Practice questions Ethics

Dr Idara C. Eshiet

• A 45-year-old female presents to your office for the first time as a new patient after recently moving into your community. Her medical history includes obesity and type II diabetes. Her current glycosylated hemoglobin level is 10%. She has been using insulin in addition to oral hypoglycemic medications for the past few years. When you ask her how she is doing with her insulin she replies, “I use it once in a while, but I feel fine so I don’t think I need it”. Which of the following is the best reply?

• A. ” your blood sugars are not well controlled. You should use insulin regularly.”

• B. ” it seems that your blood sugars are not well controlled. Do you have difficulty injecting insulin?”

• C. ” it seems that you have little understanding about diabetes and its complications. Let me explain more about it.”

• D. “since you are not using insulin regularly. I will add more oral medications and cut down on your insulin.”

• E.” it seems that your blood sugars are not well controlled. Please tell me what you understand about diabetes.”

• A 52-year-old man presents to the emergency room complaining of severe chest pain. What should the physician say in order to elicit the most important information from this gentleman?

• A. “where is your pain located ?”• B. ” have you ever had pain like this before?”• C. “ do you have any history of heart or lung

problems?”• D. ” tell me more about your pain.”• E. “is it more like a crushing pain or a sharp pain?”• F. “when did your pain begin?”• G. ” is your pain associated with nausea, vomiting or

sweating.”

• A medical intern is working on the inpatient wards at a busy community hospital. During rounds, the team evaluates a new patient who was admitted for an exacerbation of congestive heart failure. The patient’s past medical history includes atherosclerotic coronary artery disease, diabetes and osteoarthritis. The attending physician asks the intern to start beta antagonists on this patient. After rounds, the intern recalls that during medical school she learned that beta-adrenergic antagonists can blunt the symptoms of hypoglycemia in a diabetic patient. What is the most appropriate course of action?

• A. do not administer the beta antagonist because the most important principle in medicine is to “do no harm”

• B. discuss concerns about the administration of this drug with the patient, and let the patient decide whether to take the drug or not

• C. discuss concerns about this drug with the nurses, ask for their input, and ask them to keep a close eye on the patient to avoid hypoglycemia on this drug

• D. do not administer the drug until you have discussed your concerns with the attending physician and asked him how to proceed

• E. administer the drug because the attending physician is in charge of the team and to undermine his authority is unethical

• A 6-year-old male is examined in the emergency room and found to have a well-demarcated, round burn mark on his thigh. When asked about the burn he says” that happens every time I am bad”. Which of the following is the best next step in the management of this patient?

• A. contact child protective services immediately• B. talk to the parents about suspected child abuse and ask

for explanation• C. ask another physician to witness the damage and listen

to the patient story• D. try to convince the child to improve his behavior• E. send the patient home and schedule an appointment in

one week

• A 44-year-old male is brought to the emergency room after vomiting at a party. It is determined that he has been drinking heavily and has acute pancreatitis. He remain intoxicated with a blood alcohol level of 245mg/dl(0.245% BAC). He tells you that he hates hospitals and that he will sue you for touching him. He says that he does not want any more of your” worthless treatment”. What is the best response to this patient?

• A. “you are free to leave at any time”• B. “we cannot release you until you are sober”• C. “have you been arrested for alcohol-related offenses in

the past ?”• D. “do you normally require an “eye opener” when you

wake in the morning”?• E. “ do you have an alcohol problem ?”

• You are caring for a 78-year-old male in the cardiac ICU. He was admitted for chest pain and on his admission cardiac troponins were elevated. The interventional cardiologist is planning to take the patient for an emergent cardiac catheterization. While you are discussing the diagnosis and planned treatment with the patient, he states that he is afraid of dying during the procedure and asks you to pray for him. Which of the following is the most appropriate reply?

• A.” I will be happy to call a chaplain for you , sir”• B. “I am not religious, but if you are ,that can be helpful”• C.” I will keep you in my thoughts and prayers”• D. “we are not of the same faith, so my prayers may not

help you”• E. ” praying is fine, but it has been scientifically shown not

to be efficacious”

You are on the inpatient service to a community hospital. One of your patients is a 78-year-old African American female who you have just diagnosed with pneumonia. She has a past medical history significant for severe coronary artery disease, diabetes and chronic low back pain from degenerative joint disease. She has been homebound and bedridden for years. You present her with her diagnosis and you plan to treat her with antibiotics, and she replies that she does not wish to be treated. You explain that if this infection is not treated she will likely die from an overwhelming infection. She voices understanding of her illness and the possible consequences of not treating it, and she still continues to refuse treatment. Who should make the decision about whether or not to administer antibiotics to this patient?

• A. the patient’s adult son• B. the patient’s spouse• C. a federal judge• D. The patient• E. the hospital ethics committee

A physician staff in the emergency room at an urban trauma center is caring for a mother and her 6-year-old daughter who were both injured in a motor vehicle accident. The patients have both been seriously wounded sustaining blunt abdominal trauma and peritoneal lavage reveals blood in both patients. Both patients have a clouded sensorium and do not respond appropriately to questions. The husband and father of the patients’ arrived at the hospital with the patients, and when the need to operate on both of the patients was discussed with him he states that his wife and his daughter cannot receive blood products because it is against their religious beliefs. The physician discussed the risks of operating without blood products with the husband at length, but he continued to refuse stating that his family “would not go to heaven” if these products were administered. The physician plans to treat both patients aggressively with crystalloid solutions and appropriate interventions, but should the need for blood products arise what is the best course of action?

• A. administer blood products to both the mother and the daughter because you can not be sure that they share the religious beliefs of the father

• B. administer blood products to the mother because she is an adult, but the father is the automatic next-of-kin for the child, so his wishes must be respected

• C. seek a court order to administer blood products to the mother and the child

• D. the husband’s wishes for his wife must be respected, but a court order should be sought to intervene on the child’s behalf for life-saving treatment

• E. because the husband does not have documents stating that he is the durable power of attorney for health care for either of these patients, his wishes are irrelevant. Treatment should be rendered.

• You are caring for a 56-year-old male who was admitted for chest pain. His cardiac troponins are elevated and a cardiac catheterization is planned for that evening. When you are exiting the patient’s room after discussing the catheterization with him you encounter his wife who has just arrived at the hospital. She quickly asks what has happened to her husband and what is planned. What is the most appropriate course of action?

• A. inform the patient’s wife of his condition because she is his legal next of kin

• B. discuss end of life care and “Do not resuscitate” orders with the patient’s wife because of his serious condition

• C. do not discuss the patient’s status with the wife because she may not have the patient’s best wishes in mind

• D. do not discuss the patient’s status with the wife because the patient has not granted permission for his medical care to be discussed with her

• E. inform the patient’s wife that the patient has had a heart attack, but also tell her that she must not discuss any further details with her husband

• A 48-year-old male presents to your office as a new patient demanding that you sign a disability form so he can continue to collect a disability benefit without working. When you ask what his disability is, he angrily retorts that his back is hurt as he slams his disability form down in front of you. You feel yourself becoming annoyed by the patient’s threatening behavior. Which of the following is the most appropriate course of action?

• A. inform the patient that he must respect you in order to continue to see you as his physician

• B. exit the exam room and call the authorities to report this patient’s attempt at disability fraud

• C. calmly inform the patient that you can not sign his form because you will be unable to care for him due to his abusive behavior

• D. sign the patient’s form because he is clearly suffering from a painful and limiting condition

• E. clarify what information you need from the patient in order to legally sign his form and ask the patient to tell you more about his back