Minor Doctrine

    Minors may receive certain medical treatments without parental consent if deemed mature enough.

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    Exceptions to Consent

    Situations where minors can receive care without guardian consent, including emergencies and pregnancies.

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    Immunization Consent Laws

    Most states require parental consent for minor vaccinations, with few exceptions.

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    Acute Analgesic Plan

    A pain management strategy for post-operative care, often prescribing non-opioids first.

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    Guidelines for Pain Management

    New rules limiting opioid prescription durations after surgery to prevent dependence.

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    Oxycodone and Dependency

    Research shows a significant percentage of opioid-naive patients remain on narcotics long-term after prescriptions.

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    Ethics in Pain Management

    ACTP examines ethical considerations in prescribing and managing pain treatments.

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    Opioid Epidemic

    A widespread crisis involving the overuse and addiction to opioids.

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    Pain as the 5th Vital Sign

    Concept treating pain intensity with equal importance as the other vital signs.

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    Judicious Use of Opioids

    Careful and responsible prescribing of opioids for pain management.

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    Non-Opioid Options

    Pain management strategies that do not involve opioids.

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    Informed Consent Documentation

    A record of patient's understanding and agreement to treatment, including risks.

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    Therapeutic Alliance

    The relationship between a provider and patient, facilitating effective care.

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    Beneficence

    The ethical principle of acting in the best interest of the patient.

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    Nonmaleficence

    The principle of 'do no harm' in medical ethics.

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    Ethics Consult

    A clinical review by an ethics team to resolve dilemmas.

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    DNR Status

    The patient's wish to not receive CPR or life-sustaining treatment.

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    Wernicke’s Encephalopathy

    A neurological condition often due to thiamine deficiency, linked to alcohol misuse.

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    Ethical Dilemma

    A situation where moral principles conflict, complicating decision-making.

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    Study Notes

    Medical Ethics Board Review Questions

    • The course was held on July 22, 2022, by Joyce Wipf, MD, MACP, for ACP Internal Medicine Board Review Prep Course.
    • Medical ethics cases often proceed smoothly.
    • Four essential topics for ethical considerations in medical care are medical indications, patient preferences, quality of life, and contextual features (social, economic, legal, administrative).
    • When reviewing ethical cases, consider the objective of the case and the guiding ethical principle for decision-making.

    Case 1

    • A 56-year-old patient has metastatic renal cell carcinoma (Stage IV).

    • The patient has pulmonary nodules on chest X-ray.

    • The patient has declined recommended immunotherapy and wants only palliative care.

    • The patient has two children, aged 14 and 17.

    • The appropriate course of action is to initiate palliative care rather than forcing treatment.

    Case 1: Renal Cell Carcinoma

    • The patient has newly diagnosed renal cell carcinoma with metastases, and he declines treatment.
    • Options include: declaring the patient incompetent, referring the patient back to Oncology, initiating palliative care, or strongly urging immunotherapy.
    • The best course of action is to initiate palliative care, honoring the patient's wishes. This is based on the principle of respect for patient autonomy.

    Patient Preferences

    • Respect for patient autonomy is paramount in US medical decision-making.
    • Patient choices should be prioritized over family wishes in many cases.
    • The US Supreme Court supports this autonomy.
    • Special consideration must be given to children and teens due to their complexities as described by court cases.
    • It's important to communicate with families, especially in dealing with children to ensure patient wishes are followed.

    Case 2: Patient with Meningitis

    • A 21-year-old college student presented to the ED with acute headache and stiff neck for 18 hours.
    • Physical exam shows somnolence, fever, low blood pressure, and increased heart rate, along with nuchal rigidity.
    • Lab results indicate leukocytosis.
    • The patient is agitated and refuses antibiotics.
    • The physician explains the high risk of death from meningitis without treatment, but the patient continues to refuse.
    • The most appropriate course of action in this case is treatment despite the patient's refusal. This is based on the principle of beneficence – the physician's obligation to help or at least cause no harm.
    • In some situations, a court order might be necessary if a patient refuses life-saving treatment.

