DO Bioethics and Medical Law 2 — Questions and Answers
Question 1: Which of the four elements of malpractice must include proof that the physician's breach directly caused patient harm?
- Causation (Correct answer)
- Duty
- Breach
- Damages
Correct answer: Causation
Causation (both actual and proximate) requires proving that the physician's breach of the standard of care directly resulted in the patient's injury.
Question 2: A patient lacks decision-making capacity. Their legally designated healthcare proxy requests a treatment the physician believes is harmful. The physician should:
- Negotiate with the proxy using the patient's best interests as the standard (Correct answer)
- Follow the proxy's instructions without question
- Override the proxy and treat the patient as the physician sees fit
- Refuse to treat the patient
Correct answer: Negotiate with the proxy using the patient's best interests as the standard
The healthcare proxy must decide based on the patient's previously expressed wishes or best interests, and physicians may involve ethics committees if the proxy appears to deviate from this standard.
Question 3: Mandatory reporting laws in the US require physicians to report which of the following to authorities?
- Suspected child abuse and neglect (Correct answer)
- Adult patients who smoke cigarettes
- Patients who are overweight
- All cases of depression
Correct answer: Suspected child abuse and neglect
All US states mandate that physicians report suspected child abuse and neglect to child protective services, overriding patient-physician confidentiality.
Question 4: What is the ethical distinction between withholding and withdrawing life-sustaining treatment?
- There is no ethical distinction; both are morally equivalent when informed consent is obtained (Correct answer)
- Withdrawing treatment is always unethical
- Withholding is permissible but withdrawing is never allowed
- Withdrawing requires a court order; withholding does not
Correct answer: There is no ethical distinction; both are morally equivalent when informed consent is obtained
Medical ethics and US law hold that withholding and withdrawing life-sustaining treatment are morally equivalent when consistent with the patient's informed wishes.
Question 5: The principle of double effect permits the use of high-dose opioids for pain relief even if they may hasten death, provided that:
- The primary intent is pain relief, not to hasten death (Correct answer)
- The patient has a terminal prognosis of less than 6 months
- The family gives consent in addition to the patient
- A palliative care specialist approves the dose
Correct answer: The primary intent is pain relief, not to hasten death
Double effect permits an action with both good and harmful effects when the intent is the good effect (analgesia), the harmful effect is not the means to the good, and the good outweighs the harm.
Question 6: A physician in private practice wants to dismiss a patient from their practice. To avoid patient abandonment, the physician must:
- Provide adequate notice and continue emergency care during the transition period (Correct answer)
- Simply inform the patient they are no longer accepted
- Dismiss immediately if the patient has been non-compliant
- Obtain the patient's written consent to be dismissed
Correct answer: Provide adequate notice and continue emergency care during the transition period
Patient abandonment is avoided by giving sufficient written notice (typically 30 days), assisting with referrals, and continuing emergency care until care is transferred.
DO Bioethics and Medical Law 2
Which of the four elements of malpractice must include proof that the physician's breach directly caused patient harm?