ABFM Professional Standards and Ethics 3 — Questions and Answers
Question 1: A patient refuses a blood transfusion based on religious beliefs despite a life-threatening hemorrhage. The physician should:
- Administer blood over the patient's objection to preserve life
- Obtain a court order to override the refusal
- Respect the competent adult's refusal and document thoroughly (Correct answer)
- Transfer care to a physician who will administer blood
Correct answer: Respect the competent adult's refusal and document thoroughly
Competent adults have the absolute right to refuse any medical treatment, including life-saving interventions, for any reason including religious beliefs.
Question 2: Which of the following is NOT a component of a valid advance directive?
- The patient's signature
- Notarization or witness signatures per state law
- A physician's countersignature (Correct answer)
- Specification of the patient's wishes regarding life-sustaining treatment
Correct answer: A physician's countersignature
Advance directives are legal documents requiring patient signature and witnesses/notarization per state law, but a physician countersignature is generally not required for validity.
Question 3: A patient discloses plans to seriously harm a specific, identifiable third party. Under the Tarasoff duty, the physician must:
- Maintain confidentiality as psychiatric disclosures are always protected
- Warn the identifiable potential victim and notify law enforcement (Correct answer)
- Only document the threat and increase the frequency of appointments
- Refer to psychiatry and transfer all responsibility for the duty to warn
Correct answer: Warn the identifiable potential victim and notify law enforcement
The Tarasoff ruling established that therapists and physicians have a duty to protect identifiable potential victims by warning them and notifying authorities.
Question 4: A physician in a small town is asked to provide care for a close personal friend. The most appropriate approach is to:
- Refuse all care as dual relationships are always prohibited
- Provide emergency care only and facilitate transfer to another physician for ongoing care (Correct answer)
- Provide full care as the pre-existing relationship improves communication
- Provide care but waive all fees to avoid a conflict of interest
Correct answer: Provide emergency care only and facilitate transfer to another physician for ongoing care
Personal relationships with patients compromise objectivity; physicians should provide emergency care when necessary but arrange for an independent provider for ongoing care.
Question 5: When a patient lacks decision-making capacity and has no advance directive, the standard hierarchy for surrogate decision-making in most US states begins with:
- The attending physician
- The hospital ethics committee
- The spouse or domestic partner (Correct answer)
- Adult children of the patient
Correct answer: The spouse or domestic partner
In most US states, the legal default surrogate hierarchy begins with the spouse or domestic partner as the first-tier decision-maker.
Question 6: A patient asks their physician to falsify a disability form to obtain benefits the physician does not believe are medically warranted. The physician should:
- Complete the form as requested to preserve the therapeutic relationship
- Refuse and explain that falsifying documents is fraudulent and unethical (Correct answer)
- Refer the patient to another physician who may have a different opinion
- Complete the form but note disagreement in the medical record
Correct answer: Refuse and explain that falsifying documents is fraudulent and unethical
Falsifying medical documents constitutes fraud; physicians must decline and explain the ethical and legal implications to the patient.
Question 7: The 'substituted judgment' standard for surrogate decision-making requires the surrogate to:
- Decide what is medically best for the patient based on clinical evidence
- Choose the least invasive treatment available
- Make the decision the patient would have made based on known values and preferences (Correct answer)
- Consult with all family members before making any decision
Correct answer: Make the decision the patient would have made based on known values and preferences
Substituted judgment requires the surrogate to replicate the patient's own decision based on previously expressed values, not what the surrogate believes is best.
ABFM Professional Standards and Ethics 3
A patient refuses a blood transfusion based on religious beliefs despite a life-threatening hemorrhage.
The physician should: