AF Medical Ethics & Patient Rights 3 — Questions and Answers
Question 1: An AF patient with dementia cannot make decisions about his own care. Who is the legally and ethically appropriate decision-maker?
- The attending cardiologist, as the clinical expert
- The patient's legally designated healthcare proxy or surrogate (Correct answer)
- The nursing staff caring for the patient daily
- The hospital ethics committee in all cases
Correct answer: The patient's legally designated healthcare proxy or surrogate
When a patient lacks decision-making capacity, a legally designated healthcare proxy or surrogate is the appropriate decision-maker.
Question 2: A pharmaceutical representative offers a nurse gift cards in exchange for recommending a specific anticoagulant to AF patients. This situation represents:
- An acceptable practice if disclosed to the patient
- A conflict of interest that violates professional ethics (Correct answer)
- A legal marketing strategy permitted under FDA guidelines
- A minor courtesy that does not affect clinical judgment
Correct answer: A conflict of interest that violates professional ethics
Accepting gifts from pharmaceutical companies in exchange for prescribing or recommending products is an ethical violation and may be illegal.
Question 3: A nurse overhears a physician discussing a patient's AF diagnosis loudly in a public hallway. The nurse's most appropriate action is to:
- Ignore the conversation since it is among clinical staff
- Address the confidentiality concern with the physician privately (Correct answer)
- File an immediate formal complaint with hospital administration
- Ask the patient if they mind having their information discussed openly
Correct answer: Address the confidentiality concern with the physician privately
Discussing patient information in public areas violates confidentiality; the nurse should address this professionally with the physician.
Question 4: Which scenario BEST demonstrates the ethical principle of beneficence in AF management?
- Withholding risky ablation procedures from elderly patients
- Prescribing anticoagulation therapy to reduce a patient's stroke risk (Correct answer)
- Charging patients fairly regardless of their insurance status
- Telling patients the truth about the chronic nature of AF
Correct answer: Prescribing anticoagulation therapy to reduce a patient's stroke risk
Beneficence means acting in the patient's best interest; prescribing evidence-based anticoagulation to reduce stroke risk exemplifies this principle.
Question 5: A competent AF patient refuses a recommended TEE procedure. The care team should:
- Proceed with the TEE because it is medically necessary
- Document the refusal and explore the patient's concerns and reasoning (Correct answer)
- Obtain family consent to proceed over the patient's objection
- Transfer the patient to another facility that will comply
Correct answer: Document the refusal and explore the patient's concerns and reasoning
Respecting autonomy requires accepting refusal from competent patients while documenting the decision and addressing underlying concerns.
Question 6: When a patient with AF asks about the cost of their prescribed anticoagulant, the ethical obligation of the nurse includes:
- Redirecting the patient to billing and avoiding the clinical conversation
- Acknowledging the concern and helping connect the patient with resources (Correct answer)
- Advising the patient to take generic alternatives without physician input
- Informing the patient that cost should not influence medical decisions
Correct answer: Acknowledging the concern and helping connect the patient with resources
Addressing financial barriers to medication adherence is part of holistic, ethical patient-centered care.
Question 7: Which situation raises the greatest concern about violation of patient autonomy in AF care?
- Encouraging a reluctant patient to consider rate-control therapy
- Administering a sedative before obtaining consent for cardioversion (Correct answer)
- Discussing risks of stroke to motivate anticoagulation adherence
- Recommending an AF specialist referral without being asked
Correct answer: Administering a sedative before obtaining consent for cardioversion
Sedating a patient prior to obtaining consent prevents voluntary, informed decision-making, violating autonomy.
AF Medical Ethics & Patient Rights 3
An AF patient with dementia cannot make decisions about his own care.
Who is the legally and ethically appropriate decision-maker?