MCCQE Ethics and Legal Duties 2 — Questions and Answers
Question 1: A capable adult patient refuses a blood transfusion on religious grounds despite life-threatening hemorrhage. What is the physician's ethical obligation?
- Override the refusal to save the patient's life
- Respect the refusal and provide alternative management (Correct answer)
- Seek emergency court authorization
- Transfer care to another physician immediately
Correct answer: Respect the refusal and provide alternative management
Capable adults have the right to refuse any treatment, including life-saving interventions, and physicians must respect this autonomy.
Question 2: Under Canadian law, who is the most appropriate substitute decision-maker for an incapable adult patient with no advance directive?
- The attending physician
- The patient's spouse or partner (Correct answer)
- The provincial public guardian
- The hospital ethics committee
Correct answer: The patient's spouse or partner
A spouse or partner is typically the highest-priority substitute decision-maker under most provincial consent legislation in Canada.
Question 3: A patient discloses that they are HIV-positive and refuses to inform their regular sexual partner. The physician determines the partner is at serious risk. What is the most appropriate next step?
- Immediately notify the partner without further discussion
- Continue counselling the patient and consider public health notification (Correct answer)
- Document and take no action to protect patient confidentiality
- Discharge the patient from care for non-compliance
Correct answer: Continue counselling the patient and consider public health notification
The physician should continue counselling the patient and, if risk persists, may report to public health authorities under duty-to-warn principles while following provincial guidelines.
Question 4: Which doctrine requires physicians to disclose information that a reasonable patient in the same circumstances would want to know before consenting to treatment?
- Therapeutic privilege
- Modified objective standard (Correct answer)
- Professional practice standard
- Subjective patient standard
Correct answer: Modified objective standard
The modified objective standard requires disclosure of what a reasonable patient would want to know, as established in Reibl v. Hughes.
Question 5: A 15-year-old presents alone requesting contraception and demonstrates clear understanding of the treatment. Under the mature minor doctrine, what should the physician do?
- Refuse treatment without parental consent
- Provide treatment after assessing capacity (Correct answer)
- Notify parents before any treatment
- Refer to a specialist only
Correct answer: Provide treatment after assessing capacity
Adolescents who demonstrate capacity to understand and appreciate treatment decisions may consent independently under the mature minor doctrine.
Question 6: A surgeon discovers an unexpected finding during an operation that was not discussed preoperatively. The finding poses no immediate threat. What is the correct action?
- Treat the finding immediately while the patient is already under anaesthesia
- Complete the consented procedure and discuss the finding postoperatively (Correct answer)
- Wake the patient to obtain consent
- Contact the next-of-kin for consent
Correct answer: Complete the consented procedure and discuss the finding postoperatively
Non-urgent unexpected findings should not be treated without prior consent; the surgeon should complete the consented procedure and obtain informed consent later.
Question 7: A physician learns that a colleague is practicing while impaired by alcohol. What is the primary professional obligation?
- Confront the colleague privately and take no further action if they deny it
- Report to the regulatory college or appropriate authority (Correct answer)
- Inform the hospital administrator only
- Document observations and wait for a formal complaint
Correct answer: Report to the regulatory college or appropriate authority
Physicians have a professional and ethical duty to report a colleague whose impairment poses a risk to patient safety to the appropriate regulatory body.
MCCQE Ethics and Legal Duties 2
A capable adult patient refuses a blood transfusion on religious grounds despite life-threatening hemorrhage.
What is the physician's ethical obligation?