ABPS Professionalism & Ethical Medical Practice 4 — Questions and Answers
Question 1: A physician who is HIV-positive wishes to continue performing invasive surgical procedures. The primary ethical consideration is:
- The physician's right to practice their specialty
- Balancing the physician's right to practice with the duty to prevent patient harm (Correct answer)
- Patient preferences about their surgeon's health status
- Hospital liability for disclosure
Correct answer: Balancing the physician's right to practice with the duty to prevent patient harm
The physician's welfare must be balanced against the duty to protect patients, typically through consultation with occupational health and infectious disease specialists.
Question 2: Which situation represents an appropriate use of placebo therapy?
- Using placebo without disclosure to replace effective therapy
- Using open-label placebo after full patient consent and education (Correct answer)
- Substituting placebo for opioids without informing the patient
- Prescribing sugar pills to patients deemed 'drug seekers'
Correct answer: Using open-label placebo after full patient consent and education
Open-label placebo use with full patient consent is ethically permissible and has demonstrated efficacy in certain conditions.
Question 3: A patient with end-stage dementia has no advance directive. The surrogate requests aggressive life-sustaining treatment. The physician believes this is not in the patient's best interest. The best course of action is:
- Comply with the surrogate's request without question
- Unilaterally withdraw treatment based on medical judgment
- Engage the surrogate in shared decision-making focused on patient's prior values (Correct answer)
- Refer the case to the courts immediately
Correct answer: Engage the surrogate in shared decision-making focused on patient's prior values
Shared decision-making with the surrogate, incorporating the patient's known values and best interest standard, is the appropriate approach in this scenario.
Question 4: The Tarasoff duty requires physicians to:
- Maintain strict confidentiality in all circumstances
- Warn identifiable third parties of credible threats made by patients (Correct answer)
- Report all mentally ill patients to law enforcement
- Disclose psychiatric records to employers
Correct answer: Warn identifiable third parties of credible threats made by patients
The Tarasoff doctrine obligates clinicians to protect identifiable potential victims when a patient makes a credible, specific threat of violence.
Question 5: When a physician has a conscientious objection to a legal medical procedure, the ethical obligation is to:
- Refuse care and document the refusal in the chart
- Provide the service despite personal beliefs
- Inform the patient and provide a timely referral to a willing provider (Correct answer)
- Recommend the patient seek care elsewhere without explanation
Correct answer: Inform the patient and provide a timely referral to a willing provider
A physician may decline services based on conscience but must inform the patient and ensure access to care through referral.
Question 6: Which scenario best illustrates moral distress in a healthcare setting?
- A physician disagreeing with a colleague's diagnosis
- A nurse who believes a patient's care is futile but is required to continue aggressive treatment (Correct answer)
- A physician who is unsure about the correct treatment option
- A resident who is tired after a long shift
Correct answer: A nurse who believes a patient's care is futile but is required to continue aggressive treatment
Moral distress occurs when a clinician knows the ethically correct action but institutional constraints prevent them from taking it.
Question 7: Under HIPAA, which of the following is a permitted disclosure without patient authorization?
- Sharing records with the patient's employer
- Reporting a communicable disease to public health authorities (Correct answer)
- Releasing information to the patient's attorney
- Providing records to insurance companies for unrelated claims
Correct answer: Reporting a communicable disease to public health authorities
HIPAA permits disclosure to public health authorities for disease surveillance and reporting without patient authorization.
ABPS Professionalism & Ethical Medical Practice 4
A physician who is HIV-positive wishes to continue performing invasive surgical procedures.
The primary ethical consideration is: