Medical Ethics Chapter 2 Quiz

Chapter Two: Doctor-Patient Relationship

• Learning Objectives (ILOs): After studying this chapter, students should be able to recognize effective doctor-patient relationships, identify appropriate termination points, and understand informed consent and patient confidentiality issues. Legitimate exceptions to confidentiality and ethical considerations at the beginning and end of life are also covered.
• General Principles: Doctors should be honest, trustworthy, respectful of patient dignity, and treat all patients politely.
• Doctor-Patient Relationship Principles: Doctors have a duty to care for patients, and all interactions should be honest, polite, and respectful. Patients also have responsibilities in the relationship. Effective communication is crucial.
• Effective Doctor-Patient Relationship Requirements: A deep understanding of human behavior and techniques for talking and listening are essential for doctors. Active listening skills are supreme. The doctor–patient relationship is traditionally a contractual one (implied).
• Confidentiality: Confidentiality is a moral, ethical, professional, and legal duty. All information disclosed during the relationship is confidential and cannot be revealed without the patient's consent, except where legally required.

Chapter Two Continued

• Breaking Bad News: Considerations for giving bad news to patients include addressing personal/professional issues, possible blame, emotional/possible reactions, and uncertainty. A 7-step protocol is described for breaking bad news
• Active Listening: The chapter describes six essential techniques for actively listening, clarifying doubts, summarizing, and using non-verbal techniques effectively in a medical setting.
• Physician-Patient Communication: Different communication skills are crucial for effective physician-patient communication: listening, explaining, truth-telling, discussing options. These skills help establish understanding and rapport.
• Termination of Relationships: Once established, the obligation to treat the patient properly is ongoing until terminated, which can occur by patient recovery, death of the patient/doctor, mutual consent, or dismissal by the patient.
• Inform Consent: Essential for any medical procedure or intervention. It outlines patients' rights to decision-making.

Other Chapters

• Guidelines and Suggestions: Always leave patients with realistic hope and realize the patient may not absorb all information on the first visit. Scheduling follow-up visits is important.
• Telling the Truth: Important to distinguish between delivering the "truth" (difficult medical conditions) and the "truth telling" (the way information is provided). Ethical disclosure of diagnoses and treatment methods, keeping the patient's best interest paramount.
• Informed Consent: The right of the patient to make decisions about their healthcare; medical procedure details, consequences, side-effects.
• Voluntariness and Competence: A patient's ability to freely and rationally make decisions (voluntariness) is essential. Also, the patient has to be competent to understand.
• Disclosure and Understanding: The patient must understand the medical information, and they should be able to ask questions, and have the ability for their questions to be answered. The informed consent document should be understandable.
• Confidentiality Principles: Physician-patient relationship rests on the principle of confidentiality. All information learned by the physician is confidential to the highest degree. Information disclosed by a patient must be kept secret unless permission is explicitly given and legally required to divulge it.
• Conflicts between Patients and Physicians: The ethical obligations of a physician involve resolving issues where patient interests conflict or are in question. Ethical conflicts should be handled with sensitivity and consideration for the relevant ethical principles.
• Confidentiality and Interests of Others: The physician has a duty to maintain confidentiality, except in certain specific circumstances. Examples can include consenting patients, professional and health colleagues, close relatives if necessary, domestic violence, and contagious illnesses.
• Gifts from Patients to Physicians: Physicians can accept small gifts from patients (nominal/modest value). It's important not to accept gifts in exchange for extra care or treatments. The acceptance of excessive gifts should be avoided since this can create an implicit expectation of preferential treatment from a physician.
• Conflict between Confidentiality and Interests of Others: The doctor should adhere to confidentiality, with exceptions in specific circumstances such as required by law or certain conditions (e.g., communicable diseases).
• Beginning-of-Life Issues, Sterilization, Assisted Reproduction, Prenatal Genetic Screening, Donation of Sperm and Eggs: Ethical Issues surrounding these situations and procedures are covered. Doctors are to be mindful of potential biases and discrimination. The physician discusses these issues in relationship with patient and family or by other family members but with due respect for patient's autonomy.
• Ethical Issues in Genomic-Based Studies: Confidentiality and concerns about gender bias are key discussion points. Issues concerning genetic information should be considered from a holistic perspective.
• Doctor- Patient Extra Professional Relationship: Relationships between doctors and patients that are not purely professional or are outside of the confines of a professional relationship are not appropriate for medical practice.
• End-of-Life Issues and Euthanasia: The ethical issues of euthanasia and physician-assisted suicide are addressed, highlighting physician responsibility in such situations and the difference between euthanasia and the withdrawal or withholding of potentially futile treatment.
• Withholding and Withdrawal of Treatments: Physicians have a right to decide whether treatments are to be withheld or withdrawn, but must act with the understanding of the patient’s values, well-being and best interests.
• Organ and Tissue Donation: Discusses donation laws and considerations (e.g., safety of donors).
• Payment for Donations: Issues surrounding payment for organ/tissue donations are explored. Financial incentivizing for organ/tissue donation is ethically problematic in the context of medical ethics. The ethical concerns over undue financial incentives in circumstances involving scarce resources (e.g., organ donation) are highlighted.
• Defensive Medicine: Doctors utilize defensive medicine practices to decrease liability regarding patient care. Ethical issues involved in clinical decision-making.
• Doctor and Society: Principles, and policies regarding doctor responsibilities for public health, including resource allocation (scarce resources, and equitable distribution).
• Relationships with Physician Colleagues, Teachers, and Students: Discusses professional behavior among physicians and respects owed to teachers. Ethical responsibilities regarding reporting unsafe or unethical practices are presented.
• Cooperation: Discusses the cooperation between individual physicians with different competencies, and/or other healthcare providers to assist in the care of a patient.
• Chapter Five: Ethical Dilemmas: Describes a framework for solving ethical dilemmas in medical decision-making (identifying facts, reviewing constraints, examining options, discussing and prioritizing alternatives), making choices in the context of uncertainty. Ethical, legal and professional considerations for patient care.

This quiz focuses on the key concepts of the doctor-patient relationship outlined in Chapter Two. It covers effective communication, informed consent, patient confidentiality, and the ethical responsibilities of both doctors and patients. Test your understanding of the principles necessary for fostering a respectful and trusting healthcare environment.