HERES A LIST OF ETHICS Q's!
Good luck on Step 3!
1. A 25- year old mother refused immunization for her 2-month old son. The social worker spoke to the mother. (Important for Board examination)
Next step in management: immunization should be given for the benefit of the child.
2. A 30-year old mother refused surgery for suspected appendicitis for her 6-year old daughter. The social worker spoke to the mother. (Important for Board examination)
Next step in management: surgical removal of the appendix should be preformed for the benefit of the child.
3. A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death is certain without surgery. (Important)
Next step in management: amputation should NOT be preformed.
Adolescent patients or adults who are competent in making decisions have an absolute right to determine what shall be done with their own bodies. However, most pediatric patients are not competent to make their own decisions. Please remember, children (15 years or older) are usually able to give a genuinely informed consent. Therefore physicians may respond to their request, except in a case of irreversible sterilization.
4. A 17-year old girl is a Jehovahs Witness. She refuses a lifesaving blood transfusion. She is aware of the consequences. She spoke to the social worker. (Important)
Next step in management: blood transfusion should NOT be given because she is competent to make the decision.
5. A 5-year old girl is a Jehovahs Witness. She requires emergency blood transfusion. Her mother refuses blood transfusion. A social worker along with two physicians spoke to the mother. (Important)
Next step in management: blood transfusion should be given because the patient is not competent. Mother cannot refuse her daughters treatment.
6. A 2-year old boy was brought to the ER by his parents for an injury. Physicians made the diagnosis of child abuse. There are three other children living in the same household. Both parents confess to child abuse but request the physician to keep it confidential. Social worker was involved. (Important)
Next step in management: the case should be reported to Child Welfare Agency (CWA). All children should be removed from the parents.
7. A 15-year old boy with STD (sexually transmitted disease) came to see a physician. He asked the physician not to tell his parents. (VERY IMPORTANT)
Next step in management: the physician should treat the patient and notify the appropriate health authority, but should not tell his parents.
8. A 16-year old boy wants to use a condom. He comes to the clinic for free samples. He requested the physician, however, not to tell his parents. (Important)
Next step in management: condom should be given and physician should not tell his parents.
9. A 30-year old male patient is recently diagnosed with HIV. He lives with his wife and two other children but is promiscuous. He requested the physician not to tell his wife. He lost his job recently. Social worker spoke to the patient. (Very Important)
Next step in management: physician should notify the appropriate authority (e.g. department of health) for the safety of other specific persons who are engaged in unsafe sexual practices. The physician however, should ask the patient to divulge the diagnosis to his wife and other sexual partners.
10. A very small premature infant was born in the delivery room by NSVD (normal spontaneous vaginal delivery). The attending physician decided not to resuscitate the newborn. Physician spoke to the mother. Mother started to cry. Newborn expired after 30 minutes. Is the physician liable for the newborns death?
Answer: NO. Please remember, no physician in the USA has ever been found liable for withholding or withdrawing any life sustaining treatment from any patient for any reason.
11. A physician picked up a car accident victim from the street and brought him to the ER in his car. He did not want to wait for an ambulance because the patients condition was critical. Physical examination in the ER reveals quadriplegia. Is the physician liable for this consequence? (Very Important)
Answer: YES, because the physician did not protect the neck of the patient resulting in quadriplegia.
12. A policeman brought an alcoholic patient to the ER. The policeman asked the physician to give him a sample of gastric contents by putting a nasogastric tube for laboratory study. The patient refused insertion of a nasogastric tube. (Very Important)
Next step in management: nasogastric tube should not be placed. Blood alcohol level however should be preformed. The policeman should not give orders to a physician.
13. A 60-year old man with a history of myocardial infarction (MI) suddenly develops ventricular tachycardia. A physician from another department was present. The patient needs resuscitation. (Very Important)
Next step in management: the physician must resuscitate that patient. Physician should not refuse treatment because he belongs to another department.
14. A 15-year old homosexual boy wanted to change his sexual orientation. He was not successful. He needed help. He requested the physician not to tell his parents. (Important)
Next step in management: physician should help him avoid homosexual activities. Physician should not tell his parents about his homosexual activities.
15. A 15-year old homosexual boy is brought by his parents to a physician. His parents do not accept their sons sexual orientation. The boy refuses to change. (Important)
Next step in management: physician should tell his parent that homosexual activity is considered as an alternative life style. Parents should talk to his son but should not force him to change his homosexual activities.
