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Legal Medicine and Medical Ethics

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Legal Medicine and Medical Ethics

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Sample practice questions

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1) Which principle of ethics says to "do no harm"?
  1. Beneficence
  2. Justice
  3. Nonmaleficence
  4. Respect for autonomy
2) The principle of double effect:
  1. is a principle of diminishing returns
  2. is the Principle of Utility
  3. means it is acceptable to knowingly cause harm in pursuit of some good
  4. means it is not acceptable to knowingly cause harm in pursuit of some good
3) A fully conscious and oriented patient with advanced renal cancer expressed clearly his wish verbally to his treating doctor not to receive chemotherapy or resuscitation. He would prefer to die in peace. A few days later, the patient becomes unconscious. The patient’s family asks the doctor to give the patient chemotherapy. What should you do if you recognize a conflict between the known verbal wishes of a patient and the decision of his family?
  1. Be ready to seek a court intervention
  2. Don’t listen to the family
  3. Follow the family’s request, and give chemotherapy
  4. Refer the patient to another team for second opinion
4) What is required for maintaining human dignity, or remaining human, in bio-ethics?
  1. A good
  2. A necessary good
  3. A transcendental good
  4. An obligatory good
5) Understanding and appreciating patient’s need and worries are important keys for proper treatment. What is the most worrying and stressing question, any patient may has as you advise him for admission?
  1. How long need I to stay in the hospital?
  2. What is the visiting time?
  3. What is wrong with me?
  4. Who is/are my treating team/s?
6) With regard to relationship with the pharmaceutical industry:
  1. doctors should regularly seek assistance for holidays abroad
  2. must strive to attend all academic activities such as panel discussion and Lectures at holiday resorts
  3. should pay more attention to the pharmaceutical literature
  4. there should be mutual pooling to promote welfare of the health institutions
7) In Behavioral Sciences, the Bio-Psycho-Social (BPS) model of health care is best described as:
  1. a method in which a patient should be seen psychologist and a social worker
  2. biological aspects of disease being more being more important than psychosocial aspects
  3. the management of Psychological and social Issues of patients
  4. the use of social and psychological factors alongside the biological aspects of the illness
8) Granted informed consent ethically means:
  1. a routine procedure in the hospital
  2. the patient and family signed to accept complications including death as outcome of treatment or surgery
  3. the patient consents to accept any complication
  4. the physician/surgeon should do what is medically indicated, and ought to be for the good for the patient and cause no harm
9) A hospital has a large number of unreported incidents of needle stick injuries. There is no reporting system in place. The victims of maleficence here are the:
  1. communities
  2. employees
    Health care organizations are responsible for employees’ safety and health. Occupational and safety health acts (OSHA) give employees rights to a safe and secure environment in any organization. If health care institutions do not take care of their employees then the employees are victims of maleficence.
  3. families
  4. patients
10) According to the ethical principles, the benefits we are obliged to provide as healthcare professionals are specified in part by:
  1. our contract with the hospital or clinic
  2. our employer, the law, our conscience
  3. our relationship, role, and agreements
  4. our upbringing and personal values
11) Medical ethics concerns the importance of patients understanding the consequences of their consent. Which of these is often left out but may be just as important to the patient?
  1. Understanding the expense (there may be hidden costs)
  2. Understanding the harm it might cause physicians (it might increase hospital costs)
  3. Understanding the legal consequences (it might get them into trouble)
  4. Understanding the nature of their consent (it may involve lying, breaking a promise, etc.)
12) Bioethics science suggests that health care has moved, historically, from the __________ model to respect for autonomy.
  1. Contractual
  2. Covenant
  3. Engineering
  4. Priestly
    In the Priestly Model, the patient relinquishes his moral authority and puts full decision-making responsibility in the hands of the physician
13) People with a Type A personality have an increased risk of:
  1. ear disease
  2. eye disease
  3. heart disease
  4. psychiatric disorders
14) A 25-year-old healthy man dies in a fatal road traffic accident; he has advance directives about his organ donations. Who would most likely receive the man's liver?
  1. A 45-year-old alcoholic with irreversible liver failure
  2. A 75-year-old women with extreme dementia and end-stage renal failure
  3. A 35-year-old entrepreneur with acute renal failure
    Many factors are considered when rationing donated organs, like life expectancy, quality of life after transplantation, social utility, and the utilitarian view of which recipient does the greatest good to society.
  4. A 10-year-old boy with multi organ failure and brain death
15) The four main principles of medical ethics are:
  1. autonomy, nonmaleficence, beneficence, and justice
  2. autonomy, privacy, respect, and confidentiality
  3. veracity, privacy, beneficence, and nonmaleficence
  4. veracity, privacy, confidentiality, and fidelity
16) A 35-year-old man is admitted with pain in the right knee. Investigations reveal that he is suffering from end-stage osteosarcoma and he needs extensive chemotherapy and radiotherapy. He has a living will that if he is ever diagnosed with cancer, he does not want to be aggressively treated by chemotherapy, radiotherapy and other therapies. However, the physician treats him with all sorts of treatment possible to cure his cancer. The physician is exercising:
  1. ideal beneficence
  2. obligatory beneficence
  3. paternalism
  4. specific beneficence
17) A 34-year-old woman comes to the ER with her 20-day-old baby who is suffering from a lesion in his groin. The ER nurse notices the lesion and knows that such lesions in neonates, if not treated timely, can lead to fatal outcomes. However, the ER physician examines the baby and finds him to be alert, pink and active, and so sends the baby back home. 24 hours later, the baby returns to the ER. He is unconscious, cyanosed, and has severe breathlessness and several lesions on his trunk. The health care providers have committed which form of harm to the patient?
  1. Advertent negligence
    Advertent negligence involves when health care providers know that consequences of not performing reasonably required actions in a particular situation could be fatal for the patient.
  2. Assault
  3. Battery
  4. Inadvertent negligence
18) You are a female doctor and a male patient has entered your clinic. He is wearing unsuitable clothes and approaches you very closely and starts asking you personal questions in a seductive tone. What should you do?
  1. Call in a nurse
  2. Call the police
  3. Refuse to examine him
  4. Use open ended questioning technique
19) A doctor, on account of his physical appearance, mannerism, or personality qualities, reminds the patient of his or her father. This is can be explained by the phenomenon of:
  1. confidentiality
  2. informed consent
  3. resistance
  4. transference
20) A 62-year-old man just had a tumour biopsy of the thalamus showing Glioblastoma. As you leave the OR, you see his brother in the hall, and he begs you not to tell his father because the knowledge would kill him even faster. A family conference to discuss the prognosis is already scheduled for later that afternoon. What is the best way for the doctor to handle this situation?
  1. Patient should withhold informing the patient about the seriousness of the Glioblastoma because of the grave diagnosis
  2. The doctor should ask the patient how he wants to handle the information in front of the rest of the family, and allow for some family discussion time
  3. The doctor should honor the request of the family member who is protecting his beloved brother from the bad news
  4. The doctor should tell the brother that withholding information is not permitted under any circumstance
21) A 75-year-old male patient suffering from metastatic cancer of the prostate is admitted to hospice for palliative comfort care. He asks the doctor to increase his dose of narcotics analgesics to relieve his pain and suffering. However, the doctor is reluctant to increase the dose because the patient already has the maximum possible dose of analgesics and a further increase in dose will only hasten the patient’s death. Under the rule of double effect (RDE), to maximize comfort and to decrease pain and suffering, analgesics’ dose could be increased. The physician can take decisions only if it satisfies the following:
  1. The nature of the act
  2. The agent’s intention
  3. The distinction between means and effects
  4. All of the above conditions must be fulfilled to justify that benefits outweigh the harm
    The rule of double effect could be implemented if the agent’s intention is to relieve suffering and not killing of the patient. The nature of the act is not vicious but it is to promote good. The transparent line must be visible between means and effects and it should satisfy the ethical principles. Furthermore, good effects must outweigh the bad effects of the action e.g. every medicine used in cure has side effects yet regulatory bodies approve them on the grounds that they cause more good than harm.
22) Paternalism among doctors is not an ethical attitude because it conflicts with:
  1. doctors' autonomy
  2. doctors’ tasks and duties
  3. medical care
  4. patient autonomy
23) You operated on a 46-year-old patient for removal of large ICH. The patient remained in a coma. Three days later, the patient had a heart attack and died in ICU. As you are leaving the ICU, the patient’s wife rushes to you in the hospital corridor, asking about her husband. What should you do?
