CCP Ethics & Professional Standards in Chronic Care 3 — Questions and Answers
Question 1: A patient with advanced COPD has decision-making capacity and requests aggressive life-sustaining treatment that the care team believes is medically futile. Ethically, the care team should:
- Implement all requested treatments without further discussion
- Engage in shared decision-making, explaining clinical realities while respecting patient values (Correct answer)
- Transfer care immediately to avoid conflict
- Obtain a court order to override the patient's wishes
Correct answer: Engage in shared decision-making, explaining clinical realities while respecting patient values
Shared decision-making balances professional obligation with patient autonomy and is the preferred approach in disputes over medically futile treatment.
Question 2: Which of the following best describes 'distributive justice' as it applies to chronic care resource allocation?
- Ensuring every patient receives the most expensive available treatment
- Fair distribution of healthcare resources across populations based on need (Correct answer)
- Giving priority to patients who have paid the most into the insurance system
- Allocating resources solely based on physician preference
Correct answer: Fair distribution of healthcare resources across populations based on need
Distributive justice in healthcare means allocating limited resources equitably based on need and fair criteria across populations.
Question 3: A care coordinator is managing a patient who belongs to a religious community that refuses certain standard treatments. The ethically correct approach is to:
- Proceed with standard treatment regardless of religious beliefs
- Document the beliefs, provide culturally competent education, and respect informed refusal (Correct answer)
- Transfer the patient to a specialist without explanation
- Require the patient to sign a waiver of all care before continuing
Correct answer: Document the beliefs, provide culturally competent education, and respect informed refusal
Culturally competent care requires understanding religious beliefs, providing full information, and respecting the informed decisions of competent adults.
Question 4: Professional boundary violations in chronic care most commonly begin with:
- Deliberate intent to harm the patient
- Small, seemingly benign boundary crossings that escalate over time (Correct answer)
- Formal requests from patients for social relationships
- Official policy changes within the care organization
Correct answer: Small, seemingly benign boundary crossings that escalate over time
Boundary violations typically evolve through a process of gradual escalation from minor crossings, making early recognition critical.
Question 5: A chronic care professional working in a community health center serves a population where many patients lack health literacy. This creates an ethical obligation to:
- Simplify care plans without informing patients of available options
- Provide information in accessible formats and confirm patient understanding (Correct answer)
- Limit discussions to only what is absolutely necessary
- Redirect patients with low literacy to physician-only care
Correct answer: Provide information in accessible formats and confirm patient understanding
Effective informed consent requires that information be communicated in a manner the patient can understand, regardless of literacy level.
Question 6: When a chronic care professional disagrees with a physician's treatment plan for ethical reasons, the most appropriate first step is to:
- Implement the plan without comment to avoid conflict
- Raise concerns directly and professionally with the physician (Correct answer)
- Report the physician to the state medical board immediately
- Contact the patient's family to discuss the disagreement
Correct answer: Raise concerns directly and professionally with the physician
Professional ethics require that concerns be raised through direct, respectful communication with the relevant clinician before escalating.
Question 7: In chronic care, the principle of 'veracity' most directly obligates the professional to:
- Verify all patient self-reported information through third parties
- Be truthful with patients about their diagnosis, prognosis, and care options (Correct answer)
- Report all patient information to public health authorities
- Confirm billing accuracy before submitting claims
Correct answer: Be truthful with patients about their diagnosis, prognosis, and care options
Veracity requires truthful, honest communication with patients about all aspects of their care, including uncomfortable truths.
CCP Ethics & Professional Standards in Chronic Care 3
A patient with advanced COPD has decision-making capacity and requests aggressive life-sustaining treatment that the care team believes is medically futile.
Ethically, the care team should: