CASPer Exam CASPer: Medical Ethics 3 — Questions and Answers
Question 1: A physician's patient is also their personal friend. The friend asks for a prescription for anxiety medication without a formal evaluation. What is the ethical issue?
- Prescribing to friends is illegal under federal law
- Dual relationships compromise objectivity and proper standard of care (Correct answer)
- The friend does not have insurance and cannot be billed
- Anxiety medication requires psychiatric consultation first
Correct answer: Dual relationships compromise objectivity and proper standard of care
Treating friends creates dual relationships that impair clinical objectivity and may lead to substandard care by bypassing proper evaluation.
Question 2: During a routine exam, a patient discloses they are a truck driver and have been experiencing blackout spells they haven't reported to their employer. What should the physician do?
- Maintain confidentiality and only treat the condition medically
- Immediately contact the patient's employer
- Counsel the patient on the risk to public safety, document the discussion, and consider reporting per state law (Correct answer)
- Refuse to treat until the patient self-reports to their employer
Correct answer: Counsel the patient on the risk to public safety, document the discussion, and consider reporting per state law
The duty to protect public safety may override confidentiality; the physician should counsel the patient and follow state-mandated reporting requirements for impaired drivers.
Question 3: A competent elderly patient refuses a blood transfusion on religious grounds, even though refusal will likely result in death. The patient fully understands the consequences. What is the ethical response?
- Administer the transfusion to save the patient's life
- Seek a court order to override the religious objection
- Respect the patient's refusal and provide alternative supportive care (Correct answer)
- Transfer the patient to a facility that will treat them against their wishes
Correct answer: Respect the patient's refusal and provide alternative supportive care
A competent adult's informed refusal of treatment, even life-saving treatment, must be respected regardless of the physician's personal or religious views.
Question 4: A medical student witnesses their supervising resident falsify a lab result in a patient's chart. The student is worried about repercussions. What should the student do?
- Say nothing since they are only a student with no authority
- Confront the resident directly and demand they correct the record
- Report the incident to the program director or appropriate authority (Correct answer)
- Correct the chart themselves without notifying anyone
Correct answer: Report the incident to the program director or appropriate authority
Falsifying medical records is a serious ethical and legal violation; all healthcare team members, including students, have a duty to report it through proper channels.
Question 5: A researcher wants to enroll cognitively impaired adults in a clinical trial that offers no direct benefit to participants. What additional protection is most critical?
- IRB approval is sufficient since the researcher is responsible
- Surrogate consent combined with assent from participants where possible (Correct answer)
- Compensation should be increased to offset their vulnerability
- The trial should be conducted only if a family member is present during all procedures
Correct answer: Surrogate consent combined with assent from participants where possible
Vulnerable populations require surrogate decision-maker consent plus participant assent when feasible, as they cannot provide fully informed independent consent.
Question 6: A patient asks their physician to lie to their insurance company to get a procedure covered that the insurer has denied. The physician agrees the procedure is medically necessary. What should the physician do?
- Submit false documentation since the patient's health is the priority
- Decline to falsify records but help the patient appeal the denial through legitimate means (Correct answer)
- Refer the patient to another doctor who may be willing to help
- Withdraw from the case to avoid the conflict
Correct answer: Decline to falsify records but help the patient appeal the denial through legitimate means
Falsifying insurance records is fraud; the physician should advocate for the patient through legitimate appeal and prior authorization processes instead.
Question 7: Which ethical principle is MOST directly violated when a physician performs a procedure on a patient without explaining the risks, benefits, or alternatives?
- Justice
- Non-maleficence
- Informed consent / Autonomy (Correct answer)
- Beneficence
Correct answer: Informed consent / Autonomy
Performing a procedure without disclosure of risks, benefits, and alternatives violates informed consent, which is the operationalization of patient autonomy.
CASPer Exam CASPer: Medical Ethics 3
A physician's patient is also their personal friend.
The friend asks for a prescription for anxiety medication without a formal evaluation.
What is the ethical issue?