Medical Ethics and Law Flashcards

A pharmacist is counselling a patient picking up a new opioid prescription when the patient reveals a specific, credible plan to physically harm an identified neighbour. The patient becomes agitated and leaves. Under Canadian law and pharmacy ethics, which of the following BEST describes the pharmacist's obligation?

Answer: The pharmacist may disclose to the identified third party and law enforcement when there is a serious, credible, and imminent threat to an identifiable person.

Canadian common law and privacy legislation (including PIPEDA and provincial health information acts) recognize a 'duty to warn' exception to confidentiality when a threat is serious, credible, and directed at an identifiable person. In such cases, disclosure to the potential victim and law enforcement is not only permitted but may be ethically required. Confidentiality is not absolute, and waiting for patient consent or limiting action to College notification fails to adequately protect the third party.

An 82-year-old patient in Ontario is assessed as lacking capacity to consent to a high-risk medication regimen. She has no advance directive. Her daughter holds Power of Attorney (POA) for Property; her son, who visits daily, claims decision-making authority. Under the Ontario Health Care Consent Act, who is the lawful substitute decision-maker for her medication treatment?

Answer: A Power of Attorney for Personal Care takes priority; absent one, the legislated hierarchy applies — a willing and able child acts as substitute, with the property POA being irrelevant to healthcare.

Under Ontario's Health Care Consent Act, a Power of Attorney for Property is strictly limited to financial matters and carries no authority over healthcare decisions. Only a Power of Attorney for Personal Care (POAPC) grants substitute healthcare decision-making authority. Absent a POAPC, the Act's hierarchy applies: spouse/partner first, then children. The son's daily contact is irrelevant in law; either willing child may act, but the daughter's property POA does not give her priority.

Under Canada's Medical Assistance in Dying (MAID) framework, a pharmacist has a sincere conscientious objection to participating in MAID. A patient eligible for MAID asks the pharmacist where they can obtain information about the process and how to access it. Which response BEST reflects the pharmacist's legal and ethical obligations under most Canadian provincial regulatory frameworks?

Answer: The pharmacist must ensure the patient can access information or services through an effective referral to another provider or resource, even if personally declining to participate.

Canadian federal law (Bill C-14, amended by C-7) and most provincial pharmacy regulatory frameworks respect conscientious objection, but do not permit a provider's objection to block a patient's access to a lawful health service. Pharmacists who object are generally required to make an effective referral — ensuring the patient can realistically access MAID information or services through another route. Simply refusing all engagement without facilitating access is ethically inadequate and may violate provincial regulatory standards.

A pharmacist consistently fails to identify clinically significant drug interactions during medication reviews across multiple patients over 18 months. Investigation reveals no malicious intent; rather, she has not updated her clinical knowledge since graduating 15 years ago and is unaware of current interaction profiles. A complaint is filed with the provincial College. Under most provincial pharmacy legislation, this pattern is MOST accurately characterized as:

Answer: Incompetence, because the pattern reflects a sustained deficit in knowledge, skill, or judgment that falls below the standard reasonably expected of a practitioner.

Provincial pharmacy acts typically distinguish among three grounds for College action: professional misconduct (intentional, reckless, or dishonest acts), incompetence (a pattern of practice demonstrating a lack of knowledge, skill, or judgment below the standard expected), and incapacity (a physical or mental condition impairing practice). Failing to maintain contemporary clinical knowledge, resulting in systematic errors without intent, is the textbook definition of incompetence. The College would most likely respond with remedial education requirements, supervised practice, or conditions on registration rather than the more punitive penalties reserved for misconduct.

A 16-year-old presents at a community pharmacy requesting emergency contraception without parental involvement. She articulates the purpose of the medication, the timeframe for efficacy, and potential side effects accurately, and states clearly she does not want her parents informed. Under the mature minor doctrine as applied across most Canadian common law provinces, which statement is MOST accurate?

Answer: The pharmacist may assess the minor's capacity and, if she demonstrates adequate understanding of the decision, dispense without parental consent and without any obligation to notify parents.

The mature minor doctrine, recognized in Canadian common law, holds that a minor who demonstrates sufficient intelligence and understanding to appreciate the nature and consequences of a proposed intervention may provide legally valid consent independently of parents. A 16-year-old who clearly understands the medication, its mechanism, and its side effects meets this threshold. There is no post-dispense parental notification requirement — confidentiality applies to capable minors just as it does to adults. Emergency contraception is OTC and squarely within this doctrine's application.

An unconscious patient is brought to an emergency department. She carries a valid, properly executed advance directive explicitly refusing blood products under any circumstances, consistent with her documented religious beliefs. The attending physician, believing a blood transfusion is immediately necessary to prevent death, orders the product and asks the hospital pharmacist to dispense. What is the pharmacist's correct ethical and legal position?

Answer: Decline to dispense and communicate the advance directive to the clinical team, because a competent patient's explicit prior refusal must be honoured even when they are currently incapacitated.

A validly executed advance directive represents a competent individual's autonomous decision made in anticipation of incapacity. Canadian courts (including Malette v. Shulman, Ontario Court of Appeal) have unequivocally held that a competent patient's documented refusal of treatment — including blood products — must be respected even in life-threatening emergencies. Implied consent applies only in the absence of known wishes; here, the patient's wishes are explicitly documented. Dispensing would facilitate a battery against the patient. The pharmacist's role includes flagging this directive to the clinical team and declining to participate in overriding it. Next-of-kin consent cannot override a competent prior refusal.