NAC OSCE Medical Ethics & Professionalism 2 — Questions and Answers
Question 1: A physician learns that a colleague is practising while impaired by alcohol. According to the CMA Code of Ethics and provincial college obligations, what is the MOST appropriate action?
- Report concerns to the provincial regulatory college (e.g., CPSO) and offer support to the colleague through physician health programs (Correct answer)
- Confront the colleague privately and take no further action if they agree to stop
- Ignore the situation as it is a personal matter
- Immediately contact the media to protect public safety
Correct answer: Report concerns to the provincial regulatory college (e.g., CPSO) and offer support to the colleague through physician health programs
CMA ethics and provincial college regulations require physicians to report a colleague whose impairment poses a risk to patients; physician health programs provide confidential support, but patient safety must be prioritised.
Question 2: A patient lacks decision-making capacity and has no advance directive. Who is the appropriate substitute decision maker (SDM) under Ontario's Health Care Consent Act?
- The highest-ranked capable person in the hierarchy: spouse/partner > adult child > parent > sibling > other relative > OPGT (Correct answer)
- The most available family member regardless of relationship
- The attending physician makes all decisions
- The patient's employer or next of kin regardless of legal hierarchy
Correct answer: The highest-ranked capable person in the hierarchy: spouse/partner > adult child > parent > sibling > other relative > OPGT
Ontario's Health Care Consent Act specifies a legal hierarchy for SDMs; the spouse/partner ranks first, followed by adult children, parents, siblings, and then the Office of the Public Guardian and Trustee (OPGT).
Question 3: A physician provides care to a remote First Nations community in Northern Ontario. Which principle from the TRC Calls to Action should guide their practice?
- Acknowledging and integrating culturally safe, trauma-informed care that recognises the impacts of residential schools and colonisation (Correct answer)
- Applying identical protocols to all patients regardless of background
- Prioritising Western medicine exclusively to standardise care
- Avoiding discussion of historical trauma to prevent re-traumatisation
Correct answer: Acknowledging and integrating culturally safe, trauma-informed care that recognises the impacts of residential schools and colonisation
The TRC Calls to Action (particularly #23-24) call on health professionals to integrate Indigenous health knowledge and provide culturally safe care that acknowledges the intergenerational trauma of residential schools.
Question 4: A pharmaceutical representative offers a physician tickets to a major sporting event. According to the CMA Code of Ethics and provincial college policies, what is the MOST appropriate response?
- Decline the gift — gifts from industry that could influence prescribing decisions are prohibited (Correct answer)
- Accept if the value is under $100
- Accept if it is disclosed to patients
- Accept and donate equivalent value to charity
Correct answer: Decline the gift — gifts from industry that could influence prescribing decisions are prohibited
CMA Code of Ethics and CPSO policies prohibit physicians from accepting gifts from industry that could influence clinical decisions or create a perception of bias, regardless of monetary value.
Question 5: A patient with a serious psychiatric illness lacks capacity to consent to treatment. The patient previously expressed in a capable state that they would not want antipsychotic medications. What should guide the SDM's decision?
- The patient's prior capable wishes (prior capable wish) take precedence over best interests (Correct answer)
- The SDM's own judgment about what is best for the patient
- The physician's recommendation overrides previous wishes in psychiatric emergencies
- Best interests always override prior capable wishes
Correct answer: The patient's prior capable wishes (prior capable wish) take precedence over best interests
Ontario's Health Care Consent Act and Canadian ethics principles hold that prior capable wishes expressed by the patient when capable must be followed by the SDM, even if they conflict with current best interests.
Question 6: A 19-year-old international student presents requesting a prescription for a stimulant medication, claiming a diagnosis of ADHD from another country. According to Canadian prescribing standards, what is the MOST appropriate approach?
- Conduct an independent assessment or obtain verified records before prescribing — do not prescribe based on self-report alone (Correct answer)
- Prescribe immediately to maintain continuity of care
- Refuse all stimulants permanently to this patient
- Refer immediately to psychiatry without any assessment
Correct answer: Conduct an independent assessment or obtain verified records before prescribing — do not prescribe based on self-report alone
Canadian college standards require physicians to conduct their own clinical assessment or verify documentation before prescribing controlled substances; prescribing based solely on patient self-report risks contributing to diversion.
NAC OSCE Medical Ethics & Professionalism 2
A physician learns that a colleague is practising while impaired by alcohol.
According to the CMA Code of Ethics and provincial college obligations, what is the MOST appropriate action?