    Limits of Beneficence

    • The "principle of beneficence" is the obligation to help or at least cause no harm to a patient.
    • If a patient refusing life-saving treatment for a life-threatening condition, the provider has a crucial obligation to pursue avenues for further understanding the patient's decision and rationale .
    • If there's still uncertainty about a patient's refusal, treatment should proceed even against his will.

    Religious Preferences

    • Court cases uphold the right of adults to refuse care on religious grounds.
    • However, adults cannot legally withhold life-saving care from their children based on religious beliefs.
    • Women cannot be forced to undergo a cesarean section or internal fetal monitoring for religious reasons.

    Patient Preferences: Cultural Differences

    • Cultural norms about decision-making may differ significantly between cultures and should be acknowledged.
    • In some cultures, children may take responsibility for decision-making and may feel the need to protect parents from bad news.
    • Open discussion and review of prognosis, including Rx options, is crucial for all patients but important to note cultural sensitivity.
    • It's important to inquire about patient preference for who makes medical decisions during difficult situations— especially when serious concerns arise

    Case 3: Therapeutic Privilege

    • Therapeutic privilege is an exception to the rule of informed consent.
    • It arises when full disclosure of relevant health information is medically contraindicated by the physician.

    Disclosure of Medical Errors

    • A medical error requires disclosure if it impacts patient health, well-being, or medical decision-making.
    • Disclosure is important whether or not there's a high likelihood the error will be recognized.
    • Medical errors, if not disclosed, do not necessarily imply negligent or unethical behavior, but their non-disclosure can lead to those potential outcomes.
    • The ethical obligation exists for healthcare professionals to communicate regarding errors.
    • Most patients appreciate their physician acknowledging errors.

    Medical Care Mistakes

    • Tell patients about medical mistakes and errors to improve their trust and reduce the potential for legal action.
    • Providing explanations for errors and how they were rectified is crucial; and notify your institution's "risk management" in order to improve practice.
    • Financial restitution is not required in most cases.

    Case 5: Mature Minor

    • Sixteen-year-old gifted athlete needs a physical for school soccer.
    • Her mother cannot attend, and chart shows missed appointments and long time since her last tetanus shot.
    • Patient wishes to receive tetanus booster and wants information about contraception.
    • The state has laws providing care for emancipated minors that do not include immunizations in urgent care.

    Care of Minors

    • Minors can legally act on their own behalf.
    • Laws have exceptions for guardian consent for urgent medical care, such as emergent Rx, STDs, pregnancy, and contraception.
    • A minor's age, intelligence, maturity, training, experience, economic independence, conduct, or freedom from parental control are assessed to determine whether or not they are a mature minor.
    • Vaccinations typically require parental consent.

    Case 6: Opioid Pain Management

    • A 49-year-old male experienced two tooth extractions and was prescribed oxycodone for 5 days post-procedure.
    • He experienced post-operative pain and asked for an additional 5-day course.
    • The dental office was closed.
    • CDC data shows that opioid use in post-operative pain continues long after the procedure if not managed immediately or in a short period of time.
    • New guidelines limit post-op pain management.

    Ethics of Pain Management

    • National guidelines emphasize judicious opioid use in acute pain management and a preference for non-opioid pain management approaches.
    • The length of time that opioids are prescribed is limited as there's a high risk for addiction and prolonged use.

    ABIM Blueprints for Ethics Questions

    • MOC examples in ethics include assessment of decisional capacity, competency and surrogate decision-making in elderly patients.

    Case 7: Durable Power of Attorney (DPOA)

    • An 84-year-old woman in a nursing home with aspiration pneumonia and is unconscious and deteriorating; ABGs include low pH.
    • She has a durable power of attorney (DPOA) for health care.
    • The patient's niece seeks comfort care only, not IV antibiotics or fluids, as the patient has progressive dementia.

    Durable Power of Attorney for Health Care

    • A statute passed by the state legislature authorizes individuals to appoint a DPOA for health care.
    • The DPOA carries out the patient's wishes (substituted judgment) or, if unclear, acts in the patient's best interests and welfare, including end-of-life medical decisions.
    • DPOA authority ends upon the patient's death.
    • The valid appointment needs to be established while the patient is capable of understanding the complexities of medical and legal decisions.

