THE ETHICAL FOUR
A doctor respects a patient's decision to refuse treatment, even though the doctor believes it would help them.
Which principle of medical ethics is being demonstrated?
Autonomy
A medical student posts a picture of a patient's medical chart on their private Instagram story.
What ethical responsibility has been violated?
Patient confidentiality
A patient says they do not understand the procedure they are about to undergo, but the physician is running behind schedule. What should the physician do?
A. Proceed because the patient signed a form
B. Explain the procedure and answer questions
C. Ask the nurse to convince the patient
D. Cancel the procedure immediately
B. Explain the procedure and answer questions.
Before surgery, a patient receives an explanation of the procedure, its risks, benefits, and alternatives. What is this process called?
Informed consent
A physician considers prescribing a medication that could help a patient but also carries serious side effects. Which ethical principle emphasizes avoiding unnecessary harm?
Nonmaleficence
A physician carefully considers the risks of a medication to avoid causing unnecessary harm to a patient.
Which ethical principle is demonstrated?
Nonmaleficence
A healthcare worker recognizes a patient from their neighborhood and tells a friend that they saw that person at the hospital. Why might this be an ethical violation?
It may disclose confidential information about a patient's healthcare. Even revealing that someone is receiving medical care can compromise privacy.
A patient tells their doctor that they are afraid of an upcoming surgery and have several questions.
What is the most appropriate response?
Listen to the patient's concerns, answer their questions, and ensure they understand their options.
A patient signs a consent form but changes their mind immediately before a procedure.
Can the patient withdraw consent?
Yes!
Two patients need the same limited medical resource. One is wealthy and offers to pay extra to receive it first. Which ethical principle argues against prioritizing someone simply because of their wealth?
Justice
A hospital has only one available ICU bed, but two patients urgently need it. The medical team must determine how to allocate the bed fairly.
Which ethical principle is most directly involved?
Justice
A patient's mother calls the hospital asking about her 22-year-old daughter's test results. The daughter has not authorized sharing her information. Should the healthcare provider share the results?
No, unless another applicable legal permission or exception allows it.
A physician makes a medication error, but the patient does not appear to have experienced any harm. What is the most ethical next step?
A. Say nothing because no harm occurred
B. Wait for symptoms
C. Report the error and follow the appropriate disclosure process
D. Ask another physician to take responsibility
C. Report the error and follow the appropriate disclosure process.
A patient refuses a recommended medical treatment because they prefer a different approach. What must the healthcare professional do before accepting the refusal as informed?
Explain the relevant risks, benefits, and alternatives, and assess the patient's understanding and decision-making capacity.
An informed refusal requires meaningful understanding.
Two patients are waiting for an organ transplant, but only one organ is available. Should the organ automatically go to the person who has waited longest?
No.
Organ allocation follows established criteria that can include medical urgency, compatibility, waiting time, and expected benefit, depending on the organ.
A patient with advanced cancer wants an experimental treatment with significant risks and very little evidence of effectiveness. The patient understands the risks and still wants it.
Which two ethical principles must the physician balance?
Autonomy and nonmaleficence
A medical student discovers that a patient with HIV is dating one of their close friends. What should the medical student do?
A. Warn their friend
B. Maintain confidentiality and raise concerns through appropriate clinical channels
C. Confront the patient and demand disclosure
D. Tell the friend anonymously
B. Maintain confidentiality and raise concerns through appropriate clinical channels.
A conscious 45-year-old patient with severe internal bleeding refuses a life-saving blood transfusion because of religious beliefs. The patient understands the consequences. What should the physician do?
A. Give the transfusion anyway
B. Confirm decision-making capacity and informed refusal, then respect the decision
C. Ask family to override the refusal
D. Sedate the patient and transfuse
B. Confirm decision-making capacity and informed refusal, then respect the decision.
An elderly patient with dementia is confused about the date and location but clearly explains the purpose, risks, and benefits of an upcoming surgery. Does having dementia automatically mean the patient cannot consent?
No.
Decision-making capacity is decision-specific. Dementia alone does not automatically remove the ability to provide informed consent.
A hospital can fund either a very expensive treatment for a small number of patients with a rare, life-threatening disease or a less expensive program benefiting many patients with a common chronic condition. Which ethical principle is involved, and why is the decision difficult?
Justice. The hospital must balance fairness, medical need, expected benefits, equity, and the number of people who could receive care.
A patient has terminal cancer. Before the physician shares the diagnosis, the patient's family asks the physician not to tell the patient because they fear the emotional distress it may cause. What is the most ethical approach?
A. Follow the family's wishes
B. Tell the patient immediately without considering their preferences
C. Ask how much information the patient wishes to receive
D. Allow the family to decide
C. Ask how much information the patient wishes to receive.
A patient has a serious communicable disease and refuses to notify people who may have been exposed. Under what circumstances might confidential patient information be disclosed without consent?
When disclosure is legally required or permitted, such as certain public health reporting or notification procedures.
An unconscious patient arrives with life-threatening injuries and requires immediate surgery. No family members or applicable advance directives can be located. What should the physician do?
A. Wait for family consent
B. Proceed under the emergency exception to informed consent
C. Refuse treatment
D. Ask another patient for permission
B. Proceed under the emergency exception to informed consent.
An unconscious patient has a valid advance directive refusing mechanical ventilation in the exact circumstances they now face. Their family demands that the physician place them on a ventilator. What should guide the physician's decision?
A. The family's wishes
B. The patient's valid, applicable advance directive
C. The physician's personal beliefs
D. Whichever option avoids conflict
B. The patient's valid, applicable advance directive.
Two patients need a liver transplant and have similar predicted outcomes. Patient A is 28 and has liver failure associated with a history of alcohol use disorder; they have completed treatment. Patient B is 52 and has liver failure from an inherited condition. Both have strong support systems. Should the cause of liver disease automatically determine who receives the transplant?
No. Allocation should follow established medical and ethical criteria rather than assumptions about personal blame or deservingness.