NAC OSCE Medical Ethics & Professionalism — Questions and Answers
Question 1: A competent 17-year-old presents requesting contraception and asks that her parents not be told. According to Canadian law and medical ethics, what is the appropriate response?
- Provide confidential contraceptive counselling and prescription — mature minors have the right to consent to their own care in all Canadian provinces (Correct answer)
- Refuse until parental consent is obtained
- Inform the parents regardless of the patient's wishes
- Defer to provincial child welfare authorities
Correct answer: Provide confidential contraceptive counselling and prescription — mature minors have the right to consent to their own care in all Canadian provinces
All Canadian provinces recognise the mature minor doctrine; a competent minor can consent to healthcare without parental involvement, and confidentiality must be maintained unless there is a safety concern.
Question 2: A surgeon declares a conflict of interest because they own shares in a medical device company whose implants they use. According to the Canadian Medical Association (CMA) Code of Ethics, what is the MOST appropriate action?
- Disclose the conflict of interest to patients and the institution, and consider recusing from decisions involving that device (Correct answer)
- Continue using the device as long as it is clinically superior
- Divest shares secretly without disclosure
- Disclose only to the hospital administration but not to patients
Correct answer: Disclose the conflict of interest to patients and the institution, and consider recusing from decisions involving that device
The CMA Code of Ethics requires full disclosure of conflicts of interest to both patients and the institution, with recusal from relevant decisions if the conflict cannot be managed, to preserve trust and integrity.
Question 3: A patient with capacity refuses a blood transfusion on religious grounds despite being told it may be life-saving. What is the ethically and legally correct response in Canada?
- Respect the refusal, document it thoroughly, and explore alternative treatments (Correct answer)
- Override the refusal because life preservation takes precedence
- Seek emergency court order to transfuse
- Ask the family to consent on the patient's behalf
Correct answer: Respect the refusal, document it thoroughly, and explore alternative treatments
Canadian law (Malette v Shulman, 1990 Ontario Court of Appeal) established that a competent adult's informed refusal of treatment must be respected even if it results in death; autonomy overrides beneficence.
Question 4: Under Canadian mandatory reporting laws, which situation REQUIRES a physician to report to authorities regardless of patient confidentiality?
- Reasonable suspicion of child abuse or neglect (Correct answer)
- A patient with diabetes who drives occasionally
- An elderly patient with mild cognitive impairment
- A patient with well-controlled epilepsy on medication
Correct answer: Reasonable suspicion of child abuse or neglect
All Canadian provinces have mandatory child protection reporting laws; any regulated professional with reasonable grounds to suspect child abuse or neglect must report to child protective services — confidentiality does not apply.
Question 5: A physician is asked to complete a medical-legal report for a patient involved in a motor vehicle accident. What is the physician's primary obligation according to the CPSO and CMA?
- To provide an honest, objective, and accurate report based on clinical findings — not to advocate for the patient's legal position (Correct answer)
- To support the patient's claim as their treating physician
- To refuse all medical-legal work as it creates conflicts of interest
- To defer entirely to the patient's lawyer for framing the report
Correct answer: To provide an honest, objective, and accurate report based on clinical findings — not to advocate for the patient's legal position
CMA guidelines on medical-legal reporting require physicians to be impartial and accurate; a treating physician's duty in a medico-legal context is to the truth and the court, not to advocate for the patient.
Question 6: According to the Canadian federal law (MAID legislation, Bill C-7 2021), which patient is eligible for Medical Assistance in Dying (MAiD) under Track 1?
- An adult with a grievous and irremediable medical condition where natural death is reasonably foreseeable (Correct answer)
- Any adult with a terminal illness regardless of decision-making capacity
- A minor aged 16-17 with parental consent
- A patient with a mental illness as the sole underlying condition
Correct answer: An adult with a grievous and irremediable medical condition where natural death is reasonably foreseeable
Bill C-7 (2021) amended MAID eligibility; Track 1 (no 90-day assessment period) applies when natural death is reasonably foreseeable; Track 2 applies when it is not; mental illness as sole underlying condition remains under a sunset clause.
NAC OSCE Medical Ethics & Professionalism
A competent 17-year-old presents requesting contraception and asks that her parents not be told.
According to Canadian law and medical ethics, what is the appropriate response?