MCCQE Ethics and Legal Duties 3 — Questions and Answers
Question 1: A patient with terminal cancer has a valid advance directive refusing resuscitation. During a hospital admission for pneumonia, the patient becomes unconscious. Family members demand full resuscitation. What should the physician do?
- Follow the family's wishes to avoid conflict
- Honor the advance directive and explain its legal status to the family (Correct answer)
- Attempt resuscitation as a compromise
- Consult ethics committee before making any decision
Correct answer: Honor the advance directive and explain its legal status to the family
A valid advance directive reflects the patient's autonomous wishes and is legally binding; family preferences do not override it.
Question 2: Which of the following best describes the principle of non-maleficence in clinical practice?
- Maximizing patient benefit at any cost
- Avoiding actions that cause unnecessary harm (Correct answer)
- Treating all patients equally regardless of resources
- Respecting patient autonomy above all other principles
Correct answer: Avoiding actions that cause unnecessary harm
Non-maleficence requires physicians to avoid causing unnecessary harm, including through negligent acts or omissions.
Question 3: A physician is asked to complete a disability form for a patient they have not examined. What is the ethical concern?
- Violation of patient confidentiality
- Fraudulent certification without adequate assessment (Correct answer)
- Breach of therapeutic privilege
- Conflict with substitute decision-maker rights
Correct answer: Fraudulent certification without adequate assessment
Signing medical-legal documents without an adequate examination constitutes fraud and violates professional integrity.
Question 4: A patient requests that the physician withhold a cancer diagnosis from them and share all information only with their adult children. How should the physician respond?
- Comply fully and disclose only to the children
- Explore the patient's reasons and negotiate an acceptable disclosure plan respecting autonomy (Correct answer)
- Refuse to follow the request and disclose everything directly to the patient
- Refer the patient to another physician
Correct answer: Explore the patient's reasons and negotiate an acceptable disclosure plan respecting autonomy
Physicians should explore cultural or personal reasons behind the request and find a plan that respects the patient's own autonomous choice about receiving information.
Question 5: Under the Canadian Charter of Rights and Freedoms, which section most directly protects a patient's right to make medical decisions about their own body?
- Section 2 — Fundamental freedoms
- Section 7 — Life, liberty, and security of the person (Correct answer)
- Section 15 — Equality rights
- Section 8 — Search and seizure protection
Correct answer: Section 7 — Life, liberty, and security of the person
Section 7 protects security of the person, which includes the right to make decisions about one's own bodily integrity.
Question 6: A physician has a personal moral objection to prescribing medical assistance in dying (MAID). What is their legal obligation in Canada?
- They may refuse without any further duty
- They must provide an effective referral to a willing provider (Correct answer)
- They must provide MAID regardless of personal beliefs
- They must transfer the patient's care entirely
Correct answer: They must provide an effective referral to a willing provider
Under Bill C-14 and professional guidelines, conscientious objectors must provide timely and effective referrals so patients can access MAID.
Question 7: A research participant enrolled in a clinical trial develops an unexpected serious adverse event. What is the researcher's immediate obligation?
- Complete the trial before reporting to minimize bias
- Immediately report the event to the Research Ethics Board and consider stopping the trial (Correct answer)
- Inform only the sponsor and continue
- Withdraw the participant silently to protect trial data
Correct answer: Immediately report the event to the Research Ethics Board and consider stopping the trial
Serious adverse events must be promptly reported to the REB; participant safety takes precedence over data integrity.
MCCQE Ethics and Legal Duties 3
A patient with terminal cancer has a valid advance directive refusing resuscitation.
During a hospital admission for pneumonia, the patient becomes unconscious.
Family members demand full resuscitation.
What should the physician do?