ADM Medical Ethics & Patient Rights 3 — Questions and Answers
Question 1: A patient with severe alcohol use disorder is brought to the ED intoxicated and unable to consent. They have no advance directive. What guides the physician's treatment decisions?
- Substituted judgment based on next of kin's preferences
- Best interest standard given the patient's incapacity (Correct answer)
- Defer all treatment until the patient is sober and can consent
- Treat only life-threatening complications and discharge
Correct answer: Best interest standard given the patient's incapacity
When a patient lacks decision-making capacity and no surrogate or advance directive is available, the best interest standard guides treatment.
Question 2: A physician learns that a patient in a buprenorphine program is driving while impaired. After counseling the patient, the behavior continues. What is the next most appropriate step?
- Immediately report the patient to the DMV without further discussion
- Consult state law regarding duty-to-warn obligations and consider notification of authorities if required (Correct answer)
- Discharge the patient from the program
- Take no action to preserve confidentiality
Correct answer: Consult state law regarding duty-to-warn obligations and consider notification of authorities if required
Physicians must balance confidentiality with duty-to-protect obligations defined by state law when a patient poses a danger to others.
Question 3: Which of the following best describes the ethical concept of 'therapeutic privilege'?
- The right of a physician to treat a patient without consent in an emergency
- Withholding information from a patient when disclosure would harm them, justifying paternalistic non-disclosure (Correct answer)
- Prescribing medications off-label based on clinical judgment
- A physician's right to refuse to treat a patient for personal reasons
Correct answer: Withholding information from a patient when disclosure would harm them, justifying paternalistic non-disclosure
Therapeutic privilege refers to withholding information from a patient on the grounds that disclosure would cause harm, though it is widely criticized as undermining autonomy.
Question 4: A patient with opioid use disorder discloses active heroin use during a confidential research study on addiction treatment. The researcher suspects the patient is also selling heroin. What is the most appropriate action?
- Report the suspected drug dealing to law enforcement immediately
- Maintain research confidentiality as agreed in the consent form and consult the IRB if needed (Correct answer)
- Expel the participant from the study
- Disclose to the patient's primary care provider
Correct answer: Maintain research confidentiality as agreed in the consent form and consult the IRB if needed
Research participants are protected by the terms of the consent agreement; deviations require IRB consultation unless imminent danger exists.
Question 5: A physician practicing addiction medicine observes a colleague diverting controlled substances for personal use. What is the ethically required response?
- Confront the colleague privately and take no further action
- Ignore the behavior as it does not directly involve patient care
- Report the conduct to the appropriate institutional or licensing authority (Correct answer)
- Advise the colleague to seek help and monitor the situation
Correct answer: Report the conduct to the appropriate institutional or licensing authority
Physicians have a professional obligation to report colleague impairment or misconduct that poses a risk to patient safety.
Question 6: A patient with active cocaine use disorder is listed for a liver transplant. The transplant team wants to remove the patient from the list due to continued use. What ethical framework should guide this decision?
- Utilitarianism only — maximize organ utility for society
- Punitive justice — substance users forfeit transplant rights
- Fair procedural justice — apply transparent, consistent criteria that do not discriminate based on SUD diagnosis alone (Correct answer)
- Beneficence — give the organ to the sickest patient regardless of substance use
Correct answer: Fair procedural justice — apply transparent, consistent criteria that do not discriminate based on SUD diagnosis alone
Allocation decisions must use transparent, consistently applied criteria and should not categorically exclude patients based solely on a substance use disorder diagnosis.
Question 7: A minor aged 16 presents alone seeking treatment for opioid use disorder. Under most US state laws, which statement is correct?
- Minors cannot consent to any SUD treatment without parental permission
- Most states allow minors to consent to SUD treatment without parental involvement (Correct answer)
- Parental consent is always required and cannot be waived
- Only a court can authorize SUD treatment for a minor
Correct answer: Most states allow minors to consent to SUD treatment without parental involvement
Most US states have laws permitting minors to consent to substance use disorder treatment to reduce barriers to care.
ADM Medical Ethics & Patient Rights 3
A patient with severe alcohol use disorder is brought to the ED intoxicated and unable to consent.
They have no advance directive.
What guides the physician's treatment decisions?