ABOG Professional Ethics & Standards 3 — Questions and Answers
Question 1: A patient requests her complete medical records including psychotherapy notes. Under HIPAA, what is the physician's obligation?
- Provide all records including psychotherapy notes upon request
- Provide all records except psychotherapy notes, which have special protections (Correct answer)
- Deny access until the physician reviews the records first
- Require notarized consent before releasing any records
Correct answer: Provide all records except psychotherapy notes, which have special protections
HIPAA grants patients the right to access their medical records, but psychotherapy notes have special protections and may be withheld from the standard designated record set.
Question 2: During a prenatal visit, a patient asks her OB/GYN not to disclose her HIV-positive status to her husband. What is the most appropriate ethical response?
- Disclose the information to the husband because he is at risk
- Respect the patient's confidentiality and not disclose to the husband (Correct answer)
- Notify public health authorities immediately
- Discontinue care if the patient refuses disclosure
Correct answer: Respect the patient's confidentiality and not disclose to the husband
Physician-patient confidentiality generally protects the HIV-positive patient's information; disclosure to partners typically requires patient consent except where state law mandates partner notification.
Question 3: Which concept describes the obligation of physicians to distribute healthcare resources fairly across the population?
- Autonomy
- Fidelity
- Justice (Correct answer)
- Veracity
Correct answer: Justice
Justice in bioethics refers to the fair and equitable distribution of healthcare benefits, burdens, and resources across individuals and society.
Question 4: An obstetrics resident notices an attending physician is impaired by alcohol during an on-call shift. What is the most appropriate action?
- Say nothing to protect the attending's career
- Take over the patient's care and report the impairment to a senior supervisor immediately (Correct answer)
- Suggest the attending take a break and reassess later
- Document the observation privately without reporting
Correct answer: Take over the patient's care and report the impairment to a senior supervisor immediately
Physician impairment poses immediate danger to patients; the resident is ethically and professionally obligated to ensure patient safety and report the situation to a supervisor.
Question 5: A patient in active labor loses capacity due to eclamptic seizures. Her previously stated birth plan specifies no cesarean section. What should the physician do?
- Follow the birth plan strictly regardless of clinical deterioration
- Perform the cesarean section if clinically indicated, as prior expressed wishes are not binding in emergencies (Correct answer)
- Obtain consent from the patient's mother before proceeding
- Wait for the patient to regain capacity before making any decisions
Correct answer: Perform the cesarean section if clinically indicated, as prior expressed wishes are not binding in emergencies
When a patient loses capacity in an emergency, the physician must act in the patient's best medical interest; a previously stated birth preference is not an advance directive with the same legal weight.
Question 6: Which of the following best describes 'therapeutic privilege' and its current status in medical ethics?
- A physician's right to withhold information that might distress the patient, widely accepted in modern ethics
- Withholding harmful information from a patient, largely rejected in modern medical ethics as paternalistic (Correct answer)
- Prescribing placebo treatments without patient knowledge, considered acceptable in certain cases
- A patient's right to request that certain test results be withheld
Correct answer: Withholding harmful information from a patient, largely rejected in modern medical ethics as paternalistic
Therapeutic privilege — withholding information to prevent patient distress — is largely rejected in modern ethics as it undermines informed consent and patient autonomy.
Question 7: An OB/GYN is approached to participate in a clinical trial as a co-investigator. Which document must all research participants sign before enrollment?
- A HIPAA authorization only
- An informed consent document approved by an Institutional Review Board (IRB) (Correct answer)
- A waiver of liability form signed by the sponsor
- A declaration of willingness to participate verified by a notary
Correct answer: An informed consent document approved by an Institutional Review Board (IRB)
All human subjects research requires IRB-approved informed consent, which documents that participants understand risks, benefits, and their right to withdraw.
ABOG Professional Ethics & Standards 3
A patient requests her complete medical records including psychotherapy notes.
Under HIPAA, what is the physician's obligation?