ABA Professional Ethics and Standards 3 — Questions and Answers
Question 1: The ethical concept of 'therapeutic privilege'—withholding information from a patient to avoid distress—is generally considered:
- Acceptable when the anesthesiologist believes truth will cause harm
- Rarely justified and largely inconsistent with modern informed consent standards (Correct answer)
- Standard practice for high-risk procedures
- Required when family members request nondisclosure
Correct answer: Rarely justified and largely inconsistent with modern informed consent standards
Therapeutic privilege is largely rejected in modern medical ethics because it undermines patient autonomy and informed consent.
Question 2: Under ABA standards, which situation most clearly obligates an anesthesiologist to initiate a formal ethics consultation?
- A patient requests a second anesthesia opinion
- Irresolvable disagreement exists between the family's wishes and the patient's advance directive (Correct answer)
- The surgeon prefers a regional technique the anesthesiologist disagrees with
- A patient declines preoperative labs
Correct answer: Irresolvable disagreement exists between the family's wishes and the patient's advance directive
An ethics consultation is warranted when there is an unresolvable conflict between the documented patient's wishes and surrogate decision-makers.
Question 3: An anesthesiologist notices a billing discrepancy suggesting upcoding by the practice administrator. Their ethical obligation is to:
- Ignore it as an administrative matter outside clinical scope
- Address it through appropriate internal or external reporting channels (Correct answer)
- Personally correct the billing records without notifying anyone
- Report only if the amount exceeds a significant threshold
Correct answer: Address it through appropriate internal or external reporting channels
Fraudulent billing harms patients and payers; anesthesiologists must report suspected fraud through proper institutional or regulatory channels.
Question 4: Which behavior by an anesthesiology resident most directly violates the ABA's professionalism standards?
- Asking an attending for help with a difficult airway
- Falsifying a portion of the anesthesia record to conceal an error (Correct answer)
- Declining to perform a procedure they have not been trained on
- Discussing concerns about a case with the chief resident
Correct answer: Falsifying a portion of the anesthesia record to conceal an error
Falsifying medical records is a fundamental breach of honesty and integrity that violates core ABA professionalism standards.
Question 5: A patient who has been adequately informed asks about an off-label use of a sedative for home use post-discharge. The anesthesiologist's ethical approach is to:
- Prescribe it without comment because patient autonomy allows it
- Refuse any off-label prescribing categorically
- Provide evidence-based information and prescribe only if clinically justified (Correct answer)
- Refer the patient to their primary care physician without discussion
Correct answer: Provide evidence-based information and prescribe only if clinically justified
Off-label prescribing is legal and sometimes appropriate when evidence-based, but requires honest discussion of risks and clinical justification.
Question 6: The principle of justice in anesthesia practice is best demonstrated by:
- Providing the same anesthetic technique to every patient regardless of comorbidities
- Allocating scarce anesthesia resources equitably based on clinical need (Correct answer)
- Prioritizing VIP patients for faster OR scheduling
- Charging all patients the same fee regardless of procedure complexity
Correct answer: Allocating scarce anesthesia resources equitably based on clinical need
Justice requires fair allocation of limited resources based on medical need rather than social status or personal relationships.
Question 7: When an anesthesiologist disagrees with a DNR order in the perioperative period, the most ethical course is to:
- Automatically suspend the DNR for the entire perioperative period
- Discuss the order with the patient and surgeon and document a revised perioperative plan (Correct answer)
- Refuse to administer anesthesia unless the DNR is revoked
- Honor the DNR without any discussion with the patient or team
Correct answer: Discuss the order with the patient and surgeon and document a revised perioperative plan
Perioperative DNR management requires collaborative discussion with the patient and team to clarify goals of care, not automatic suspension.
ABA Professional Ethics and Standards 3
The ethical concept of 'therapeutic privilege'—withholding information from a patient to avoid distress—is generally considered: