CASPer Exam CASPer: Medical Ethics 5 — Questions and Answers
Question 1: A medical team believes a patient's request for a high-risk elective procedure is unwise, but the patient is fully informed and competent. What should the team do?
- Refuse the procedure since the risk outweighs benefit in the team's judgment
- Proceed with the procedure while respecting the patient's informed choice (Correct answer)
- Require a psychiatric evaluation before agreeing to proceed
- Obtain a second surgical opinion to delay the process
Correct answer: Proceed with the procedure while respecting the patient's informed choice
A competent, fully informed patient's autonomous decision to accept a high-risk procedure must be respected even if the clinical team disagrees with the choice.
Question 2: A clinical trial coordinator notices that the principal investigator is enrolling participants who do not fully meet inclusion criteria in order to meet enrollment deadlines. What is the most appropriate response?
- Trust the PI's judgment since they are the senior researcher
- Report the protocol deviation to the IRB and institution's research compliance office (Correct answer)
- Enroll the participants to help the team meet deadlines
- Withdraw from the study to avoid personal liability
Correct answer: Report the protocol deviation to the IRB and institution's research compliance office
Protocol deviations that compromise participant eligibility must be reported to the IRB to protect participant safety and research integrity.
Question 3: A physician is asked to write a letter of medical necessity to support a patient's disability claim. The physician believes the patient is exaggerating symptoms. What should the physician do?
- Write the letter as the patient requests to maintain the therapeutic relationship
- Decline to write the letter and document an honest clinical assessment (Correct answer)
- Refuse all further care of the patient
- Contact the disability agency anonymously with concerns
Correct answer: Decline to write the letter and document an honest clinical assessment
Physicians must provide truthful documentation; writing a letter that misrepresents clinical findings constitutes fraud and violates the duty of honesty.
Question 4: A wealthy patient offers a large personal donation to the hospital in exchange for priority placement on an organ transplant waitlist. How should the transplant team respond?
- Accept the donation and prioritize the patient based on the hospital's discretion
- Decline to alter waitlist position; transplant allocation must follow UNOS equity criteria (Correct answer)
- Refer the decision to hospital administration since it involves institutional funding
- Allow priority if an ethics committee approves the exception
Correct answer: Decline to alter waitlist position; transplant allocation must follow UNOS equity criteria
Organ allocation is governed by UNOS criteria based on medical need and time; financial influence on waitlist position is ethically and legally prohibited.
Question 5: A physician notices a patient's chart contains a significant medical error made by a previous provider. The error has not harmed the patient yet. What is the ethical obligation?
- Correct the error silently in the chart to protect the previous provider
- Inform the patient of the error, document it, and correct the clinical plan (Correct answer)
- Report only to risk management and do not tell the patient
- Ignore the error since it has not caused harm
Correct answer: Inform the patient of the error, document it, and correct the clinical plan
Transparency requires disclosing medical errors to patients even before harm occurs, and the clinical record must be corrected to ensure ongoing safe care.
Question 6: A patient asks their physician not to share any information about their diagnosis with their spouse, even in an emergency. The physician should:
- Override this request if the physician believes disclosure would help the patient
- Honor the request and maintain confidentiality unless a legal exception applies (Correct answer)
- Inform the spouse immediately since spouses have inherent rights to medical information
- Document the request but share information anyway to protect the family relationship
Correct answer: Honor the request and maintain confidentiality unless a legal exception applies
Patients have the right to restrict disclosure of their health information, including to spouses, and this must be honored absent a specific legal exception.
Question 7: In a resource-scarce disaster scenario, a triage officer must decide between saving a young healthy victim with minor injuries versus an elderly victim with life-threatening injuries requiring extensive resources. Which ethical framework most directly informs disaster triage decisions?
- Deontological ethics: treat each patient with equal dignity regardless of outcome
- Virtue ethics: act as a compassionate healer would in all circumstances
- Utilitarian ethics: maximize lives saved and overall benefit with available resources (Correct answer)
- Autonomy: let patients decide how resources are allocated
Correct answer: Utilitarian ethics: maximize lives saved and overall benefit with available resources
Disaster triage uses a utilitarian framework to maximize total survivors and benefit from scarce resources, which may mean prioritizing salvageable patients over those requiring disproportionate resources.
CASPer Exam CASPer: Medical Ethics 5
A medical team believes a patient's request for a high-risk elective procedure is unwise, but the patient is fully informed and competent.
What should the team do?