  1. Ask her to bring members of her family and meet you later
  2. Calm her and ask a nurse or other female doctor to join you to a private room to inform her about the death of her husband
  3. Inform her that her husband just passed away
  4. Refer her to the ICU staff to ask them
24) A famous movie star fractures his vertebrae due to an accident and becomes quadriplegic; he is paralyzed below the neck. He made his advance directive that clearly states that he no longer wanted to live a life of a persistent vegetative state and so he wants physician-assisted suicide. His family is against his decision and wants to make him live. They hope further research in stem cells and genomics will find a cure for his quadriplegic state. Ethical considerations in decision making for the movie star will include:
  1. an integrated model: coherence theory
    Justified physician-assisted suicide requires many conditions to fulfill before actual action should take place. No single decision making model or theory could lead to durable solution where everyone concerns are solved without compromising human rights, ethical obligations and personal preferences. An integrated model: coherence theory basically deals with that patient’s benefits come first and then these benefits are seen in coherence with families, society, community, nation and global perspective of effects on human beings and humanity in reflection to equity, equality, morality, norms, values, and social justice (Beauchamp & Childress, 2001; Burkhardt & Nathaniel, 2013; Weir, (Ed.), 1997)
  2. bottom up models: cases and inductive generalization
  3. four quadrant approach: Aristotle virtue theory
  4. principlism and common morality theory
25) The concept of justice in ethics is:
  1. For all medical Professionals to do good for all patients under circumstances
  2. an obligation of the patient to the society
  3. taken as patients right to choose or refuse treatment
  4. that the health resources must be distributed according to the principals of equity
26) Informed consent should not include the “Patient Preference rule” for specifying questions because these questions:
  1. absolve patients from their duties
  2. invite wasting time with silly questions
  3. suggest patients are competent to make decisions themselves
  4. take power out of the hands of doctors
27) Medical ethics:
  1. is covered by Hippocratic Oath
  2. is the code of conduct of doctor’s professional life
  3. is the study of legal aspects of a doctor’s professional life
  4. is the study of moral aspects of a doctor’s professional life
28) The information in informed consent must be:
  1. communicated free of emotion
  2. delivered in writing
  3. strictly medical
  4. understood by the patient
29) Which of these is not considered when triaging patients?
  1. Excessive bleeding
  2. Pain
  3. Patient responsibility for their condition
  4. Spine injuries
30) How should you ethically handle cases of “double effects” where your surgical or medical action will produce both bad results and good results?
  1. Your actions should be written in literature
  2. Your actions should conforms to society’s norms
  3. Your actions should not go directly against the dignity of the patient
  4. Your actions should should be endorsed by senior consultants
31) The classification of patients as intellectually subnormal or confused may put ethical consideration on:
  1. their ability to give informed consent
  2. their autonomy
  3. their guilt of negligence
32) You are a male doctor and a female patient comes to your clinic wearing revealing clothes. She comes up very close to the doctor and starts asking personal questions in a seductive tone. What would be the appropriate response?
  1. Ask about her personal life
  2. Call in a nurse
  3. Refuse to examine her
  4. Use an open ended questioning technique
33) The bio-ethical principle and the rational choice principle mainly guide:
  1. insurance companies
  2. patients
  3. physicians
  4. surrogates
34) In the context of patient rights, the principle of autonomy is best described as:
  1. self-awareness
  2. self-governance
    The autonomy principle of bioethics is the right of individuals to make their own decisions regarding their healthcare. The right to make your own decisions is often referred to as self-governance.
  3. self-promotion
  4. selfishness
35) What are the four pillars of medical ethics?
  1. Beneficence, non-maleficence, justice, and autonomy
    The four pillars of medical ethics are:
    • Beneficence (doing good)
    • Non-maleficence (avoiding harm)
    • Justice (fairness)
    • Autonomy (respecting patients’ rights to make decisions about their care)
  2. Dignity, privacy, compassion, and accountability
  3. Professionalism, consequentialism, trust, and responsibility
  4. Professionalism, sensitivity, integrity, and confidentiality

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