Medical Ethics 3

M E D IC AL E T H ICS

1. A m other refused im m unization for her 2-m onth-old son. (Im portant for Board exam ination)
N ext step in managem ent: imm unization should not be given except during an epidem ic.

2. A m other refused surgery for suspected appendicitis for her 6 -year-old daughter. The social worker spoke to the m other.
(Im portant for Board exam ination)
N ext step in M anagem ent: surgical rem oval of the appendix should be perform ed for the benefit of the child.

3. A 16-year-old boy w as diagnosed with osteosarcom a of the right thigh. The surgeon recom m ended am putation. The boy refused
am putation. H e is doing very w ell otherwise. H e is aw are that death is certain without surgery. (Im portant)
N ext step in m anagem ent: am putation should not be perform ed.
Adolescent patients or adults who are com petent in m aking decisions have an absolute right to determ ine what shall be done
with their own bodies. H owever, m ost pediatric patients are not com petent to m ake their own decisions. Please rem em ber,
children (15 years or older) are usually able to give a genuinely inform ed consent. Therefore physicians m ay respond to
their requests, except in a case of irreversible sterilization.

4. A 17-year-old girl is a Jehovah’s witness. She refused a lifesaving blood transfusion. She is aw are of th e consequences. She spoke
to the social worker. (Im portant)
N ext step in m anagem ent: blood transfusion should not be given because she is com petent to m ake the decision.

5. A 5-year-old girl is a Jehovah’s witness. She requires em ergency blood transfusion. H er m other refused blood transfusion. A social
worker along with two physicians, spoke to the m other (Im portant)
N ext step in m anagem ent: blood transfusion should be given because the patient is not com petent. M other cannot refuse her
daughter’s treatm ent.

6. A 2-year-old boy was brought to the E R by his parents for an injury. Physician m ade the diagnosis of child abuse. There are three
other children living in the sam e household. Both parents confessed to child abuse but requested the physician to keep it
confidential. Social w orker w as involved. (Im portant)
N ext step in m anagem ent: the case should be reported to Child W elfare Agency (CW A). All children should be rem oved from
the parents.

7. A 15-year-old boy with STD (sexually transm itted disease) cam e to see a physician. H e asked the physician not to tell his parents.
(Very im portant)
N ext step in m anagem ent: the physician should treat the patient and notify the appropriate health authority, but should not tell
his parents.

8. A 16-year-old boy w ants to use a c ondom . H e com es to the clinic for free sam ples. H e requested the physician, how ever, not to
tell his parents. (Im portant)
N ext step in m anagem ent: condom should be given and physician should not tell his parents.

9. A 17-year-old m ale patient is recently dia gnosed with H IV. H e lives with his girlfriend but is prom iscuous. H e requested the
physician not to tell his girlfriend. H e lost his job recently. Social w orker spoke to the patient. (Very im portant)
N ext step in m anagem ent: physician should notify the app ropriate authority (e.g., departm ent of health) for the safety of other
specific persons who are engaged in unsafe sexual practices. The physician, how ever, should ask the patient to divulge the
diagnosis to his girlfriend and other sexual partners.

10. A very sm all prem ature infant was born in the delivery room by N SVD (norm al spontaneous vaginal delivery). The attending
physician decided not to resuscitate the newborn. Physician spoke to the m other. M other started to cry. N ewborn expired after 30
m inutes. Is the physician liable for newborn’s death?
Answer: N o.

11. A physician picked up a car accident victim from the street and brought him to the E R in his car. H e did not w ant to w ait for an
am bulance because the patient’s condition w as critical. Physical exam i nation in the E R reveals quadriplegia. Is the physician liable
for this consequence? (Very im portant)
Answer: yes, because the physician did not protect the neck of the patient resulting in quadriplegia.
4 Medical Ethics

12. A policem an brought an adolescent alcoholic patient to the E R. The policem an asked the physician to give him a sam ple of gastric
contents by putting a nasogastric tube for laboratory study. The patient refused insertion of a nasogastric tube. (Very im portant)
N ext step in m anagem ent: nasogastric tube should not be placed. Blood alcohol level, however, should be perform ed. The
policem an should not give orders to a physician.

13. A 15-year-old hom osexual boy w anted to change his sexual orientation. H e w as not successful. H e needed help. H e requested the
physician not to tell his parents. (Im portant)
N ext step in m anagem ent: physician should help him avoid hom osexual activities. Physician should not tell his parents about
his hom osexual activities.

14. A 15-year-old hom osexual boy w as brought by his parents to a physi cian. H is parents do not accept their son’s sexual orientation.
The boy refused to change. (Im portant)
N ext step in m anagem ent: physician should tell his parents that hom osexual activity is considered as an alternative life style.
Parents should talk to his son but should not force him to change his hom osexual activities.

15. A 16-year-old girl becom e pregnant. H er m other w anted her to abort this pregnancy. The girl w anted to continue her pregnancy
despite difficulties. H er boy friend is a high school drop out . (Im portant)
N ext step in m anagem ent: physician should advise to continue this pregnancy because the girl is com petent to m ake this
decision.

16. A 15-year-old girl recently becom es pregnant. She w ent to a doctor for abortion. She told the doctor not to tell her parents about
this pregnancy. (Im portant)
N ext step in m anagem ent: abortion should be done and parents should not be notified. Please rem em ber, strict requirem ents
for parental consent m ay deter m any adolescents from seeking health care.

17. Can a physician provide sterile needles for intravenous drug abusers? (Im portant)
Answer: yes. It reduces the risk of acquiring H IV or hepatitis. The patients should be referred to appropriate health facilities.

18. A 17-year-old pregnant wom an went for antenatal check u p. Sonogram revealed a 27 -w eek-old fetus with erythroblastosis fetalis.
D octor recom m ended intrauterine fetal blood transfusion. She refused the procedure. Social worker discussed the case with the
m other. (Im portant)
N ext step in m anagem ent: doctor should receive a court order to do the procedure which will help the fetal condition.

19. A 17-year-old m an tells his doctor that he is going to kill his girlfriend. She lives in the university dorm itory. D octor called the
university and alerted them about the thre at. H ow ever, university security people did not protect her. She was killed by her
boyfriend. W ho should be responsible for this killing? (Im portant)
Answer: The 17-year-old m an is responsible. D octor did the right thing by notifying the university or the police. The university is
also responsible because they did not take any preventive m easures.

20. A 16-year-old pregnant wom an refuses cesarean section for com plete placenta previa. Fetus is full -term and healthy. Social worker
spoke to the m other. (Im portant)
N ext step in m anagem ent: doctor can go to court to get the perm ission for cesarean section for the benefit of the fetus.

21. A 16-year-old pregnant wom an ingested alcohol and illicit drugs (e.g., cocaine, crack) which are harm ful to the fetus. W hat should
a physician do? (Im portant)
A nsw er: T he ph ysician shou ld be carefu l in repo rting th is case becau se th e pregn ant w o m an m ay n ot co m e b ack for pren atal
care, w h ich is im p ortan t for b o th th e m o th er an d th e fetu s. H o w ev er, if the b ab y’s urin e tox icolo gy test is po sitiv e fo r illicit
drug s, case sho uld b e reported to C W A (C h ild W elfare A g en cy ). C W A sugg ests sep arate cu sto dy, fo r th e ch ild .

22. A physician w ants to study a group of children aging from 10 -12 year old. Physician already got the consent from the parents.
H ow ever, he didn’t discuss the study w ith the children. A child refused to participate. Should the physician force the child to
participate? (Im portant)
Answer: no, because a child can refuse to participate, in a research study.

23. A child needs hernia repai r. H is m other is a 40 -year-old schizophrenic patient. Surgeon discussed the procedure with the m other
who understood the procedure. Can the m other give consent? (Im portant)
Answer: yes. If a psychiatric patient understands the procedure, he or she can give the consent.
 Medical Ethics 5

24. A newborn needs a com plicated cardiac surgical procedure. H is m other is a schizophrenic patient. Cardiologist explained the
procedure to the m other who did not understand the procedure. W ho can give the consent on behalf of the patient? (Im portant)
Answer: the patient’s relative can give the consent. If nobody is available to give the consent, court order should be obtained. If a
psychiatric patient does not understand the procedure, he or she cannot give the consent. Cardiothoracic surgeon sh ould obtain
the consent.

25. A 25-year-old wom an developed postpartum psychosis. The new born developed cyanosis due to congenital heart disease. The
new born needs cardiac surgery. Surgeon discussed the procedure with the m other. She understood the procedure. Can she give
the consent? (Im portant)
Answer: yes, because she understood the procedure.

