Addiction Medicine Certification Ethics & Professional Standards 3 — Questions and Answers
Question 1: Which of the following situations represents a boundary violation rather than a boundary crossing in addiction medicine practice?
- Accepting a small homemade gift from a grateful patient once
- Attending a patient's recovery milestone celebration at a sober living house
- Entering into a business partnership with a patient in recovery (Correct answer)
- Briefly self-disclosing your own recovery history to build rapport
Correct answer: Entering into a business partnership with a patient in recovery
A business partnership with a patient is a boundary violation because it exploits the therapeutic relationship for personal gain.
Question 2: In addiction medicine, 'harm reduction' as an ethical framework is primarily grounded in which principle?
- Paternalism
- Beneficence and respect for autonomy (Correct answer)
- Non-maleficence alone
- Justice and resource allocation
Correct answer: Beneficence and respect for autonomy
Harm reduction respects patient autonomy by meeting people where they are while also pursuing beneficence through reducing drug-related harms.
Question 3: A court orders you to release a patient's SUD treatment records as part of a criminal investigation. What is the most appropriate action under 42 CFR Part 2?
- Release the records immediately since a court order overrides all privacy protections
- Comply only if the court order meets the specific criteria required under 42 CFR Part 2 (Correct answer)
- Refuse all disclosure regardless of any court order
- Release a summary of the records but not the original documents
Correct answer: Comply only if the court order meets the specific criteria required under 42 CFR Part 2
Under 42 CFR Part 2, even a court order must meet specific procedural requirements before SUD records can be disclosed.
Question 4: A pregnant patient with opioid use disorder refuses medication-assisted treatment (MAT) because she fears neonatal opioid withdrawal syndrome. Ethically, the clinician should:
- Respect her refusal and provide no further treatment recommendations
- Obtain a court order to compel treatment to protect the fetus
- Provide comprehensive education on risks of untreated OUD versus MAT, address her fears, and continue to offer treatment without coercion (Correct answer)
- Defer all decisions to the obstetric team
Correct answer: Provide comprehensive education on risks of untreated OUD versus MAT, address her fears, and continue to offer treatment without coercion
Informed consent requires thorough education and addressing patient concerns; coercion is unethical even when fetal wellbeing is at stake.
Question 5: Which of the following best characterizes 'stigma' as an ethical issue in addiction medicine?
- A legitimate clinical tool for motivating patients toward sobriety
- A barrier to care that violates the principle of justice by denying equal treatment to patients with SUD (Correct answer)
- A necessary professional boundary to maintain objectivity
- A natural consequence of patient behavior that is outside the clinician's control
Correct answer: A barrier to care that violates the principle of justice by denying equal treatment to patients with SUD
Stigma violates justice by creating unequal access to care and undermines the ethical obligation to treat SUD as a medical condition.
Question 6: A patient with SUD who is also HIV-positive asks you not to share their HIV status with their partner. You know the partner is at risk. What is the ethical framework to apply?
- Automatically disclose to the partner to protect them from harm
- Maintain strict confidentiality regardless of any risk to the partner
- Balance the patient's confidentiality with duty-to-protect considerations, following state law and counseling the patient to disclose (Correct answer)
- Refer the patient to an HIV specialist and withdraw from the case
Correct answer: Balance the patient's confidentiality with duty-to-protect considerations, following state law and counseling the patient to disclose
The clinician must balance confidentiality against duty-to-protect obligations, following applicable state laws and encouraging voluntary disclosure.
Question 7: When an addiction medicine specialist is asked to provide expert testimony in a legal case involving a patient they have treated, the most significant ethical concern is:
- Charging a fair fee for expert services
- Managing dual role conflict between treating clinician and expert witness (Correct answer)
- Ensuring testimony is favorable to the patient's legal position
- Obtaining DEA approval to discuss controlled substances in court
Correct answer: Managing dual role conflict between treating clinician and expert witness
Serving as both treating clinician and expert witness creates a dual role conflict that can compromise objectivity and harm the therapeutic relationship.
Addiction Medicine Certification Ethics & Professional Standards 3
Which of the following situations represents a boundary violation rather than a boundary crossing in addiction medicine practice?