FACEM Professional Ethics and Standards 2 — Questions and Answers
Question 1: An emergency physician suspects a colleague is impaired by alcohol while on shift. What is the most appropriate immediate action?
- Document concerns and report after the shift ends
- Notify hospital administration and remove the colleague from clinical duties (Correct answer)
- Confront the colleague privately and allow them to self-assess fitness
- Contact the medical board without informing hospital administration
Correct answer: Notify hospital administration and remove the colleague from clinical duties
Patient safety requires immediate removal of an impaired clinician from clinical duties, with prompt notification to hospital administration.
Question 2: A patient presents unconscious after a drug overdose. No family is available. Regarding disclosure of this patient's information to their employer who calls demanding details, the physician should:
- Disclose minimal information since the employer may assist with recovery
- Decline to confirm or deny the patient's presence without consent (Correct answer)
- Provide general information since the patient cannot object
- Share information if the employer seems genuinely concerned
Correct answer: Decline to confirm or deny the patient's presence without consent
Confidentiality obligations persist even when the patient is unconscious; information may not be disclosed to an employer without the patient's prior consent.
Question 3: Under the ACEM Code of Ethics, the principle of justice in emergency medicine primarily refers to:
- Legal accountability for clinical errors
- Fair distribution of healthcare resources and equitable treatment (Correct answer)
- Enforcing institutional policies without exception
- Punishing clinicians who deviate from guidelines
Correct answer: Fair distribution of healthcare resources and equitable treatment
Justice in medical ethics refers to fair and equitable allocation of healthcare resources and treating all patients without discrimination.
Question 4: A physician in a rural emergency department encounters a patient who needs a procedure the physician has not performed for several years. The best course of action is:
- Proceed with the procedure as prior training is sufficient justification
- Attempt the procedure after briefly reviewing guidelines
- Assess current competence, seek supervision or guidance, and escalate if needed (Correct answer)
- Refuse the procedure entirely and transfer regardless of patient stability
Correct answer: Assess current competence, seek supervision or guidance, and escalate if needed
Clinicians must honestly assess their current competence, seek support where possible, and escalate appropriately rather than proceeding recklessly or refusing necessary care.
Question 5: When obtaining informed consent in the emergency department, which element is NOT required?
- Explanation of the proposed treatment
- Discussion of reasonable alternatives
- Guarantee of a successful outcome (Correct answer)
- Disclosure of material risks
Correct answer: Guarantee of a successful outcome
Informed consent requires disclosure of risks, alternatives, and the nature of treatment, but physicians cannot and should not guarantee outcomes.
Question 6: A competent adult patient with a serious but treatable injury clearly refuses all treatment. The emergency physician should:
- Override refusal if the condition is life-threatening
- Document the refusal thoroughly and respect the patient's autonomous decision (Correct answer)
- Contact police to enforce treatment under duty-of-care laws
- Sedate the patient to allow treatment
Correct answer: Document the refusal thoroughly and respect the patient's autonomous decision
A competent adult's informed refusal of treatment must be respected regardless of the severity of condition; thorough documentation is essential.
Question 7: In the context of ACEM professional standards, which best describes the duty of candour?
- The obligation to maintain patient confidentiality at all times
- The duty to be open and honest with patients when things go wrong (Correct answer)
- The requirement to report all adverse events to the coroner
- The obligation to disclose personal health conditions to employers
Correct answer: The duty to be open and honest with patients when things go wrong
Duty of candour requires clinicians to be open, honest, and timely in communicating with patients when their care results in harm.
FACEM Professional Ethics and Standards 2
An emergency physician suspects a colleague is impaired by alcohol while on shift.
What is the most appropriate immediate action?