26. A newborn is diagnosed with either trisom y 18 or 13 with TE (tracheoesophageal) fistula w hich requires surgery. M other
requested surgeon to repair the TE -fistula. W hat should a surgeon do? (Im portant)
Answer: surgeon should refuse to do the reparative surgery because these conditions (trisom y 18 or 13) are nonviable. If the
patient survives, surgeon can put a gastrostom y feeding tube for nutrition. H owever, please rem em ber that a patient with
trisom y 21 (D ow n syndrom e) with T E fistula should be operated on.

27. A 17-year-old term inally ill patient wanted to die. H e has been suffering from constant pain. H e asked the physician to give him
som e m edication which can expedite his death. W hat should a physician do? (Very im portant)
Answer: physician cannot give any m edication which will expedite the death. H ow ever, physician can prescribe m edication to
m inim ize the pain. The dose should be appropriate. Physician -assisted suicide is illegal everywhere (except in the state of O regon).

28. A 17-year-old boy cam e to a doctor for recurrent UTIs and dysuria. The diagnosis of (E SRD ) end stage renal disease w as m ade
after appropriate investigations. Should the doctor tell the bad new s to th e patient? (Im portant)
Answer: yes, physician m ust tell the truth to the patient.

29. Can a m edical student introduce him self or herself as a ‘doctor’ to the patient? (Im portant)
Answer: no. A patient can refuse a m edical student from perform ing any procedure . H owever, m edical students are allow ed to
perform a procedure under appropriate supervision if the patient agrees to that.

30. A 18-year-old m an is diagnosed to have suspected bacterial m eningitis. H e refused therapy and returned to the college dorm itory.
W hat should a physician do in this situation? (Very im portant)
Answer: physician should report to the college authority and recom m end that the suspected individual should be isolated during
the course of his illness.

31. A 16-year-old m an with severe head injur y w as adm itted to a sm all hospital. The patient needs neurosurgical intervention which is
available in a nearby university hospital. H ospital refused to accept a patient who has no m edical insurance.
Answer: university hospital m ust accept the patient.

32. A newborn m ale is diagnosed w ith anencephaly. H is 1 -year-old sibling needs a kidney. H is parents requested the physician to
rem ove the kidney from the anencephalic child and to transplant that kidney in the 1 -year-old sibling. W hat should a physician
do? Answer: surgeon should perform the kidney transplantation.

33. A 17-year-old wom an slashed her wrists and w anted to die. She was unconscious and w as brought to the E R. W hat should a
physician do? (Im portant)
Answer: physician should take care of the patient. Psy chiatric consultation and social worker evaluation are indicated. A suicide
attem pt is very often a ‘cry for help’.

34. A 1-day-old infant w as diagnosed with hypoplastic left heart syndrom e. The patient is stabilized with the use of prostaglandin.
Physician discussed this case in detail with the parents. W hat should the parents decide in this situation?
Answer: the parents can choose a staged surgical repair of the heart, a final heart transplantation if the organ is available, or allow
the infant to die.

35. A 13-year-old boy with suspected m eningitis refuses therapy. H is parents also support that decision because they are supposed to
go on vacation the following day. W hat should a physician do in this situation? (Im portant)
Answer: the patient should be adm itted and treated in the hospital. If they refuse therapy, legal action should be taken.
6 Medical Ethics

36. A 2-year-old girl is adm itted with the diagnosis of intestinal obstruction. H er m other has a psychiatric problem . H er m other is not
capable of giving the consent. H er fathe r died one year ago. W hat should a surgeon do in this situation?
Answer: legal steps m ay be taken to provide a surrogate decision -m aker.

37. A 17-year-old boy cam e to a surgeon for bilateral vasectom y. H e is the father of one child and does not w ant to have a ny m ore
children. H e does not w ant to tell his girlfriend and parents? H e lives with his parents. W hat should a surgeon do in this situation?
(Im portant)
Answer: surgeon should not perform bilateral vasectom y and should offer him less radical alternatives. Please rem em ber, a
m ature m inor m ay not com prehend the im plications of this procedure.

38. A 16-year-old girl cam e to a doctor for bilateral tubal ligations. She is a m other of one child and does not to have any m ore
children. She does not w ant to tell her b oyfriend and parents. She lives with her parents. W hat should a doctor do in this
situation? (Im portant)
Answer: obgyn doctor should not perform bilateral tubal ligations and should offer her less radical alternatives.

39. A 16-year-old boy w ants to donate on e of his kidneys to his friend who is suffering from ESRD (end stage renal disease). The
boy’s parents did not agree with his decision. W hat should a physician do in this situation? (Im portant)
Answer: the physician cannot accept his kidney. H ow ever, he ca n donate one of his kidneys if, his parents agree.

40. A 15-year-old boy w ants to participate in a research study. H e told his parents who did not agree. H e lives with his parents. Can
this boy participate in the research study?
Answer: no. The boy needs cons ent from his parents to participate in a research study.

41. A 17-year-old boy lives independently. H e is m arried and has one child. H e w ants to participate in a research study. D oes he need
his parents perm ission? (Im portant)
Answer: no. H e is an em ancipated m inor w ho lives independently from his parents physically and financially.

42. An infant, born at 30 w eeks gestation, appears to be SG A (sm all for gestational age) with m ultiple m alform ations. Am niocentesis
study w as not perform ed. Infant needs resuscitation at birth. W hat should a physician do in this situation? (Im portant)
Answer: physician m ust resuscitate the patient in the delivery room because the diagnosis is uncertain.

43. A 10-year-old boy is diagnosed w ith term inally ill bone cancer and needs resuscita tion. H is parents did not sign a D N R order. The
physician has decided to perform a ‘slow code’ on his own. Is this the right decision? (Im portant)
Answer: no. Please rem em ber, a perform ance of ‘slow code’ or ‘show code’ is not acceptable to the patient. Th is decision by
the doctor represents the failure to com e to a tim ely and clear decision about a patient’s resuscitation status.

44. A 17-year-old m an is diagnosed with suspected bacterem ia and m eningitis. H e refuses antibiotic therapy. H e collapses and
requires resuscitation. W hat should a physician do in this situation?
Answer: the physician should resuscitate the patient despite the patient’s refusal to antibiotic therapy.

45. A 14-year-old boy is diagnosed w ith term inally ill cancer. H e is not responding to ch em otherapy. H is parents w ant to continue the
treatm ent. H ow ever, the boy does not w ant to continue his suffering. The physician told the parents that chem otherapy will not
be helpful. W hat is the appropriate decision at this point? (Im portant)
Answer: the boy’s decision should be respected because the treatm ent is futile.

46. A physician becam e sexually involved with a current patient who initiated or consented to the contact. Is it ethical for a physician
to becom e sexually involved?
Answer: no. Sexual involv em ent between physicians and form er patients raises concern. The physician should discuss with a
colleague or other professional before becom ing sexually involved with a form er patient. The physician should term inate the
physician-patient relationship befo re initiating a rom antic or sexual relationship with a patient.

47. A physician decided to take care of his ow n fam ily m em bers and relatives. H e is very sm art physician. Is this a right decision?
Answer: no. The physician should encourage all friends and fam i ly m em bers to have their own personal physician.

48. A father w ants to have a copy of his child’s m edical records. W hat should a physician do in this situation?
 Medical Ethics 7

Answer: the physician should retain the original chart. Inform ation should only be released with the w ritten perm ission of the
m other or the patient’s legally authorized representative (e.g., attorney). Father can also obtain the copy of the child’s m edical
record if he has the proof that he is the father of the child.

49. A physician sees patients at a reduced fee. H e spends very little tim e with each patient. Is the physician doing the right thing?
Answer: no. The physician is not providing optim al care.

50. A 3-year-old girl is diagnosed w ith blood cancer. She has been waiting for an um bilical cord blood transfusion. H er m other
delivered a newborn baby girl. U m bilical cord blood w as obtained and w as transfused to the 3 -year-old sibling. W hat is the duty of
the physician?
Answer: physician should obtain an inform ed consent of the risks of donation and he or she should follow the norm al um bilical
cord clam ping protocol. Physician should protect both the children.

51. The residents and m edical students w ere asked by an attending to follow certain orders for a patient. The residents and m edical
students believe th e orders reflect serious errors in clinical or ethical judgem ent. W hat is the appropriate w ay to handle the
situation? (Im portant)
Answer: The residents and m edical students should not follow those orders. They should discuss with the attending issuing tho se
orders. They should also discuss the situation with a senior attending physician, a chief of staff, or a chief resident.

52. A physician used a newly prescribed drug to his patient. The patient got sick after the drug w as ingested and required
hospitalization. Should the physician report this drug’s side effects to FD A (Food and D rug Adm inistration)? (Im portant)
Answer: yes. FD A should be notified only if the drug causes serious adverse events such as those resulting in death,
hospitalization, or m edical or surgical intervention.

53. A 17-year-old girl has been suffering from chronic tonsillitis. The EN T surgeon advised tonsillectom y. H er m other w ants a
second opinion. The E N T surgeon agreed. The patient w ent to another EN T surgeon and has decided to be operate d by the
second E N T surgeon. W hat should the second E N T surgeon do in this situation? (Im portant)
Answer: the second E N T surgeon should accept the patient because the m other or the patient has the right to choose the E N T
surgeon. First E N T surgeon should a ccept the patient’s decision.

54. A 19-year-old m ale w as adm itted to the hospital with m ild chest pain. H e w ants to leave the hospital before com pletion
of therapy. H ow do you m anage the patient? (Im portant)
The patient is asked to sign a statem ent that he is leaving against m edical advice (AM A). The patient m ay, how ever, leave
without signing that statem ent. This docum ent is a legal evidence that the patient w as w arned by the physician about the risk of
leaving. Please rem em ber, discharge AM A does not apply to children.

55. W hat is the responsibility of a fellow physician who is aw are of drug abuse, alcohol abuse, or psychiatric illness of his
colleagues or of a m edical condition that is harm ful to patients? (Very im portant)
The physician should protect the patie nts. The fellow physician should report to the appropriate authority (i.e., report to the
hospital authority; report to the D ean for a m edical student’s problem ).

56. A 17-year-old m ale has been suffering from severe pain due to term inal bone cancer. The patient is receiving lower
doses of narcotics and sedatives. H ow can a physician relieve his suffering? (Im portant)
The physician should increase the dosages of narcotics and sedatives up to the m axim um recom m ended am ount. The suffering
can be reduced by liste ning, spending m ore tim e with him , and reducing psychological distress.

57. A fem ale m edical student or resident noticed a m istake m ade by a junior attending physician during rounds. She is
afraid of that attending physician. W hat is the appropriate w ay to handle the situation? (Im portant)
She should discuss the situation with a m ore senior attending physician for appropriate interpretation, advice, and assistance.

58. A m ale m edical student or resident m ade a m istake during patient care. H e is afraid of w hat m ig ht result. W hat is the
appropriate w ay to handle the situation?
H e should disclose the m istake to the attending physician and try to learn from that m istake. The patient should be notified as
well.
8 Medical Ethics

59. A fem ale health care worker is concerned about taking care of patients with H IV infection or m ultidrug -resistant
tuberculosis. W hat is the appropriate w ay to handle the situation? (Im portant)
The physician should provide appropriate care to patients despite personal risk. Institutions should reduce the risk of i nfection by
appropriate equipm ent, supervision, and training. H er concern should be taken seriously.

60. A m ale physician has an opportunity for financial incentive if he sees m ore patients and refers them unnecessarily.
W hat is your opinion about this?
The physician should provide only care that is in the patient's best interest.

61. Two physicians are discussing a case inside the elevator of a hospital. W hat is your opinion about this?
They should not do that because they have to m aintain the patient's confiden tiality.

62. The patient's confidentiality should be m aintained except in the following situation:
Physicians should override third parties in case of dom estic violence, child abuse, elderly abuse, gunshot wounds, syphilis, and
tuberculosis. They should repor t these cases to appropriate governm ental authorities.

63. A physician is experiencing a very difficult ethical issue regarding a com plicated case. H e is confused. W hat should be
the next step?
H e should discuss the m atter with other faculty m em bers in his he alth care team , colleagues, or the hospital ethics com m ittee.

64. W hat is the final plan of action in an ethical issue?

Both patient and physician should agree regarding final m anagem ent. The patient should be w ell -inform ed about the m edical
condition. The ph ysician should be sym pathetic and knowledgeable regarding the relevant m edical condition.

65. D N R (do not resuscitate) order: this is appropriate if the patient or surrogate signed that order or if CPR (cardiopulm onary
resuscitation) would be futile. Physicia ns should w rite D N R orders and the reasons for them in the chart. Please rem em ber,
“slow” or “show ” codes are not acceptable. Foods and fluids are considered therapies that should be stopped. (Im portant)

66. (A) Brain death (adult): (Im portant) (N o need to m em orize the adult part)
(i) D efinition by the President's Com m ittee:
D eath is an irreversible cessation of circulation and respiratory functions or irreversible cessation of all functions of
the entire brain and brain stem .
(ii) The criteria of brain death by the staff of M assachusetts G eneral H ospital and the H arvard Com m ittee:
D eath occurs w hen there is absence of all signs of receptivity, responsivity, and all brainstem reflexes, and the E EG
is isoelectric. Som etim es m etabolic disorders and intoxications m ay m im ic the above findings.
(iii) The guidelines of brain death:
(a) The diagnosis should be m ade also by another physician and confirm ed by clinical findings and E EG .
(b) The fam ily should be notified. They should not m ake the decision about discontinuing of m e dical treatm ent
except in a situation where the patient has directed the fam ily to m ake the decision.
(c) The physician should discuss with another physician before rem oving supportive m easures (e.g.,
ventilators).
(d) Fam ily m em bers m ay request organ donation, and in m any states physicians m ay request the fam ily to m ake
an organ donation.
(B) Brain death (children):
(i) D efinition: sam e as in adults.
(ii) Criteria: sim ilar in children and adults, but the period of observation is longer in children.
Children 1w k-2 m o of age: two separate exam inations 48 hours apart
Children 2 m o -1yr of age: two separate exam inations 24 hours apart
Children m ore than 1 yr of age: two separate exam inations 12 hours apart
Spontaneous m ovem ent m ust be absent, with the exception of spinal cord reflex w ithdrawal and m yoclonus.
G eneralized flaccidity should be present. The presence of clinical criteria for 2 days in term and 3 days in preterm
infants indicates brain death in m ajority of asphyxiated newborns. The absence of cerebral blood flow on
radionuclide scan and silence of electrical activity on E EG are not alw ays observed in brain -dead new borns. There
is no universal consensus about the definition of neonatal brain death. The decision is m ade after discussing with
the fam ily and health care team . If there is difference of opinion, the ethics com m ittee should be consulted. The
decision is m ade on the basis of what is in the best interest of the infants and children.
 Medical Ethics 9

67. Practice guidelines for physicians:

(i) The best way to practice m e dicine is to select useful diagnostic techniques and therapeutic m easures which are m ost
appropriate to a particular patient and clinical condition.
(ii) Practice guidelines can reduce the health care costs, which im proves health care to patients who even do not have
adequate health care benefits.
(iii) Please rem em ber, guidelines do not and should not be the only way of m anaging an individual patient.

68. Som e im portant points about patients:

(i) For a patient with an incurable disease, the m ajor goal of therapy should be the enhancem ent of the quality of life.
(ii) The patient care begins with a personal relationship between the patient and the physician. If a patient has confidence
on the physician, reassurance m ay be the best therapy. The patient m ust understand tha t the physician is giving the
best possible care available.

69. D ow n syndrom e with different m edical conditions: (very Im portant)

(a) D uodenal atresia at birth: surgical repair is recom m ended as it is done regularly.
(b) VSD (ventricular septal defect) in newborn period: initial conservative m edical m anagem ent is follow ed by surgical
repair as it is done regularly.
(c) Cyanotic heart disease at birth: im m ediate m edical m anagem ent, which is follow ed by surgical repair as it is required
routinely.
(d) Cosm etic surgical condition (e.g., rhinophym a or big nose): there is no urgency to repair the underlying condition,
but it can be done as it is perform ed regularly.
(e) N eural tube defects (e.g., m eningom yelocele): surgical repair is recom m ended as it is done regularly.
Please rem em ber, a patient's m anagem ent should be discussed with his/her parents and the decision m ade with the best interest
of the patient in m ind.

70. A healthy m ale patient with D own Syndrom e lives independently. H e w ent to a doctor for facial cosm etic surgery. Can he m ake
his own decision? (Im portant)
Answer: yes. The patient can m ake his decision if he understands the procedure and the consequences. H e lives independently
which indicates that he is capable of m aking his own decision.

71. A term inally ill bone cancer pat ient with m ultiple m etastasis is adm itted to the hospital. H e is in critical condition. The patient
wants to know his prognosis. W hat should the doctor say?
Answer: the doctor should tell the patient politely that he will discuss his condition with him and his fam ily. The doctor should
never specify the longevity of the patient. The doctor should tell the truth even w hen the patient is a child. The doctor should not
hide any m edical inform ation from the patient.

72. An adolescent patient is recently diagnosed with cancer. H e is nervous but is eager to know about his m edical diagnosis. W hat
should the doctor’s reply be? (Im portant)
Answer: the doctor should gently tell the patient his condition.

73. A 17-year-old patient is recently diagnosed with cancer. Previousl y, he had an episode of a nervous breakdown after hearing a
fam ily death and had to be adm itted to a hospital. H e loves his fam ily m em bers and tends to be very open with them on all issues.
H ow should the doctor tell the patient about his current state? (Im portant)
Answer: the doctor should call his fam ily m em bers and discuss the patient’s m edical condition openly and politely.

74. A m ale patient w as adm itted with severe M VA (m otor vehicle accident). H e w as adm itted to the ICU and his condition is very
critical.
H e does not know the reason for his adm ission. The patient is unstable. W hat should the doctor tell the patient? (Im portant)
Answer: the doctor should w ait until the patient is stabilized and then gently tell him his m edical condition.

75. A m other gave b irth to a prem ature baby w ho w as adm itted to the N ICU (N eonatal Intensive Care Unit). The baby is on a
m echanical ventilator. The m other w ants to hold the baby. W hat should a doctor do in this situation? (Im portant)
Answer: the m other should be allowed to hold the baby.
10 Medical Ethics

76. A 17-year-old m ale patient is recently diagnosed with H IV. Should the doctor ask about his sexual orientation (i.e., m ale, fem ale,
or both)? (Im portant)
Answer: yes, the doctor should ask the patient directly but politely about his sexual o rientation.

77. A 16-year-old hom osexual m ale patient w ent to a doctor. The patient’s partner w as recently diagnosed with H IV. Should the
doctor ask the patient whether he is being penetrated by his partner or he penetrates his partner?
Answer: yes, because the person who is being penetrated has a higher incidence of H IV due to traum a in perianal area.

78. A 6-year-old boy w as brought to the E R after drowning. H e expired in the E R despite appropriate resuscitations. The fam ily
m em bers becam e angry which is a refl ection of a sense of guilt and helplessness. W hat is the appropriate w ay of giving
inform ation to the fam ily m em bers?
Answer: the physician should give the inform ation clearly and com passionately when there is no hope for survival. Parents
need to know that everything w as done to save the child.

79. A pregnant w om an who is Rh( -)ve becam e sensitized. She had H /O induced abortions. H er husband is not aw are of his wife’s
previous abortions. H e w ants to know from the physician how she becam e sensitized (Very im portant)
Answer: the physician should tell the m an to ask his wife. The physician should not m ention anything about patient’s H /O
abortions.

80. A m other brought her infant to the E R. The radiologic test reveals old fractures of the ribs. She did not know anythi ng about that
(Very im portant)
Answer: this is a case of child abuse. This case should be reported to child w elfare agency.

81. A Physician is exam ining a child with respiratory distress. The child’s m other becam e anxious during the physical exam ination
(Im portant)
Answer: child abuse

82. A m entally retarded 17 -year-old patient becam e pregnant. The patient does not w ant an abortion. H er m other and husband w ant
abortion. W hat should a physician do in this situation? (Im portant)
Answer: abortion should not be perform ed.

83. A m ale physician is exam ining an adolescent or adult fem ale patient. W hat should a physician do in this situation? (Im portant)
Answer: a chaperone should be present during the physical exam ination. The sam e rules apply w hen a physician is
exam ining a patient w ho appears to be seductive. (Im portant)

84. A fem ale physician is exam ining an adolescent or adult m ale patient. W hat should a physician do in this situation? (Im portant)
Answer: a chaperone should not be present during the physical exam ination .

85. A 18-year-old suspected H IV patient expired in a car accident. H e signed for organ donations. W hat should a physician do in this
situation?
Answer: his H IV status is not certain. The organs can be preserved until the H IV status is confirm ed. If the test for H IV is
positive, organs should be discarded.

86. A 18-year-old patient who expired in a car accident signed in his license for organ donations. H is license has expired. H e alw ays
wanted to donate his organs. W hat should a physician do in this situation? (Im portant)
Answer: physician cannot accept organs because the signed consent has expired.

87. A m ale physician sexually harassed a fem ale patient during the physical exam ination. The patient com plained to a nurse. W hat
should the nurse do in this situation?
Answer: the nurse should tell the patient to m ake an official report to the hospital authority or to an appropriate agency.

88. A m ale sm oker com es to the physician for his asthm a problem s. The physician w anted his patient to quit sm oking. W hat should
the physician advise in this situation?
Answer: the physician should ask the patient to quit sm oking im m ediately because patients are usually m ore responsive when
they are ill. The physician should assist the sm oker to m ove one step closer to quitting .
 Medical Ethics 11

89. A m other of a term inally ill patient did not sign a D N R (D o N ot Resuscitate) order; how ever, she signed a D N I (D o N ot
Intubate) order. W hat should a physician do in this situation?
Answer: the physician should follow her orders i.e., the patient should be resuscita ted but should not be intubated, despite severe
hypoxic condition of the patient.

90. A m other of a term inally ill patient signed a D N R order; how ever, she did not sign a D N I (D o N ot Intubate) order. She w ants the
child to be intubated but not be resuscitated . W hat should a physician do in this situation?
Answer: the physician should follow her orders i.e., the patient should be intubated but should not be resuscitated.

91. An adolescent car accident victim w as brought to the E R in an unconscious state. The patie nt needs im m ediate surgical
interventions. The surgeon w as unable to contact any fam ily m em ber to obtain a consent. W hat should a surgeon do in this
situation? (Im portant)
Answer: the surgeon should do the procedure without w aiting to obtain a consent for the benefit of the patient.

92. A pediatrician is recently diagnosed with H IV infection. H e is receiving m edication for H IV. H is physical and m ental conditions
are norm al. Should he tell his patients or fellow physicians about his H IV status?
Answer: no. how ever, the doctor should take appropriate precautions for infection control. H e does not have to tell his fellow
physicians, about his H IV status including the physicians who are referring patients to him . The doctor is allow ed to see patients if
he takes appropriate precautions. H ow ever, he should notify the hospital authority.

93. A physician is scared of seeing an H IV patient with an open wound. Can a physician refuse to see a patient?
Answer: yes. H ow ever, a physician’s refusal to see a patient is unethical but is legal.

94. A 17-year-old sem icom atose patient m ay require surgical intervention. H is fam ily m em bers are confused about the surgery. They
asked the surgeon for his opinion. W hat should the surgeon’s response be?
Answer: the surgeon can give his opinion and act as a m oral surrogate for the benefit of the patient. (Very im portant)

95. A 12-year-old boy is diagnosed with a term inal illness (e.g., m alignancy). H e asked the doctor about his prognosis. H is parents
requested the doctor not to tell him the bad new s. W hat should the doctor do in this situation?
Answer: the doctor should tell the truth politely and com passionately to the patient. (Very im portant)

96. A 16-year-old girl is recently diagnosed with right fem ur osteosarcom a. The doctor told the patient that she will require surgery
for rem oval of the right side leg. She started to cry. W hat should a doctor do in this situation?
Answer: first, the doctor should give her som e tissue papers for wiping her tears. Then, the doctor should be sym pathetic to her
and console her. H e m ight tell her that sim ilar reactions are usually expected from other patients with sim ilar bone cancer. Please
do not m ention that she will be fine with a leg prosthesis or without a right leg.

97. A m other is carrying a 500 gram prem ature f etus which develops acute fetal distress. The physician wanted to perform a cesarean
section. M other refused cesarean section. W hat should the doctor do in this situation?
Answer: the physician should arrange a bedside conference with the m other along with other physicians, social w orker, and
adm inistrator to discuss the m atter.

98. A 14-year-old boy is diagnosed with term inal stage of cancer. H e refuses m edical treatm ent. H ow ever, his parents w ant
appropriate m edical therapy in order to save his life.
N ext step: talk to the boy and find out why he does not w ant m edical treatm ent.

99. An infant becom es com atose after an accident. The infant w as placed on a m echanical ventilator. The health care team predicts a
very poor prognosis of the infant. H is parents w ant to discontinue the ventilator. H ow ever, the patient’s condition does not fit the
criteria of brain death.
N ext step: discuss the m atter with the hospital ethics com m ittee.

100 . A 26-w eek-gestational age preterm infant is placed on a m echanical ventilator. The in fant is less responsive to stim ulation. H ead
sonogram reveals a grade 2 intraventricular hem orrhage. The parents w ant to rem ove the baby from a ventilator and let him die.
W hat should the doctor do in this situation?
Answer: the physician should not rem ove the baby from a m echanical ventilator. H owever, the physician should arrange for a
conference with the parents and social worker. If it is not resolved, hospital ethics com m ittee m em bers should be involved.
12 Medical Ethics

101 . A 16-year-old w ants to have privacy in his m edi cal condition before he is seen by the physician. W hat should do the doctor do in
this situation?
Answer: It depends upon the underlying m edical condition (e.g., in patients with an active TB, confidentiality cannot be granted;
how ever, in patients with ST D , confidentiality is O .K.).