16. A 16-year old girl becomes pregnant. Her mother wanted her to abort this pregnancy. The girl wanted to continue her pregnancy despite difficulties. Her boyfriend is a high school drop out. (Important)
Next step in management: physician should advise to continue this pregnancy because the girl is competent to make this decision.
17. A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the doctor not to tell her parents about this pregnancy. (Important)
Next step in management: abortion should be done and parents should not be notified. Please remember, strict requirements for parental consent may deter many adolescents from seeking health care.
18. Can a physician provide sterile needles for intravenous drug abusers? (Important)
Answer: YES. It reduces the risk of acquiring HIV or hepatitis. The patients should be referred to appropriate health facilities.
19. A 26-year old pregnant woman went for antenatal check up. Sonogram revealed a 27-week old fetus with erythroblastosis fetalis. Doctor recommended intrauterine fetal blood transfusion. She refused the procedure. Social worker discussed the case with the mother. (Important)
Next step in management: doctor should receive a court to do the procedure that will help the fetal condition.
20. A 20-year old man tells his doctor that he is going to kill girlfriend. She lives in the university dormitory. Doctor called the university and alerted them about the threat. However, university security people did not protect her. Her boyfriend killed her. Who should be responsible for this killing? (Important)
Answer: the 20-year old man is responsible. Doctor did the right thing by notifying the university or the police. The university is also responsible because they did not take any preventive measures.
21. A 20-year old pregnant woman refuses cesarean section for complete placenta previa. Fetus is full-term and healthy. Social worker spoke to mother. (Important)
Next step in management: doctor can go to court to get permission for cesarean section for the benefit of the fetus.
22. A 30-year old pregnant woman ingested alcohol and illicit drugs (e.g., cocaine, crack) that are harmful to the fetus. What should a physician do? (Important)
Answer: the physician should be careful in reporting this case because the pregnant woman may not come back for prenatal care, which is important for both the mother and the fetus. However, if the babys urine toxicology test is positive for illicit drugs, case should be reported to CWA (child welfare agency). CWA suggests separate custody for the child.
23. A physician wants to study a group of children aging from 10-12 year old. Physician already got the consent from the parents. However, he didnt discuss the study with the children. A child refused to participate. Should the physician force the child to participate? (Important)
Answer: no, because a child can refuse to participate in a research study.
24. A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with the patient who understood the procedure. Can the patient give consent? (Important)
Answer: yes. If a psychiatric patient understands the procedure, he or she can give the consent.
25. A 65-year old schizophrenic patient needs coronary angiography because of suspected myocardial infarction. Cardiologists explained the procedure to the patient who did not understand the procedure. Who can give the consent on behalf of the patient? (Important)
Answer: the patients relative can give the consent. If nobody is available to give the consent, court order should be obtained. If a psychiatric patient does not understand the procedure, he or she cannot give the consent.
26. A 25-year old woman developed postpartum psychosis. The newborn developed cyanosis due to congenital heart disease. The newborn needs cardiac surgery. Surgeon discussed the procedure with the mother. She understood the procedure. Can she give the consent? (Important)
Answer: yes, because she understood the procedure.
27. A newborn is diagnosed with either trisomy 18 or 13 with TE (tracheoesophageal) fistula, which requires surgery. Mother request surgeon to repair the TE-fistula. What should a surgeon do? (Important)
Answer: surgeon should refuse to do the reparative surgery because these conditions (trisomy 18 or 13) are nonviable. If the patient survives, surgeon can put a gastrostomy feeding tube for nutrition. However, please remember that a patient with trisomy 21 (Down syndrome) with TE fistula should be operated on.
28. A 45-year old terminally ill patient wanted to die. He has pancreatic cancer and has been suffering from constant pain. He asked the physician to give him some medication which can expedite his death. What should a physician do? (Very Important)
Answer: physician cannot give any medication which will expedite the death. However, physician can prescribe medication to minimize the pain. The dose should be appropriate. Physician-assisted suicide is illegal everywhere (except in the state of Oregon).
29. A 47-year old man came to a doctor for chronic low back pain and dysuria. The diagnosis of metastatic prostate cancer was made after appropriate investigation. Should the doctor tell the bad news to the patient? (Important)
Answer: yes physician must tell the truth to the patient.
30. A surgeon wanted to perform cholecystectomy on a patient. The surgeon is not sure whether the patient has decision-making capacity. What is the next appropriate step? (Important)
Answer: consultation with a psychiatrist or neurologist may be helpful. Sometimes it is necessary to discuss the case with hospital attorneys, ethic committees, or ethic consultants. In a difficult case, the ultimate judge of a patients competency is a court.
31. A 45-year old widow was admitted to an ICU (intensive care unit) with ruptured intracranial aneurysm. She is comatose and is placed on a mechanical ventilator. She has a 20-year old son who did not keep any relation with his mother. However, he came to see his mother. His mother made a written proxy advance directive which indicates that her 50-year old female neighbor should make the substitute decision. Who is the right person to make the substitute decision in this situation? (Important)
Answer: 50-year old neighbor should make the substitute decision. Please remember, the most appropriate person to make the substitute decision is someone designated by the patient while still competent, either orally or through a written proxy advance directive. Other substitute decision makers, in their usual order of priority, include a spouse, adult child, parent, brother or sister, relative, or concerned friend. For a patient who has no other decision maker available, a phblic official may serve as a decision maker.
32. The right of patients to refuse medical intervention: patients can refuse dialysis, cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition and hydration, even if such a decision results in the patients death. A patients decision to withdraw (discontinue) or to withheld (not to initiate) life-sustaining treatment is not considered suicide and physician participation is not considered physician-assisted suicide. Physicians do not have any legal risk.
33. Can a medical student introduce himself or herself as a doctor to the patient? (Important)
Answer: no. a patient can refuse a medical student from performing any procedure. However, medical students are allowed to perform a procedure under appropriate supervision If the patient agrees to that.
34. Should a bus driver hide history of epilepsy from his employer? (Important)
Answer: no. He has requested his physician not to mention his epilepsy to the employer because this would result in the loss of his job. The physician is obligated not only to his patient but to the community. The patient should notify his employer and try to find a non-driving job in the company. If the patient disagrees, physician may notify the appropriate authority for the safety of the patient and the community.
35. A 50-year old make is diagnosed with stomach cancer. He requested the physician not to tell his wife. The following day, the wife calls to inquire about her husbands diagnosis. (Important)
Answer: the physician should not divulge the husbands diagnosis. However, the physician should encourage the patient to reveal his diagnosis to his wife.
36. A 29-year old man is diagnosed with presymptomatic Huntingtons disease. This disease is an autosomal dominant (50% chance of having the disease in each pregnancy). He requested his physician not to tell the diagnosis to his wife. The wife wants to have children. (Important)
Answer: physician should ask the patient to seek genetic counseling and to urge him to discuss the matter with his wife. Since there is a risk of harm to the future children, physician can divulge the diagnosis to protect the future children.
37. A 18-year old man is diagnosed to have suspected bacterial meningitis. He refuses therapy and returns to the college dormitory. What should a physician do in this situation? (Very Important)
Answer: physician should report to the college authority and recommend that the suspected individual should be isolated during the course of his illness.
38. A 39-year old nurse is diagnosed with hepatitis B antigen-positive. She is working in a dialysis unit. She told her doctor. However, she did not tell the hospital authority because she is afraid to lose her job. (Very Important)
Answer: physician should ask the nurse to divulge her medical condition to the hospital authority. If she refuses, physician should notify the hospital authority for the protection of patients.
39. A 20-year old man with severe head injury was admitted to a small hospital. The patient needs neurosurgical intervention which is available in a nearby university hospital. Hospital refused to accept a patient who has no medical insurance.
Answer: university hospital must accept the patient.
40. A 30-year old man needs a second prosthetic valve. He is a drug addict. Surgeon does not want to perform surgery because the patient does not take care of himself. Is this the right decision? (Important)
Answer: no. Surgery should be performed if it is medically indicated.
41. A newborn male is diagnosed with anencephaly. His 1-year old sibling needs a kidney. His parents requested the physician to remove the kidney from the anencephalic child and to transplant that kidney in the 1-year old sibling. What should a physician do?
Answer: surgeon should perform the kidney transplant.
42. A 50-year old man is in a persistent vegetative state. Physician decided to discontinue nutrition and hydration for that patient. Is this the right decision?
Answer: yes. This is an acceptable practice in most states. Few states require clear evidence that the patient would have chosen this course.
43. A medical student requested his attending to perform a pelvic examination on a patient who is anaesthetized for appendectomy. Is this ethically acceptable?
Answer: no. The patient did not give consent to perform a pelvic examination.
44. A 20-year old woman slashed her wrists and wanted to die. She was unconscious and was brought to the ER. What should a physician do? (Important)
Answer: physician should take care of the patient. Psychiatric consultation and social worker evaluation are indicated. A suicide attempt is very often a cry for help.
45. A 90-year old man was diagnosed with having Alzheimers disease 10 years ago. It is difficult to feed him. He cannot recognize his family members. He developed recurrent aspiration pneumonia. What should a physician do?
Answer: physician should discuss this with the family and should respect their decision.
46. A 1-day-old infant was diagnosed with hypoplastic left heart syndrome. The patient is stabilized with the use of prostaglandin. Physician discussed this case in detail with the parents. What should the parents decide in this situation?
Answer: the parents can choose a staged surgical repair of the heart, a final heart transplantation if the organ is available, or allow the infant to die.
47. A 55-year old woman with severe developmental disability recently is diagnosed with breast cancer. Her mental age is estimated at a 2-year old level. Her family members do not want any more intervention. What should physician do?
Answer: physician should discuss this case with the hospital ethics committee members. The usual consensus is not to do anything because of her severe mental disability.
48. A 49-year old woman with cervical cancer has a history of noncompliance. She had surgery a month ago. She missed several appointments. Can a physician force her for chemotherapy? (Important)
Answer: no. Physician can talk to her regarding the importance of chemotherapy. However, the patient must make the final decision.
49. An internist has been managing a diabetic patient for the last 10 years. The patients condition is progressively getting worse. The patient is also not happy with the physicians management. What should a physician do in this situation?
Answer: physician should find another physician (e.g., endocrinologist) who might be more successful with the patient in this particular circumstance.
50. An internist recently refused to see a patient who he has been seeing for the last 5 years. Internist stated that the patient was rude to him. The patient went to see another physician who requested the patients medical record. What should the internist do in this situation?
Answer: internist should provide the medical records of the patient to the new physician.
51. An internist refused to see a complicated hypertensive patient who he has seen for the last 10 years. Internist did not give any notice to that patient. The patient was angry with the physician. The patient was recently admitted to a hospital with the diagnosis of stroke. Is the internist responsible for the patients condition?
Answer: yes. The legal charge of abandonment can arise when the physician without giving timely notice, ceases to provide care for a patient who is still in need of medical attention. Internist is not obligated to find him another physician. However, patient should have sufficient time to arrange for another physician.
52. A physician went to vacation for 2 weeks. He did not find another physician to cover him. He is very sincere. One of his patients with hypertension developed severe headache. The patient has an appointment with the doctor as soon as he comes back from vacation. The patient did not look for another physician and decided to wait. The patient suddenly collapses and was diagnosed to have intracranial hemorrhage. Is the physician responsible for this patient? (Important)
Answer: yes. The physician has a legal obligation to arrange for coverage by another physician.
53. An ophthalmologist performed a cataract surgery on a patient who went home after the operation. In the evening, the patient started vomiting and complained of severe headache. The ophthalmologist refused to accept that the symptoms were due to postoperative complications. The patient wanted to see the doctor immediately but he refused to see that patient. The patient went to the nearest ER and was diagnosed to have dislocation of the lens and partial retinal detachment. Is the physician responsible for the patients condition?
Answer: yes ophthalmologist failed to judge the patients condition seriously enough to warrant attention.
54. A 70-year old Chinese man is diagnosed to have severe osteoarthritis. He told his doctor that he is using Chinese herbal medicine. He is feeling better. However, he had two episodes of dizzy spells since he started that herbal product. What should a doctor suggest to this patient? (Important)
Answer: the doctor should suggest to discontinue the herbal product which may be causing the dizzy spells.
55. A 35-year old woman is diagnosed to have chronic throat infection. She is frustrated with the conventional medicine. She told her doctor that she is using an alternative homeopathic medicine. She is feeling much better and she has no other complications. What should a doctor suggest to this patient?
Answer: the patient can continue an alternative homeopathic medicine. Alternative medicine therapy is accepted in the society and is also used along with conventional therapy.
56. A 45 year old woman is diagnosed to have UTI (urinary tract infection). She told her doctor that she could not afford to purchase antibiotics. However, she is using herbal medicine that is cheaper. She is complaining of fever and dysuria. What should a doctor suggest to this patient? (Important)
Answer: the patient should discontinue the herbal medicine immediately and should start antibiotics as soon as possible.
57. A 13-year old boy with suspected meningitis refuses therapy. His parents also support that decision because they are supposed to go on vacation the following day. What should a physician do in this situation? (Important)
Answer: the patient should be admitted and treated in the hospital. If they refuse, legal action should be taken.
58. A 2-year old girl is admitted with the diagnosis of intestinal obstruction. Her mother has a psychiatric problem. Her mother is not capable of giving the consent. Her father died one uear ago. What should a surgeon do in this situation?
Answer: legal steps may be taken to provide a surrogate decision-maker.
59. A 67-year old widow has been using hypnotics for the last 5 years. She is addicted. Her doctor wants to withdraw her from her present medication by trial on placebos. Is the physician making a right decision? (Important)
Answer: no. The physician cannot use placebos because his decision is deceptive. The problem of addiction should be discussed directly with the patient. The use of deceptive placebo is indicated in the following conditions:
(a) the patient insists on a prescription;
(b) the patient wishes to be treated;
(c) the alternative to placebo is either continue illness or the use of a drug with know toxicity;
(d) high response rates to placebo (e.g., postoperative pain, mild mental depression).
60. A 50-year old man is diagnosed to have multiple sclerosis. In the morning, the surgeon asked the man his opinion on the surgical procedure and he agreed. In the evening, the man refused to give consent for the same surgical procedure. He is also disoriented to place and time. Is the patient capable of making the decision?
Answer: no the patient has impaired capacity.
61. A 55-year old woman with diabetes is diagnosed to have gangrene on both feet. She was brought to the hospital. She told the doctor the she is feeling fine and she has no medical problems. Can she give consent for the amputation of both legs?
Answer: no. The appointment of a surrogate should be sought to get the consent for the surgery.
62. A 17-year old boy came to a surgeon for bilateral vasectomy. He is the father of one child and does not want to have any more children. He does not want to tell his girlfriend and parents. He lives with his parents. What should a surgeon do in this situation? (Important)
Answer: surgeon should not perform bilateral vasectomy and should offer him less radical alternatives. Please remember, a mature minor may not comprehend the implications of this procedure.
63. A 16-year old girl came to a doctor for bilateral tubal ligations. She is a mother of one child and does not want to have any more children. She does not want to tell her boyfriend and parents. She lives with her parents. What should a doctor do in this situation? (Important)
Answer: obgyn doctor should not perform bilateral tubal ligation and should offer her less radical alternatives.
64. A 16-year old boy wants to donate one of his kidneys to his friend who is suffering from ESRD (end stage renal disease). The boys parents did not agree with his decision. What should a physician do in this situation? (Important)
Answer: the physician cannot accept his kidney. However, he can donate one of his kidneys if his parents agree.
65. A 15-year old boy wants to participate in a research study. He told his parents who did not agree. He lives with his parents. Can this boy participate in the research study?
Answer: no the boy needs consent from his parents to participate in a research study.
66. A 17-year old boy lives independently. He is married and has one child. He wants to participate in a research study. Does he need his parents permission? (Important)
Answer: no. He is an emancipated minor who lives independently from his parents physically and financially.
67. A 70-year old man is diagnosed with terminal esophageal cancer and requires an insertion of a gastrostomy tube. He has signed a DNR (Do Not Resuscitate) order about a month ago. Should the preexisting DNR order stand or be suspended during the surgical procedure? (Very Important)
Answer: attending physician, surgeons, and the patient or surrogate should discuss the matter and either affirm or suspend the order in anticipation of surgery. If a patient is competent and wishes a preexisting DNR order to stand, resuscitation should not be performed in the event of an intrasurgical arrest.
68. An infant, born at 30 weeks gestation, appears to be SGA (small for gestational age) with multiple malformations. Amniocentesis study was not performed. Infant needs resuscitation at birth. What should a physician do in this situation? (Important)
Answer: physician must resuscitate the patient in the delivery room because the diagnosis is uncertain.
69. A 60-year old man is diagnosed with terminally ill colon cancer and needs resuscitation. He did not sign a DNR order. The physician has decided to perform a slow code on his own. Is this the right decision? (Important)
Answer: no. Please remember, a performance of slow code or show code is not acceptable to the patient. This decision by the doctor represents the failure to come to a timely and clear decision about the patients resuscitation status.
70. A 20-year old man is diagnosed with suspected bacteremia and meningitis. He refuses antibiotic therapy. He collapses and requires resuscitation. What should a physician do in this situation?
Answer: the physician should resuscitate the patient despite the patients refusal to antibiotic therapy.
71. A 50-year old woman is diagnosed with severe aortic stenosis. She collapsed in a doctors office and is required resuscitation. She is waiting for valve replacement surgery. What should a physician so in this situation?
Answer: this condition is called physiological futility. In severe aortic stenosis, vigorous resuscitation is highly unlikely to restore adequate cardiac output. Therefore, the physician might reasonably refrain from resuscitation.
