ABPS Ethics & Professional Standards in Plastic Surgery 5 — Questions and Answers
Question 1: A plastic surgeon is considering purchasing a medical spa to offer non-surgical aesthetic treatments performed by non-physician staff. The primary ethical concern is:
- Tax implications of the business structure
- Ensuring appropriate supervision and standards of care for all patients treated (Correct answer)
- Competition with other physician-owned practices
- Licensing fees for non-physician aestheticians
Correct answer: Ensuring appropriate supervision and standards of care for all patients treated
Physician ownership of medical spas creates ethical obligations to ensure non-physician staff perform only permitted procedures under adequate supervision.
Question 2: When a patient lacks decision-making capacity and has no advance directive, the surgeon must:
- Proceed with whatever the surgeon believes is best for the patient
- Seek the next of kin or legally authorized surrogate decision-maker (Correct answer)
- Delay all treatment until the patient regains capacity
- Obtain institutional ethics committee approval before any intervention
Correct answer: Seek the next of kin or legally authorized surrogate decision-maker
In the absence of advance directives and with incapacitated patients, the legally authorized surrogate decision-maker must be identified to provide consent.
Question 3: A patient requests a surgical procedure the surgeon believes is medically unnecessary and potentially harmful. The ABPS ethical framework supports the surgeon to:
- Perform the procedure to respect patient autonomy fully
- Decline the procedure and explain the medical rationale for refusal (Correct answer)
- Perform a modified version that is less harmful without telling the patient
- Refer to another surgeon without disclosing concerns about the procedure
Correct answer: Decline the procedure and explain the medical rationale for refusal
Surgeons are not ethically obligated to perform procedures they believe are harmful; they may decline while offering an explanation and referral.
Question 4: Regarding fee splitting and self-referral arrangements, ABPS ethics require that:
- Referral fees are acceptable if disclosed in the informed consent
- Surgeons may not pay or receive compensation for patient referrals (Correct answer)
- Fee splitting is permitted between surgeons within the same practice group
- Referral fees are prohibited only when exceeding 15% of the procedure fee
Correct answer: Surgeons may not pay or receive compensation for patient referrals
Fee splitting for referrals is prohibited under ABPS ethics because it creates financial incentives that can compromise unbiased clinical decision-making.
Question 5: A plastic surgeon publishes research findings that were influenced by industry funding without disclosing the conflict of interest. This violates which core ethical obligation?
- Beneficence toward future patients only
- Transparency and honesty in scientific communication (Correct answer)
- Nonmaleficence because the findings cause direct patient harm
- Justice because it disadvantages competing researchers
Correct answer: Transparency and honesty in scientific communication
Concealing industry funding violates the duty of transparency in research, undermining the integrity of scientific literature and clinical decision-making.
Question 6: A surgeon operating in an outpatient surgery center performs a procedure that results in an unexpected adverse event requiring hospital transfer. The ethical obligation includes:
- Completing documentation before arranging transfer to minimize liability
- Arranging immediate transfer and ensuring full communication with the receiving team (Correct answer)
- Delegating the transfer to office staff to maintain patient confidentiality
- Contacting the malpractice insurer before speaking with the patient's family
Correct answer: Arranging immediate transfer and ensuring full communication with the receiving team
Patient safety requires prompt transfer with complete clinical communication to the receiving team as the immediate priority over administrative concerns.
Question 7: Under the ABPS Maintenance of Certification (MOC) program, the ethical rationale for ongoing recertification is primarily to:
- Generate revenue for the certifying board
- Ensure surgeons maintain current competence aligned with evolving standards (Correct answer)
- Create a competitive credential advantage over non-certified peers
- Fulfill malpractice insurance requirements only
Correct answer: Ensure surgeons maintain current competence aligned with evolving standards
MOC reflects the ethical commitment to lifelong learning, ensuring that surgeons' skills and knowledge remain current as techniques and evidence evolve.
ABPS Ethics & Professional Standards in Plastic Surgery 5
A plastic surgeon is considering purchasing a medical spa to offer non-surgical aesthetic treatments performed by non-physician staff.
The primary ethical concern is: