ADM Medical Ethics & Patient Rights 2 — Questions and Answers
Question 1: A patient with opioid use disorder refuses naltrexone because they fear it will cause withdrawal. The physician believes naltrexone is the best option. What is the most ethical course of action?
- Administer naltrexone without consent to prevent harm
- Respect the refusal, explore the patient's concerns, and discuss alternative treatments (Correct answer)
- Discharge the patient for non-compliance
- Obtain a court order to compel treatment
Correct answer: Respect the refusal, explore the patient's concerns, and discuss alternative treatments
Respecting patient autonomy requires honoring informed refusals and engaging in shared decision-making about alternatives.
Question 2: A physician prescribes buprenorphine and receives a financial incentive from a pharmaceutical company for each prescription written. This arrangement most directly violates which ethical principle?
- Non-maleficence
- Justice
- Conflict of interest and fidelity to the patient (Correct answer)
- Beneficence
Correct answer: Conflict of interest and fidelity to the patient
Financial incentives tied to prescribing create conflicts of interest that undermine the physician's duty to act solely in the patient's best interest.
Question 3: Under 42 CFR Part 2, which scenario represents a permissible disclosure of a patient's substance use disorder treatment records?
- Sharing records with a patient's employer upon the employer's request
- Disclosing to law enforcement when a crime is suspected
- Releasing records with the patient's written consent specifying the recipient and purpose (Correct answer)
- Providing records to another treating physician without patient authorization
Correct answer: Releasing records with the patient's written consent specifying the recipient and purpose
42 CFR Part 2 requires specific written patient consent before records from federally assisted SUD programs can be disclosed.
Question 4: A pregnant patient with alcohol use disorder declines inpatient detoxification. What is the physician's ethical obligation?
- Involuntarily commit the patient to protect the fetus
- Notify child protective services immediately
- Provide full information on fetal risks, respect autonomy, and offer outpatient alternatives with close follow-up (Correct answer)
- Withhold further addiction care until the patient consents to inpatient treatment
Correct answer: Provide full information on fetal risks, respect autonomy, and offer outpatient alternatives with close follow-up
The physician must respect maternal autonomy while ensuring the patient has complete information about risks and maximizing engagement through available alternatives.
Question 5: A physician is treating a patient in a methadone maintenance program who reports selling some of their take-home doses. What is the most appropriate initial action?
- Immediately terminate the patient from the program
- Report the patient to law enforcement
- Discuss the behavior with the patient, reassess take-home eligibility, and adjust the treatment plan (Correct answer)
- Ignore the report to maintain the therapeutic alliance
Correct answer: Discuss the behavior with the patient, reassess take-home eligibility, and adjust the treatment plan
Addressing medication diversion requires reassessing the patient's safety and take-home criteria while preserving engagement in treatment.
Question 6: Which ethical principle is most relevant when a physician advocates for insurance coverage of medication-assisted treatment for a patient who was denied coverage?
- Autonomy
- Non-maleficence
- Justice (Correct answer)
- Confidentiality
Correct answer: Justice
Justice requires equitable access to effective treatments, making advocacy for fair coverage an ethical duty.
Question 7: A patient in recovery from methamphetamine use disorder requests that their addiction history not be shared with a new cardiologist. The cardiologist is treating a condition potentially exacerbated by stimulant use. What should the addiction medicine physician do?
- Comply fully with the restriction and share nothing
- Override the restriction because the cardiologist needs the information
- Discuss with the patient how withholding this information may affect their cardiac care, and encourage disclosure (Correct answer)
- Terminate care for the patient due to non-cooperation
Correct answer: Discuss with the patient how withholding this information may affect their cardiac care, and encourage disclosure
The physician should educate the patient on clinical risks of non-disclosure while respecting their right to control information sharing.
ADM Medical Ethics & Patient Rights 2
A patient with opioid use disorder refuses naltrexone because they fear it will cause withdrawal.
The physician believes naltrexone is the best option.
What is the most ethical course of action?