NZREX Professional Ethics β Questions and Answers
Question 1: Which of the four pillars of medical ethics refers to the obligation to act in the patient's best interest?
- Beneficence (Correct answer)
- Non-maleficence
- Autonomy
- Justice
Correct answer: Beneficence
Beneficence refers to the duty to act in the patient's best interest and promote their wellbeing. Non-maleficence is 'do no harm', autonomy respects the patient's right to decide, and justice concerns fair distribution of resources.
Question 2: A junior doctor witnesses a colleague arriving to work smelling of alcohol. What is the most appropriate action?
- Report the concern to a senior colleague or supervisor immediately to protect patient safety (Correct answer)
- Say nothing as it may damage the colleague's career
- Ask the colleague privately if they are okay and take no further action
- Wait to see if any adverse events occur before reporting
Correct answer: Report the concern to a senior colleague or supervisor immediately to protect patient safety
Protecting patient safety takes precedence. This situation requires immediate escalation to a senior colleague or supervisor. NZ's Medical Council and MCNZ guidelines on professional obligations require doctors to act on concerns about impaired colleagues.
Question 3: Which of the following best describes 'double effect' in medical ethics?
- An action intended for a good effect that has a foreseen but unintended harmful effect β morally permissible if the harm is proportionate (Correct answer)
- Deliberately causing harm to achieve a benefit
- Deceiving a patient for their own good
- Withholding treatment to allow natural death
Correct answer: An action intended for a good effect that has a foreseen but unintended harmful effect β morally permissible if the harm is proportionate
The principle of double effect holds that an action with both good and harmful effects (e.g., high-dose opioids for pain relief that may hasten death) is permissible if: the action is not intrinsically wrong, intent is the good effect, the harm is not the means to the good, and the benefit is proportionate to the harm.
Question 4: A patient discloses in confidence that they intend to seriously harm a specific person. What is the most appropriate action?
- Warn the identifiable potential victim and notify police, overriding confidentiality due to serious risk of harm (Correct answer)
- Maintain confidentiality absolutely β no exceptions
- Inform the patient's family only
- Document the disclosure and take no further action
Correct answer: Warn the identifiable potential victim and notify police, overriding confidentiality due to serious risk of harm
The 'duty to protect' (Tarasoff principle) applies when there is a credible, serious, imminent threat to an identifiable third party. NZ law and ethics allow (and in some circumstances require) confidentiality to be breached to prevent serious harm.
Question 5: What does the term 'futility' mean in the context of end-of-life medical decision-making?
- Treatment that provides no physiological benefit or cannot achieve the patient's goals of care (Correct answer)
- Treatment that is too expensive for the health system
- Refusing treatment because the patient is elderly
- Withholding treatment at the family's request
Correct answer: Treatment that provides no physiological benefit or cannot achieve the patient's goals of care
Medical futility refers to treatment that cannot achieve its intended physiological effect or cannot achieve the patient's goals. Futile treatment need not be offered; however, this decision should be made in consultation with the patient, family, and team.
Question 6: Which ethical framework best describes the view that the right action is the one that produces the greatest good for the greatest number?
- Utilitarianism (Correct answer)
- Deontology
- Virtue ethics
- Principlism
Correct answer: Utilitarianism
Utilitarianism (consequentialism) judges actions by their outcomes β the right action maximises overall welfare or utility. In healthcare, this may justify resource allocation decisions that benefit more people even at the expense of individuals.
NZREX Professional Ethics
Which of the four pillars of medical ethics refers to the obligation to act in the patient's best interest?