A WTF ethics question in Kaplan Qbook

Tajima

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    A woman gave birth to her 5th kid. She wants a tubal ligation. The physician should:

    a. maintain strict confidentiality and not disclose the patient's wishes to her husband
    b. discuss the benefits and risks of the procedure with both the patient and her husband

    I chose a.

    The right answer was b.

    WTF?

    The right answer was that BOTH SPOUSES need to consent to a sterilization procedure and this is somehow right because I was supposed to bring it up with the husband since this would impact his autonomy to have more children in the future! WTF!? Now I don't know about you but I found this answer to be very misogynistic, as if a woman's primary role in life is to provide a breeding ground for her male keeper within the holy union of man-woman marriage.

    Is it true that both spouses need to consent to a procedure on ONE individual who has the capacity to make her own decisions and deserves confidentiality as much as anyone else?

    Am I misreading something here, or is that question just effed up? Is this the actual ethical principle followed in the USA? Does the SA in USA stand for "Saudi Arabia"?
     
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    zhopv10

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      Couple thoughts 1. It never said in the question that she did not want to discuss it with the husband or didn't want him to know. This would change it more towards a. As it stands if they are both there then there isn't a reason they both can't participate in their discussion. 2. To me the question reads like patient just talks about it to you and answer choice a you the provider take it upon yourself to make sure the husband doesn't find out. You can't really read too much between the lines in step 1 questions I think, if it didn't say she wants to keep it secret then it shouldn't be assumed that she necessarily wants to keep it a secret in which case they may care to discuss it as a couple. 3. Nowhere in your stem you gave or the answers did it say that consent was needed from both (maybe the original question did?) so again this seems like you are giving information about the procedure in order to inform both parties. As for consent I have no idea about the legality of such thing. I would be very surprised if consent from both spouses was needed.

      As a side note here, just because the husband wants to be in on the conversation does not mean he wants to control the wife. They are a couple, big decisions are generally made with some communication. I for one would like to know about and hear the risks etc of such a procedure. Not because I want to control my wife or anything but because it is a big decision that actually does affect both of us, and I would like to know about risks to keep an eye out for her post surgery. Obviously the decision is ultimately hers but it is a big decision that affects both partners in the marriage, so a healthy conversation is completely healthy imo. I mean honestly if I heard of a women wanting to keep a sterilization procedure secret or something I would be a little worried (is she scared to let him know? Is she being abused? Or is she just independent idk). Is that a little assuming/judgmental, maybe, wouldn't make much difference as a provider except I may keep an eye out for signs of abuse or something to protect the pt and such. Obviously that doesn't play out as much from the provider role (if the pt requested it to stay secret then that is that except for the notable exceptions we learn and such). But ya just thought I'd throw that out there.
       
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      Ethics isn't a black and white topic, but given the limited information here, it seems that B is most appropriate (although, for a different reason than the husband's autonomy). Choice A makes no mention of ensuring the patient is adequately informed on the risks and benefits of the procedure, while answer choice B makes sure that at least the patient will be well informed about the decision. If you could only take one of these actions, would you keep a secret from her husband or would you inform her on the decision she wants to make?

      This is just my opinion...
       
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      zhopv10

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        ^good point. I just wanted to tack on a quick clarification on mine, I'm not suggesting that the discussion by both is necessarily any intrinsic right to the husband. Just meant to point out (in terms of the question) that nothing in the stem suggested that she didn't want to share it with him so we can't make that assumption, and without that assumption the important thing that needs to be done is explain the risks and such of the procedure as was mentioned above, that was a great clarifying point.
         
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        Tajima

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          I'm still not convinced that b is the correct answer.

          The stem makes no mention of the patient wanting to disclose the procedure to her husband and the answer choices make no mention of "giving her the option" to bring the husband into the conversation. It merely says to do so. Had the b choice been "Discuss the benefits and risks of the procedure with the patient, and ask the patient if she wants to bring her husband into the discussion or not" then b would make more sense. The answer choice as it stands makes it sound like the only option the patient has to discuss the procedure is with her husband. That's wrong to me. She deserves to have the option to not discuss the procedure with her husband and not disclose to the husband that she has had a sterilization procedure. On answering this question I erred on the side of patient confidentiality. If you were to change the person from the husband to the father, mother or best friend, answer b would be flat out wrong.

          I am not familiar with state laws, and the answer key in the back of the chapter makes a mention of the consent of both spouses being required to go forth with a sterilization procedure, so I am wondering if this is actually a thing. I've not heard of it.
           

          gyngyn

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            I am not familiar with state laws, and the answer key in the back of the chapter makes a mention of the consent of both spouses being required to go forth with a sterilization procedure, so I am wondering if this is actually a thing. I've not heard of it.
            This is an antiquated view that is contrary to current principles of practice.
            I have never practiced in a state where a husband's consent was required for a procedure on his wife.
             
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            Kazaki

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              I think dempty's spot on with this one. If option a was to discuss the benefits and risks with the patient, and option b was to do so with both the patient and the husband, then I'm certain that a would be the right choice. Because in that case option a would maintain patient confidentiality AND insure that you've informed the patient.
               

              zeevee

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                she can have abortion without her husbands consent but not sterilization ? odd .May be the husband just needs to be informed but the final verdict is of the female thats what the question is suggesting ? What is the constitution when the man has to be sterilized ?
                its an odd ball Q IMO and definitely needs to be remembered as an exception in the exam
                 

                zhopv10

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                  ^she can have a sterilization w/o her husbands consent. The point of the question as made earlier was that that was the only choice that involved giving an explanation of the procedure which is required. The question never said that she did not want her husband to know, thus we don't have necessarily reason to specifically x him out of the equation. (I might ask something like "ok I'm going to explain some of the risks and how the procedure will happen, would you like your husband to hear this as well, it's completely fine either way?" Maybe she says yes? Or likely you would already know since this is likely not a first visit. Anyway tangent) OP said that the answer explanation said something about consent so maybe it's just an oddball question altogether/low likelihood of it being that way on a current exam. Especially considering that's not legally required as mentioned previously as well.


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                  chillaxbro

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                    A woman gave birth to her 5th kid. She wants a tubal ligation. The physician should:

                    a. maintain strict confidentiality and not disclose the patient's wishes to her husband
                    b. discuss the benefits and risks of the procedure with both the patient and her husband

                    I chose a.

                    The right answer was b.

                    WTF?

                    The right answer was that BOTH SPOUSES need to consent to a sterilization procedure and this is somehow right because I was supposed to bring it up with the husband since this would impact his autonomy to have more children in the future! WTF!? Now I don't know about you but I found this answer to be very misogynistic, as if a woman's primary role in life is to provide a breeding ground for her male keeper within the holy union of man-woman marriage.

                    Is it true that both spouses need to consent to a procedure on ONE individual who has the capacity to make her own decisions and deserves confidentiality as much as anyone else?

                    Am I misreading something here, or is that question just effed up? Is this the actual ethical principle followed in the USA? Does the SA in USA stand for "Saudi Arabia"?
                    On the other hand, I had a uworld question where the woman admits that her kid isn't her husband's but he doesnt know. He's your patient too. She tells you not to tell him. What do you do?
                     

                    worldbeater

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                      On the other hand, I had a uworld question where the woman admits that her kid isn't her husband's but he doesnt know. He's your patient too. She tells you not to tell him. What do you do?
                      I got this question wrong when I got it. You don't tell the husband, although it's kind of messed up in my opinion. Why does husband get screwed over twice: once his wife by a random dude, and twice by not knowing he has a kid that's not his?

                      I think the concept is that the patient is always right, in this case the patient your currently seeing takes priority over a patient at your practice.

                      Is it true that both spouses need to consent to a procedure on ONE individual who has the capacity to make her own decisions and deserves confidentiality as much as anyone else?
                      Your right, you only usually need one person's consent, especially if its the patient. Kaplan has a lot of the questions that are "right 10% of the time", as opposed with the normal 90%, that's why I don't like it. But, I think it's a good bank to do towards the beginning of your prep, so you can get the feel of how to handle practice questions in general.
                       

                      EmetyreUSMLEStep1Tutor1

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                        A woman gave birth to her 5th kid. She wants a tubal ligation. The physician should:

                        a. maintain strict confidentiality and not disclose the patient's wishes to her husband
                        b. discuss the benefits and risks of the procedure with both the patient and her husband

                        I chose a.

                        The right answer was b.

                        WTF?

                        The right answer was that BOTH SPOUSES need to consent to a sterilization procedure and this is somehow right because I was supposed to bring it up with the husband since this would impact his autonomy to have more children in the future! WTF!? Now I don't know about you but I found this answer to be very misogynistic, as if a woman's primary role in life is to provide a breeding ground for her male keeper within the holy union of man-woman marriage.

                        Is it true that both spouses need to consent to a procedure on ONE individual who has the capacity to make her own decisions and deserves confidentiality as much as anyone else?

                        Am I misreading something here, or is that question just effed up? Is this the actual ethical principle followed in the USA? Does the SA in USA stand for "Saudi Arabia"?
                        lol, thats f***d up!
                         

                        Merely

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                          I got this question wrong when I got it. You don't tell the husband, although it's kind of messed up in my opinion. Why does husband get screwed over twice: once his wife by a random dude, and twice by not knowing he has a kid that's not his?

                          I think the concept is that the patient is always right, in this case the patient your currently seeing takes priority over a patient at your practice.


                          Your right, you only usually need one person's consent, especially if its the patient. Kaplan has a lot of the questions that are "right 10% of the time", as opposed with the normal 90%, that's why I don't like it. But, I think it's a good bank to do towards the beginning of your prep, so you can get the feel of how to handle practice questions in general.

                          Thats not ethical I think that you should have to tell the husband
                           

                          pd1112

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                            This is a classic example of reading too much into the question. Sterilization procedures, whether performed on males or females, more than likely will have significant impact on the patient's spouse or intimate partner(s), so patients are always encouraged to discuss his/her desire to have the procedure with the partner first. Ob/Gyns & urologists typically will not produce the consent form for the patient to sign until the 2nd or 3rd office visit for counseling about the procedure, giving the patient plenty of time to discuss it with the partner.

                            As others have said, in this particular question, there's no mention about the patient desiring to keep it secret, so there's clearly not enough information to make choice A correct. More often than not, when it comes to ethics questions for the boards, the least controversial answer choice is the best. There is nothing controversial about choice B with the information provided.
                             
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