CDS Medical Ethics & Patient Rights 3 — Questions and Answers
Question 1: A patient with a psychiatric disability has a valid advance directive refusing electroconvulsive therapy. During a psychiatric crisis, the treatment team wants to proceed anyway. Ethically, the team should:
- Proceed because the patient currently lacks capacity
- Honor the advance directive as the patient's prior competent wish (Correct answer)
- Override the directive if two physicians agree
- Seek family consent to bypass the directive
Correct answer: Honor the advance directive as the patient's prior competent wish
A valid advance directive represents the patient's autonomous prior decision and must be honored even when the patient currently lacks decision-making capacity.
Question 2: The ethical principle of justice, as applied to disability services, most directly requires:
- Equal treatment regardless of individual need
- Fair and equitable distribution of healthcare resources (Correct answer)
- Maximum care to those with the best prognosis
- Preference for patients who can pay privately
Correct answer: Fair and equitable distribution of healthcare resources
Justice in healthcare requires fair, equitable allocation of resources and services, ensuring people with disabilities receive care proportionate to their needs.
Question 3: A CDS is working with a client whose provider consistently dismisses pain complaints due to the client's disability. This pattern reflects which systemic issue?
- Evidence-based practice
- Diagnostic overshadowing (Correct answer)
- Informed consent failure
- Capacity assessment error
Correct answer: Diagnostic overshadowing
Diagnostic overshadowing occurs when symptoms or complaints are incorrectly attributed to a disability rather than being independently evaluated.
Question 4: Under HIPAA, what right does a patient with a disability have regarding their own medical records?
- Access only through a legal guardian
- The right to inspect and obtain a copy of their records (Correct answer)
- Access only if the provider agrees it is appropriate
- Records may be withheld if the patient has a cognitive disability
Correct answer: The right to inspect and obtain a copy of their records
HIPAA grants all patients, including those with disabilities, the right to inspect and receive copies of their own health records.
Question 5: A provider wants to enroll a patient with a physical disability in a clinical trial. The key ethical requirement before enrollment is:
- Physician-only decision since it is a research setting
- Voluntary informed consent from the patient (Correct answer)
- Family approval regardless of patient capacity
- IRB waiver of patient consent
Correct answer: Voluntary informed consent from the patient
Voluntary informed consent is a foundational ethical requirement for research participation, rooted in the Belmont Report's respect for persons principle.
Question 6: A disability specialist advocates that medical decisions for patients with disabilities should include the patient's own perspective and lived experience. This aligns with which framework?
- Paternalistic model of care
- Nothing about us without us principle (Correct answer)
- Beneficence-only model
- Physician-led decision-making model
Correct answer: Nothing about us without us principle
'Nothing about us without us' is a disability rights principle asserting that people with disabilities must be involved in decisions that affect their own lives and care.
Question 7: When a patient with a disability demonstrates capacity to make medical decisions, the provider's role is to:
- Make decisions for the patient to protect them from harm
- Provide information and support the patient's autonomous choice (Correct answer)
- Defer all decisions to family members
- Require a second capacity evaluation before proceeding
Correct answer: Provide information and support the patient's autonomous choice
When a patient has decision-making capacity, the provider's ethical role is to offer complete information and respect the patient's autonomous choices.
CDS Medical Ethics & Patient Rights 3
A patient with a psychiatric disability has a valid advance directive refusing electroconvulsive therapy.
During a psychiatric crisis, the treatment team wants to proceed anyway.
Ethically, the team should: