Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Ethical principles (autonomy, beneficence, non-maleficence, justice). These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 1: A 76-year-old man is brought to the hospital after having a stroke. Head CT is done in the emergency department and shows intracranial hemorrhage. Upon arrival to the ED he is verbally non-responsive and withdraws only to pain. He does not open his eyes. He is transferred to the medical ICU for further management and intubated for airway protection. During his second day in the ICU, his blood pressure is measured as 91/54 mmHg and pulse is 120/min. He is given fluids and antibiotics, but he progresses to renal failure and his mental status deteriorates. The physicians in the ICU ask the patient’s family what his wishes are for end-of-life care. His wife tells the team that she is durable power of attorney for the patient and provides appropriate documentation. She mentions that he did not have a living will, but she believes that he would want care withdrawn in this situation, and therefore asks the team to withdraw care at this point. The patient’s daughter vehemently disagrees and believes it is in the best interest of her father, the patient, to continue all care. Based on this information, what is the best course of action for the physician team?
- A. Call other family members and consult them for their opinions
- B. Listen to the patient’s daughter’s wishes and continue all care
- C. Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated
- D. Listen to the patient’s wife’s wishes and withdraw care (Correct Answer)
- E. Consult the hospital ethics committee and continue all care until a decision is reached
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***Listen to the patient’s wife’s wishes and withdraw care***
- The **durable power of attorney for healthcare** legally designates the wife as the patient's surrogate decision-maker when the patient lacks capacity, overriding other family opinions.
- In the absence of a living will, the **surrogate's interpretation of the patient's best interests** and previously expressed wishes is legally and ethically binding.
*Call other family members and consult them for their opinions*
- While involving family is good practice in general, the presence of a **legally appointed durable power of attorney** means that other family members' opinions do not supersede the designated surrogate's decisions.
- Consulting other family members could **create more conflict and delay** crucial decisions, as the wife holds the legal authority.
*Listen to the patient’s daughter’s wishes and continue all care*
- The daughter's wishes, while understandable, **do not hold legal authority** over the decisions of the legally appointed durable power of attorney.
- Disregarding the wife's authority would be a **breach of ethical and legal obligations** in patient care.
*Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated*
- A compromise that goes against the legal surrogate's explicitly stated decision (to withdraw all care) is **ethically problematic and legally unsound**.
- Healthcare decisions should be based on the patient's best interest as interpreted by the **authorized surrogate**, not on attempting to please all family members.
*Consult the hospital ethics committee and continue all care until a decision is reached*
- While an ethics committee consult is appropriate if there's **disagreement over the interpretation of the patient's wishes** *among legally designated surrogates* or concerns about the surrogate's decision-making capacity, it's not the first step when a clear legal surrogate with documentation is present and makes a decision.
- Continuing all care against the wishes of the **legal proxy** would be contrary to patient autonomy and the principles of substituted judgment.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 2: A 29-year-old man is admitted to the emergency department following a motorcycle accident. The patient is severely injured and requires life support after splenectomy and evacuation of a subdural hematoma. Past medical history is unremarkable. The patient’s family members, including wife, parents, siblings, and grandparents, are informed about the patient’s condition. The patient has no living will and there is no durable power of attorney. The patient must be put in an induced coma for an undetermined period of time. Which of the following is responsible for making medical decisions for the incapacitated patient?
- A. The spouse (Correct Answer)
- B. An older sibling
- C. Physician
- D. Legal guardian
- E. The parents
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***The spouse***
- In the absence of a **living will** or **durable power of attorney**, the law typically designates the **spouse** as the primary decision-maker for an incapacitated patient.
- This hierarchy is established to ensure decisions are made by the individual most intimately connected and presumed to understand the patient's wishes.
*An older sibling*
- Siblings are generally further down the **hierarchy of surrogate decision-makers** than a spouse or parents.
- They would typically only be considered if higher-priority family members are unavailable or unwilling to make decisions.
*Physician*
- The physician's role is to provide medical care and guidance, not to make medical decisions for an incapacitated patient when family surrogates are available.
- Physicians only make decisions in **emergency situations** when no surrogate is immediately available and treatment is immediately necessary to save the patient's life or prevent serious harm.
*Legal guardian*
- A legal guardian is usually appointed by a **court** when there is no appropriate family member available or when there is a dispute among family members.
- In this scenario, with a spouse and other close family members present, a legal guardian would not be the first choice.
*The parents*
- While parents are close family members, they are typically considered **secondary to the spouse** in the hierarchy of surrogate decision-makers for an adult patient.
- They would usually only be the decision-makers if the patient were unmarried or the spouse were unavailable.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 3: A 19-year-old man presents to an orthopedic surgeon to discuss repair of his torn anterior cruciate ligament. He suffered the injury during a college basketball game 1 week ago and has been using a knee immobilizer since the accident. His past medical history is significant for an emergency appendectomy when he was 12 years of age. At that time, he said that he never wanted to have surgery again. At this visit, the physician explains the procedure to him in detail including potential risks and complications. The patient acknowledges and communicates his understanding of both the diagnosis as well as the surgery and decides to proceed with the surgery in 3 weeks. Afterward, he signs a form giving consent for the operation. Which of the following statements is true about this patient?
- A. He cannot provide consent because he lacks capacity
- B. He has the right to revoke his consent at any time (Correct Answer)
- C. His parents also need to give consent to this operation
- D. He did not need to provide consent for this procedure since it is obviously beneficial
- E. His consent is invalid because his decision is not stable over time
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***He has the right to revoke his consent at any time***
- **Informed consent** for medical procedures is an ongoing process, and a patient retains the right to **withdraw consent** at any point, even after initially signing the consent form.
- This right is a fundamental aspect of patient autonomy and ensures that medical interventions are only performed with a patient's current and willing agreement.
*He cannot provide consent because he lacks capacity*
- The patient is 19 years old, which in most jurisdictions (including the US where the age of majority is typically 18) means he is considered an **adult** and legally capable of providing his own consent.
- The scenario explicitly states he "communicates his understanding of both the diagnosis as well as the surgery," indicating he possesses the **mental capacity** to make an informed decision.
*His parents also need to give consent to this operation*
- As a 19-year-old, the patient has reached the **age of majority** and is legally entitled to make his own medical decisions, including consenting to surgery.
- Parental consent is generally required for minors (individuals under the age of majority), but not for adults like this patient.
*He did not need to provide consent for this procedure since it is obviously beneficial*
- Even for procedures that are clearly **beneficial**, informed consent is ethically and legally mandatory to uphold **patient autonomy** and ensure respect for individual rights.
- The concept of "obviously beneficial" does not negate the requirement for a patient's explicit agreement to a medical intervention.
*His consent is invalid because his decision is not stable over time*
- While the patient might have initially hated surgery at age 12, his current decision at age 19 to proceed with the ACL repair is based on current information and his mature understanding.
- The fact that his previous aversion to surgery has changed does not invalidate his current, well-informed decision; it simply indicates a change in perspective based on new circumstances and greater maturity.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 4: You are a resident on a pediatric service entering orders late at night. Upon arrival the next morning, you note that you had mistakenly ordered that low molecular weight heparin be administered to a 17-year-old patient who does not need anti-coagulation. When you talk to her, she complains about the "shot" she had to get this morning but is otherwise well. How should you handle the situation?
- A. Since there was no lasting harm to the patient, it is not necessary to disclose the error
- B. Tell the patient and her parents about the error (Correct Answer)
- C. You cannot disclose the error as a resident due to hospital policy
- D. Tell the patient, but ask her not to tell her parents
- E. Speak to risk management before deciding whether or not to disclose the error
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***Tell the patient and her parents about the error***
- Full **disclosure of medical errors** is a fundamental ethical principle, even if no lasting harm occurred, because it promotes trust and transparency.
- As a **minor**, the patient's parents/guardians have the right to be informed about medical errors affecting their child's care and safety.
*Since there was no lasting harm to the patient, it is not necessary to disclose the error*
- This statement is incorrect because the **absence of harm** does not negate the ethical obligation to disclose a medical error; it is crucial for patient trust and learning from mistakes.
- Failing to disclose an error, even if harmless, can erode trust and is considered a breach of **professional integrity and transparency**.
*You cannot disclose the error as a resident due to hospital policy*
- While hospital policies may guide the process of disclosure (e.g., involving attending physicians or risk management), they do not prevent residents from participating in or initiating the disclosure of an error.
- The resident's role involves acknowledging the error and initiating the appropriate steps for disclosure, often in collaboration with their **supervising physician**.
*Tell the patient, but ask her not to tell her parents*
- This is unethical and legally problematic because, as a **minor**, the patient's parents or legal guardians have the right to be informed about significant medical events and errors related to their child's care.
- Asking the patient to withhold information from her parents undermines **parental rights** and creates an inappropriate and potentially harmful dynamic.
*Speak to risk management before deciding whether or not to disclose the error*
- While consulting **risk management** is an important step in the process of disclosing a medical error to ensure compliance and support, it should not be a prerequisite for the decision to disclose.
- The ethical imperative is to disclose the error; risk management primarily guides *how* to best disclose it, not *whether* to disclose it.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 5: A 28-year-old woman dies shortly after receiving a blood transfusion. Autopsy reveals widespread intravascular hemolysis and acute renal failure. Investigation reveals that she received type A blood, but her medical record indicates she was type O. In a malpractice lawsuit, which of the following elements must be proven?
- A. Duty, breach, causation, and damages (Correct Answer)
- B. Only duty and breach
- C. Only breach and causation
- D. Duty, breach, and damages
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***Duty, breach, causation, and damages***
- In a medical malpractice lawsuit, all four elements—**duty, breach, causation, and damages**—must be proven for a successful claim.
- The healthcare provider had a **duty** to provide competent care, they **breached** that duty by administering the wrong blood type, this breach **caused** the patient's death and renal failure, and these injuries constitute **damages**.
*Only duty and breach*
- While **duty** and **breach** are necessary components, proving only these two is insufficient for a malpractice claim.
- It must also be demonstrated that the breach directly led to the patient's harm and resulted in legally recognized damages.
*Only breach and causation*
- This option omits the crucial elements of professional **duty** owed to the patient and the resulting **damages**.
- A claim cannot succeed without establishing that a duty existed and that quantifiable harm occurred.
*Duty, breach, and damages*
- This option misses the critical element of **causation**, which links the provider's breach of duty to the patient's injuries.
- Without proving that the breach *caused* the damages, even if a duty was owed and breached, and damages occurred, the claim would fail.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 6: A psychiatrist receives a call from a patient who expresses thoughts of harming his ex-girlfriend. The patient describes a detailed plan to attack her at her workplace. Which of the following represents the psychiatrist's most appropriate legal obligation?
- A. Warn the ex-girlfriend and notify law enforcement (Correct Answer)
- B. Only notify the patient's family
- C. Warn only law enforcement
- D. Maintain patient confidentiality
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***Warn the ex-girlfriend and notify law enforcement***
- This scenario directly triggers the **"duty to warn"** and **"duty to protect"** principles, primarily stemming from the **Tarasoff v. Regents of the University of California** case.
- The psychiatrist has a legal obligation to take reasonable steps to protect the identifiable victim, which includes directly warning the intended victim and informing law enforcement.
*Only notify the patient's family*
- Notifying the patient's family alone does not fulfill the **legal obligation to protect** an identifiable third party from a serious threat of harm.
- While family involvement might be part of a comprehensive safety plan, it is insufficient as the sole action in this critical situation.
*Warn only law enforcement*
- While notifying law enforcement is a crucial step, the **Tarasoff duty** specifically mandates warning the **intended victim** directly (or those who can reasonably be expected to notify the victim).
- Relying solely on law enforcement might not ensure the immediate safety of the ex-girlfriend, especially if there's a delay in their response or ability to locate her.
*Maintain patient confidentiality*
- Patient confidentiality is a cornerstone of psychiatric practice, but it is **not absolute** when there is a serious and imminent threat of harm to an identifiable individual.
- The **duty to protect** a potential victim *outweighs* the duty to maintain confidentiality in such extreme circumstances.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 7: A 19-year-old woman comes to the physician for a routine examination. She has one sexual partner, with whom she had unprotected sexual intercourse 3 days ago. She does not desire a pregnancy and is interested in a reliable and long-term contraceptive method. She has read in detail about the reliability, adverse-effects, health risks, and effective duration of intrauterine devices (IUD) as a birth control method. She requests the physician to prescribe and place an IUD for her. The physician feels that providing contraception would be a violation of her religious beliefs. Which of the following responses by the physician is most appropriate?
- A. “First, I would like to perform an STD panel since you are sexually active.”
- B. “I need to discuss this with my pastor before I decide whether to insert an IUD, as this is against my religious beliefs.”
- C. “Prescribing any means of contraception is against my religious beliefs, but as a doctor, I am obliged to place the IUD for you.”
- D. “I can understand your need for the IUD, but I cannot place it for you due to my religious beliefs. I would be happy to refer you to a colleague who could do it.” (Correct Answer)
- E. I understand your concerns, but I cannot place the IUD for you due to my religious beliefs. I recommend you use condoms instead.
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***“I can understand your need for the IUD, but I cannot place it for you due to my religious beliefs. I would be happy to refer you to a colleague who could do it.”***
- Physicians have the right to **refuse to perform a procedure** based on their personal religious or moral beliefs, provided it is **not an emergency** and they do not abandon the patient.
- The physician fulfills their ethical obligation by offering a **referral** to another healthcare provider who can meet the patient's needs, upholding the principle of **patient autonomy** and access to care.
*“First, I would like to perform an STD panel since you are sexually active.”*
- While an **STD panel** is good practice for a sexually active individual, it does not directly address the patient's immediate request for contraception or the physician's religious dilemma.
- Delaying the discussion of contraception for an STD panel, especially in the context of recent unprotected intercourse, might be seen as ignoring the patient's urgent need for **emergency contraception** or a long-term method.
*“I need to discuss this with my pastor before I decide whether to insert an IUD, as this is against my religious beliefs.”*
- Consulting a religious leader about a medical decision is **unprofessional** and violates patient confidentiality and the physician's responsibility to provide care directly.
- This response places the patient's care based on a **third party's opinion** rather than the patient's needs and the physician's professional obligations.
*“Prescribing any means of contraception is against my religious beliefs, but as a doctor, I am obliged to place the IUD for you.”*
- While ethical obligations dictate that physicians should not abandon patients, they are not always obligated to perform procedures that fundamentally conflict with their deeply held **religious or moral beliefs**.
- This statement presents an internal conflict but doesn't offer a practical or ethical resolution that respects both the physician's beliefs and the patient's right to care.
*“I understand your concerns, but I cannot place the IUD for you due to my religious beliefs. I recommend you use condoms instead."*
- The physician correctly states their inability to place the IUD due to religious beliefs but fails to offer an **appropriate referral**, which is a crucial ethical step to ensure continuity of care.
- **Recommending condoms** is not equivalent to the patient's request for a reliable, long-term IUD and falls short of providing comprehensive, patient-centered care.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 8: A 28-year-old woman is brought to the emergency department after being resuscitated in the field. Her husband is with her and recalls seeing pills beside her when he was in the bathroom. He reveals she has a past medical history of depression and was recently given a prescription for smoking cessation. On physical exam, you notice a right-sided scalp hematoma and a deep laceration to her tongue. She has a poor EEG waveform indicating limited to no cerebral blood flow and failed both her apnea test and reflexes. She is found to be in a persistent vegetative state, and the health care team starts to initiate the end of life discussion. The husband states that the patient had no advance directives other than to have told her husband she did not want to be kept alive with machines. The parents want all heroic measures to be taken. Which of the following is the most accurate statement with regards to this situation?
- A. The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.
- B. The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.
- C. The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf. (Correct Answer)
- D. An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.
- E. A court-appointed guardian may be appointed as the patient's health care surrogate and may make end-of-life decisions on her behalf.
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.***
- The **hierarchy for healthcare surrogates** typically prioritizes the spouse over parents when there is no advance directive. The husband's recollection of the patient's wishes, although not a formal advance directive, is also relevant.
- State laws generally designate the **spouse as the primary default decision-maker** for incapacitated patients, followed by adult children, parents, and then adult siblings.
*The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.*
- A physician's role is to provide medical care and guidance, not to act as a **healthcare surrogate** due to potential conflicts of interest.
- Appointing the treating physician as a surrogate undermines the principles of **patient autonomy** and impartial decision-making.
*The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.*
- While parents are part of the surrogate hierarchy, they are generally ranked below the **spouse** in most jurisdictions.
- The parents' desire for "heroic measures" directly conflicts with the patient's stated wish to her husband, potentially leading to decisions not in the patient's best interest or previously expressed values.
*An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.*
- An ethics committee's role is to provide **guidance and recommendations** in complex cases, mediate disputes, and ensure ethical principles are upheld, not to act as the primary healthcare surrogate.
- A functional healthcare surrogate takes precedence over an ethics committee in making direct treatment decisions.
*A court-appointed guardian may be appointed as the patient's health care surrogate and may make end-of-life decisions on her behalf.*
- A court-appointed guardian is typically sought only if there is **no clear or willing surrogate** from the established hierarchy, or if there is a dispute among family members that cannot be resolved.
- In this scenario, the husband is the legally recognized next of kin and surrogate by default, making court intervention unnecessary at this stage.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 9: A 73-year-old man is admitted to the hospital for jaundice and weight loss. He is an immigrant from the Dominican Republic and speaks little English. A CT scan is performed showing a large mass at the head of the pancreas. When you enter the room to discuss these results with the patient, his daughter and son ask to speak with you outside of the patient's room. They express their desire to keep these results from their father. What is the appropriate response in this situation?
- A. Consult the hospital ethics committee
- B. Deliver the information in Spanish
- C. Respect the children's wishes to hold prognosis information
- D. Tell the children that you are obligated to tell the father
- E. Explore the reasoning behind the children's request (Correct Answer)
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***Explore the reasoning behind the children's request***
- Understanding the family's cultural background, including beliefs about illness and communication, is crucial for navigating this sensitive situation.
- This approach allows the healthcare provider to assess whether the family's request stems from a protective desire rooted in their culture or a misunderstanding, which can inform the next steps.
*Consult the hospital ethics committee*
- While an ethics consultation may be necessary if an impasse is reached, it is not the immediate first step.
- Initial direct communication and exploration with the family are preferable to first understand the context before escalating to an ethics committee.
*Deliver the information in Spanish*
- This addresses the language barrier but does not resolve the ethical dilemma of withholding information from the patient at the family's request.
- Providing the information in Spanish without first understanding the family's wishes might violate their cultural norms or inadvertently cause distress.
*Respect the children's wishes to hold prognosis information*
- Respecting the children's wishes without understanding their rationale could violate the patient's right to **autonomy** and **informed consent**.
- In most Western medical ethics frameworks, the patient has the primary right to receive information about their health, even if it is distressing.
*Tell the children that you are obligated to tell the father*
- Immediately stating an obligation without understanding the family's perspective can come across as abrupt and culturally insensitive.
- This approach might create an adversarial dynamic, making it harder to build trust and find a mutually agreeable solution.
Ethical principles (autonomy, beneficence, non-maleficence, justice) US Medical PG Question 10: A 12-year-old boy and his mother are brought to the emergency department after a motor vehicle accident. The boy was an unrestrained passenger in a head-on collision and was ejected from the front seat. The patient's mother was the driver and she is currently being resuscitated. Neither the child nor the mother are conscious; however, it is documented that the family are all Jehovah's witnesses and would not want a transfusion in an acute situation. The husband/father arrives to the trauma bay and confirms this wish that everyone in the family would not want a transfusion in accordance with their beliefs. The father is confirmed as the official healthcare proxy. Which of the following is the best next step in management?
- A. Consult the hospital ethics committee
- B. Do not transfuse the boy or the mother
- C. Do not transfuse the mother and transfuse the boy (Correct Answer)
- D. Do not transfuse the boy and transfuse the mother
- E. Transfuse the boy and mother
Ethical principles (autonomy, beneficence, non-maleficence, justice) Explanation: ***Do not transfuse the mother and transfuse the boy***
- While the **mother's wishes** for no transfusion must be respected, the boy's status as a **minor** (12 years old) allows for medical intervention to save his life, particularly in an emergency.
- In situations where a parent's religious beliefs conflict with a minor's best interest for life-saving treatment, the **state's interest in protecting children** often overrides parental autonomy.
*Consult the hospital ethics committee*
- While an ethics consultation may be appropriate in non-emergent or complex cases, in an **acute, life-threatening emergency** for a minor, delaying treatment to consult an ethics committee could be detrimental.
- The immediate priority is to provide **life-saving treatment** to the minor.
*Do not transfuse the boy or the mother*
- Refusing transfusion for the mother is consistent with her advance directives and the father's confirmed wishes, respecting her **autonomy**.
- However, refusing transfusion for the minor boy, given his age and the life-threatening situation, would prioritize parental religious beliefs over the **child's right to life-saving care**.
*Do not transfuse the boy and transfuse the mother*
- This option incorrectly applies the principles of autonomy and best interest. The mother, as an adult, has the right to refuse care, but the **minor child's right to life-saving treatment** generally takes precedence over parental refusal in emergencies.
- Transfusing the mother against her stated wishes and confirmed by her healthcare proxy would be a violation of her **autonomy**.
*Transfuse the boy and mother*
- Transfusing the boy is generally appropriate given his minor status and life-threatening condition in an emergency.
- However, transfusing the mother against her documented wishes and the confirmed consent of her healthcare proxy would be a **violation of her autonomy and right to refuse medical treatment**.
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