FACEM Professional Ethics and Standards 3 — Questions and Answers
Question 1: A 15-year-old presents to the ED requesting treatment for a sexually transmitted infection without parental knowledge. The physician should:
- Refuse treatment without parental consent
- Treat the patient if they demonstrate sufficient maturity to understand the treatment (Correct answer)
- Notify parents regardless of the patient's wishes due to their age
- Defer treatment until a social worker is available
Correct answer: Treat the patient if they demonstrate sufficient maturity to understand the treatment
The mature minor doctrine allows adolescents who demonstrate sufficient understanding to consent to treatment, particularly for sensitive conditions like STIs.
Question 2: An emergency physician receives a gift from a grateful patient's family. According to professional ethics guidelines, the physician should:
- Accept any gift as it does not influence clinical decisions
- Accept only gifts below a defined modest threshold per institutional policy (Correct answer)
- Accept the gift but declare it formally to the hospital
- Refuse all gifts regardless of their nature or value
Correct answer: Accept only gifts below a defined modest threshold per institutional policy
Most professional guidelines permit acceptance of modest gifts but prohibit gifts that could influence or appear to influence clinical decision-making.
Question 3: Which of the following best describes the concept of 'therapeutic privilege' in emergency medicine ethics?
- The right of physicians to override patient consent in emergencies
- Withholding information from a patient if disclosure would cause serious harm (Correct answer)
- Prioritizing physician judgment over patient preferences in all cases
- The legal immunity granted to emergency physicians for good-faith decisions
Correct answer: Withholding information from a patient if disclosure would cause serious harm
Therapeutic privilege allows withholding specific information if its disclosure would seriously harm the patient, but it is narrowly defined and rarely justified.
Question 4: A patient who is a nurse asks an emergency physician to access her colleague's medical records to check on his condition. The correct response is:
- Grant access as both are healthcare workers
- Deny access as the nurse has no therapeutic relationship with the patient (Correct answer)
- Allow read-only access given the professional context
- Check with hospital administration before allowing access
Correct answer: Deny access as the nurse has no therapeutic relationship with the patient
Access to medical records is restricted to those with a direct therapeutic relationship with the patient; professional status does not override privacy rights.
Question 5: During a mass casualty event, a physician must use triage principles. From an ethical standpoint, utilitarian triage primarily aims to:
- Treat the most critical patients first regardless of survival probability
- Maximise the number of lives saved given limited resources (Correct answer)
- Provide equal treatment time to all patients
- Prioritise patients based on their social role
Correct answer: Maximise the number of lives saved given limited resources
Utilitarian triage allocates resources to maximize overall survival and good outcomes when resources are scarce, which may mean not treating unsalvageable patients first.
Question 6: An emergency physician is asked by police to draw blood from a patient for a blood alcohol level without the patient's consent and without a warrant. The physician should:
- Comply immediately as law enforcement requests take precedence
- Refuse as this violates patient autonomy and privacy without legal authorization (Correct answer)
- Proceed if the physician personally believes the patient is intoxicated
- Consult a colleague before deciding
Correct answer: Refuse as this violates patient autonomy and privacy without legal authorization
Non-consensual blood draws for law enforcement generally require a valid court order or warrant; compliance without authorization violates patient rights.
Question 7: When a clinician's personal moral beliefs conflict with providing a legal medical treatment in the ED, the primary obligation is to:
- Withhold the treatment based on conscientious objection without further action
- Ensure the patient receives timely access to the treatment through referral or transfer (Correct answer)
- Inform the patient their request conflicts with the physician's values and discharge them
- Delay treatment until an ethics committee review is completed
Correct answer: Ensure the patient receives timely access to the treatment through referral or transfer
Conscientious objection is recognized but clinicians must ensure patients receive timely access to legal treatment by facilitating appropriate referral or handover.
FACEM Professional Ethics and Standards 3
A 15-year-old presents to the ED requesting treatment for a sexually transmitted infection without parental knowledge.
The physician should: