CASPer Exam CASPer: Medical Ethics 4 — Questions and Answers
Question 1: A patient with schizophrenia is brought to the ER after a suicide attempt. They are now calm and demanding to leave. How should the team proceed?
- Allow the patient to leave since they are currently calm
- Assess decision-making capacity before allowing discharge (Correct answer)
- Automatically detain the patient because of the psychiatric diagnosis
- Call the patient's family to make the decision
Correct answer: Assess decision-making capacity before allowing discharge
Psychiatric diagnosis alone does not determine capacity; a formal capacity evaluation must assess whether the patient can understand, appreciate, reason, and communicate a decision.
Question 2: A nurse notices that a dying patient's pain is inadequately controlled but the attending physician has not updated orders. The patient is suffering visibly. What should the nurse do?
- Wait for the attending to make rounds before raising the issue
- Administer extra medication from another patient's supply
- Contact the attending physician or on-call provider immediately to advocate for better pain management (Correct answer)
- Document the pain level and defer to the physician's existing orders
Correct answer: Contact the attending physician or on-call provider immediately to advocate for better pain management
Nurses have an ethical duty to advocate for patient comfort; inadequate pain management requires immediate escalation to the prescribing provider.
Question 3: A physician has a personal moral objection to abortion. A patient requests information about abortion options. What is the physician's ethical obligation?
- Decline to discuss abortion and end the appointment
- Provide complete information and refer the patient to providers who can help (Correct answer)
- Share their moral views to persuade the patient against abortion
- Document the refusal without offering any alternative resources
Correct answer: Provide complete information and refer the patient to providers who can help
While physicians may conscientiously object to performing procedures, they are ethically obligated to inform patients of all legal options and provide timely referrals.
Question 4: A hospital wants to use de-identified patient data to train an AI diagnostic tool for commercial sale. No individual patients can be identified. Is consent required?
- No, because data is de-identified and HIPAA does not apply
- Yes, because patients have an ongoing interest in how their data is used commercially (Correct answer)
- No, because hospital administration has authority over all institutional data
- Only consent from the IRB is needed, not individual patients
Correct answer: Yes, because patients have an ongoing interest in how their data is used commercially
Even when technically permissible under HIPAA, ethical practice and emerging standards suggest patients should be informed and given opportunity to opt out when their data is used for commercial AI development.
Question 5: A physician learns their patient is HIV-positive and has an ongoing sexual partner who is unaware of the diagnosis. The patient refuses to disclose. What should the physician do?
- Maintain strict confidentiality and take no further action
- Counsel the patient on their ethical and legal duty to disclose, and consider partner notification per state law if they refuse (Correct answer)
- Immediately notify the partner without the patient's knowledge
- Discharge the patient from the practice for non-compliance
Correct answer: Counsel the patient on their ethical and legal duty to disclose, and consider partner notification per state law if they refuse
The physician should counsel the patient about disclosure obligations and may have a duty to warn identifiable third parties under state law when serious harm is foreseeable.
Question 6: A patient in the ICU has no advance directive. The family is divided: the spouse wants comfort measures only, while adult children want full resuscitation. Who has decision-making authority?
- The adult children, because there are more of them
- The treating physician, who should make the final call
- The legal next-of-kin hierarchy, typically the spouse as first priority (Correct answer)
- An ethics committee must decide because the family is divided
Correct answer: The legal next-of-kin hierarchy, typically the spouse as first priority
When no advance directive exists, surrogate decision-making follows a legal hierarchy that places the spouse above adult children in most US states.
Question 7: A physician is pressured by hospital administrators to discharge patients quickly to improve bed turnover metrics. The physician believes some patients need additional inpatient care. What is the ethical priority?
- Follow administrative guidance to maintain hospital efficiency
- Discharge patients but document disagreement in the chart
- Advocate for patients' clinical needs and resist premature discharge that compromises care (Correct answer)
- Refer all borderline cases to specialists to transfer the decision
Correct answer: Advocate for patients' clinical needs and resist premature discharge that compromises care
Physicians have an ethical obligation to act in their patients' best clinical interests even when institutional pressures conflict with optimal care.
CASPer Exam CASPer: Medical Ethics 4
A patient with schizophrenia is brought to the ER after a suicide attempt.
They are now calm and demanding to leave.
How should the team proceed?