    DPOA Authority and Limits

    • The DPOA appointment takes effect when the patient is capable of making such decision.
    • A patient needs to consistently understand medical and legal issues.
    • Patients must act in the patient's best interests.
    • Emphasis is given to the patient's goals of care using POLST forms.

    Living Will

    • A living will is a document allowing persons to express wishes about their care if unable to do so.
    • Living wills provide guidance for terminal illness and irreversible states.
    • Problems may arise due to vagueness of terms.
    • Interpretation of the living will may be necessary.

    Decision-Making

    • Many states prioritize family members for decision-making with multiple family members— selecting a representative.
    • Courts appoint a guardian to determine best interests in instances of conflicting views.
    • Decisions are usually resolved outside of court.

    Decision-Making-2

    • A short trial of therapy helps determine the response to treatment for conflicting views regarding aggressive treatment or a unclear prognosis.

    Privacy and Confidentiality

    • The doctor-patient relationship isn’t absolute.
    • Patients who seek restriction of disclosure should be honored unless it’s for the “common good,” like notifying others at risk of “reportable diseases."
    • Patients who disclose intent to harm others must be reported to the authorities.

    HIPAA Privacy Rule

    • HIPAA Privacy Rule allows use and disclosure of patient information for treatment purposes.
    • Consent isn't required if it's for reviews by consultants or external medical records for care.
    • Specific standards apply for psychotherapy records.
    • Providers can share information with family members regarding a patient status during instances where the patient can’t make their own decisions.

    HIPAA Rules in Setting of Threats to Public Safety

    • The HIPAA Privacy Rule doesn't prevent disclosure of patient information to law enforcement, family members, or other parties when there's a serious danger to others.

    Case 9: HIPAA Security Rule and Cell Phone Use

    • Hospital staff care for a patient with sepsis, new neurological findings, and rashes.
    • A resident uses her cell phone to take photos of the patient for Morning Report.
    • The appropriate action is to ask the patient for consent before using their cell phone for photos.
    • Informed consent must be used for recording.

    Healthcare Information Privacy and Security

    • The Security Rule sets national standards for protecting the confidentiality, integrity, and security of electronic health information.

    Case 10: Confidentiality-Patient Confidentiality

    • A 33 year-old male presented the ED with urethritis.
    • Examination of the discharge indicates intracellular gram-negative diplococci consistent with gonorrhea.
    • The patient does not want his wife to know about his exposure,
    • In this case, treat the patient and instruct him to contact his wife.
    • Confidentiality is an important part of the doctor-patient relationship, but in certain situations such as communicable/reportable diseases, there is an obligation to inform.

    Case 11: Genetic Conditions

    • A 44 year-old male presents to the clinic with familial polyposis/colon cancer.
    • He does not want to share this information with his children.
    • In this scenario, it’s often best to try to urge the patient to share this information if the risks are known and significant; however, there is no legal requirement to inform.

    Case 12: Workplace Issues

    • A surgical colleague performs a cholecystectomy and is showing signs of alcohol withdrawal.
    • The colleague may also be experiencing Wernicke's encephalopathy.
    • The best course of action is to talk directly with the colleague and to encourage him/her to seek appropriate professional help.

    Ethical Dilemmas

    • If an ethical dilemma can't be resolved, obtain an ethics consult, hospital attorney, or risk management.

    Case Answers

    • The answers are listed for each case

    Conclusion

    • The course was a 3 day of active board review!

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    Related Documents

    Medical Ethics Board Review Questions - ACP Internal Medicine PDF

    Description

    This quiz focuses on medical ethics as covered in the ACP Internal Medicine Board Review Prep Course. It explores essential topics such as medical indications, patient preferences, and contextual features affecting ethical decisions. Engage with real case scenarios, including a patient with metastatic renal cell carcinoma, to deepen your understanding of medical ethics.

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