Professional Documents
Culture Documents
Introduction
The following principles are intended to be applied only to a variety of individual situations you may face on the
USMLE
Capacity vs competence
Competent patients have the right to refuse medical information and medical treatment(s)
o psychotic
risks
benefits
alternatives
including no treatment
o exceptions
emergencies
waiver by patient
patient lacks decision-making capacity
therapeutic privilege
patient is informed
o consent from a patient's spouse is not required treatment of a patient with capacity
End-of-Life Issues
If the patient cannot make decisions, surrogate decision makers must use the following criteria:
living will = patient provides specific instructions to withhold or withdraw life-sustaining treatment
o when no living will or durable power of attorney exists, the clinician is responsible for determining an
appropriate surrogate decision maker from available family members
spouse
adult children (> 18 yrs)
parents
adult siblings
grandparents/grandchildren
Euthanasia
continue treatment
stop treatment
Confidentiality
o exceptions
tarasoff decision
o marriage
o a parent
o military service
o living alone
Parents cannot withhold life- or limb-saving treatment from their children, but can refuse other treatments
Examples
treat
do not treat
Other Principles
o transferring a patient to another physician's care is rarely (if ever) a correct answer on the USMLE
o If a treatment (such as abortion, birth control, etc) is against a physician's personal beliefs - that physician
does not have to provide that treatment; however, they are responsible for referring their patient to a
provider who is willing and able to provide such care
o consulting risk management alone is rarely (if ever) a correct answer on USMLE
If suspected abuse is occurring, physicians are mandated reporters and MUST report
Ethical Principles
Autonomy
o respecting confidentiality
Beneficence
Nonmaleficence
o "do no harm"
Justice
o distributive Justice
Other Principles
Open-ended questions are the best way to elicit a patient history; closed-ended questions are useful for follow-up
or clarification
Many patient encounters necessitate a combination of the above ethical principles--a few general principles
include:
o nonetheless, ensuring that the patient is receiving the best available care is always the primary priority
o all patients, regardless of age, should have the option of speaking to their physician alone
Conflicts of interest:
o physicians can accept honoraria and be compensated for travel expenses, but cannot have assistance wit
slide presentations from pharmaceutical companies
Capacity
o physician's can determine capacity which is the ability for the patient to understand their treatment as
well as the risks, benefits and alternatives