Medical Ethics & Professionalism Flashcards

A physician working for a large corporation is asked by the employer to conduct routine health screenings and share aggregate employee data—but also individual results if 'safety-critical' roles are flagged. An employee's screening reveals early-stage hypertension. The employer requests disclosure. What is the most ethically appropriate action?

Answer: Decline to disclose and inform the employee of the employer's request, offering a referral for treatment

In occupational health, dual-loyalty conflicts are managed by upholding the physician's primary obligation to the individual patient. Early-stage hypertension does not constitute an immediate safety threat sufficient to override confidentiality. The physician must protect the employee's privacy, disclose the employer's request transparently, and facilitate access to care—not act as an instrument of employer surveillance.

During a clinical trial, a research team discovers mid-study that the experimental drug significantly outperforms the placebo. The trial is only 60% complete. Continuing the trial means the control group will be deprived of an evidently effective treatment. What principle most directly governs the obligation to stop the trial?

Answer: Beneficence and non-maleficence through the principle of clinical equipoise and the role of a Data Safety Monitoring Board

Clinical equipoise—the genuine uncertainty about which arm is superior—is the ethical justification for randomization. Once equipoise is broken by compelling interim evidence, continuing exposes the control group to known harm, violating non-maleficence. The Data Safety Monitoring Board (DSMB) exists precisely to make independent early-termination decisions. While autonomy and justice are relevant, the operative ethical mechanism here is clinical equipoise adjudicated by the DSMB.

A competent adult patient with a terminal diagnosis refuses a blood transfusion on religious grounds. The patient's adult child, who holds a general power of attorney for financial matters, insists that the physician administer the transfusion. Without it, the patient will likely die within 24 hours. What should the physician do?

Answer: Honor the patient's refusal; a general financial power of attorney does not confer healthcare decision-making authority

A competent patient's informed refusal is legally and ethically binding, even when fatal. A general financial power of attorney does not extend to healthcare decisions—that requires a specific healthcare proxy or medical power of attorney. The adult child therefore has no authority to override the patient's expressed wishes. Compelling the transfusion would constitute battery and a serious violation of patient autonomy.

A psychiatrist treats a patient who discloses ongoing sexual abuse of a minor. The patient explicitly refuses consent to report, citing fear of retaliation. The psychiatrist is in a jurisdiction where mandatory reporting laws for child abuse apply. How should the psychiatrist proceed?

Answer: Report to child protective authorities, as mandatory reporting laws supersede therapeutic confidentiality in cases of child abuse

Mandatory reporting laws create a legal and ethical obligation that overrides normal confidentiality rules when a child is at risk of harm. Unlike the Tarasoff duty—which involves professional judgment—mandatory reporting statutes are non-discretionary. The psychiatrist must report immediately to child protective services regardless of patient consent or the impact on therapeutic alliance. Delaying or conditioning the report is legally impermissible and ethically unjustifiable given ongoing harm to a vulnerable third party.

A surgeon has a conscientious objection to performing elective sterilization procedures. A patient in a remote area specifically requests the procedure and has no reasonable access to another provider. Referral would require the patient to travel more than 400 km. In this context, what does the principle of conscientious objection ethically require of the physician?

Answer: The physician must provide the procedure or arrange timely access at no additional burden to the patient, given that objection cannot cause patient abandonment in urgent or sole-provider contexts

Conscientious objection is a recognized right, but it is not absolute. The WMA and DHA ethical frameworks require that conscientious objection never result in patient abandonment or denial of timely care. When a physician is the sole accessible provider, the duty of non-abandonment and the patient's right to legal healthcare services substantially limits the right to object. The physician must either perform the procedure or ensure genuinely equivalent access—not merely formal referral that imposes unreasonable burdens on the patient.

A physician discovers that a respected senior colleague has been practicing while visibly impaired on multiple occasions. No patient harm has been documented yet. The colleague is a close personal friend and the department's only subspecialist. What is the most appropriate first step according to medical professionalism standards?

Answer: Confront the colleague privately and urge self-referral to an impaired physician program, documenting this action and reporting to the medical director if the colleague declines

Professional codes consistently require physicians to act when a colleague's impairment poses patient risk, even absent documented harm—because waiting for harm is ethically unacceptable. The appropriate sequence is: (1) a direct, documented private intervention urging self-referral to an impaired physician assistance program; (2) if the colleague refuses or the impairment continues, escalation to institutional leadership or the licensing body. Bypassing internal channels as a first step is disproportionate; monitoring silently is a failure of professional duty. The colleague's personal relationship or clinical indispensability does not modify this obligation.