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for the BLOOD TRANSFUSION question i think the right answer is A . giving blood transfusion is a life saving event so father cant intervene . and when there is no consent from the wife about not wanting transfusion then husband have no right to stop the transfusion .

can some one tell me if i am wrong . please explain . i am getting confused

Doctor saheb, this is the part i dont understand " the parents are not allowed to stop the life saving or limb saving procedures from the child so there is no question of asking them"........

they cannot withhold life & limb saving procedures but here they want to SAVE "life support " for their son. so why wont we allow parents to make a clear decision in a little while.

My answer was " life support maintained until the parents give a clear decision", if parents want to terminate life support, then we can argue that " they cannot withhold life & limb saving procedures".

did i confuse u even more, that is my personality. sorry about that.

i think in this question as u said choice B should not be there , but they have put it to test whether students know the rule that " limb and life saving procedures cant be stopped by parents " .

i dont know .

marie ur questions would help everyone if they are at once place . beleive me . look when u stop posting them they will be dispersed every where . and if some one to have a revision they have to search a lot and waste time . ok if u dont like posting those questions in this link u can make ur own separate link and then post them all there .

i hope u understand and dont take me wrong . i am telling this for the benefit of everyone .
take care .

docsaheb Since u requested nicely,,,,,,,,,,,

like last time i will post them on this thread.

i just posted it induvidually cause it gave a better edge while doing discussions.

Thanks to you for starting this thread.

16.A 37 yr old man comes to your office for his regular visit. He has seemed severyly depressed fro some time but refuses to discuss either his feelings or treatment options. He does not want antidepressants .

his only medication is Vitamins, your relationship with him is excellent but he just wont confide his feelings although he firmly denies suicidal ideation.

You prescribe a SSRI for him & tell him that it is a vitamin.Over a period of several months, his mood markedly improves & he feels much better

Which of the foll most appropriately characterizes your action????

a.Is appropriate because it benefited the patient.

b.Is appropriate because there were no side effects

c.Is not appropriate because you are not a psychiatrist

d.Is not appropriate because u treated the pt without his consent


e.Is acceptable as long as u inform the pt now that he is feeling better.


Ans: D Is not appropriate because u treated the pt without his consent

A pt must give consent to any test or treatment performed upon him as long as the patient has the capacity to decide. Physicians are not acting ethically when they treat a pt without his consent even if it benefits the pt.
Another way of saying this is œ I have a right to be sick & miserable if I want.( the patient;s view ).

17.A 52 yr olds man with cerebral palsy is being evaluated for screening colonoscopy. He has a mental age of an 8 yr old & a second grade reading level in terms of comprehension.

He lives alone & survives on combination of Public assistance & part time jobs sweeping floors. U have thoroughly explained the procedure to him in terms of risks & benefits. He repeatedly refuses the procedure entirely on the basis of œ I just don™t want it œ

What should u do?

a.perfoem the procedure

b.seek consent from the family

c.honor his decision & do not perform the colonoscopy

d.seek a court order mandating the procedure


Ans:C honor his decision & do not perform the colonoscopy.

Just because the patient may be incompetent in certain areas of his life does not mean he is not able to consent for medical procedures. The pt described has a severe & permanent cognitive impairment.,however he is still able to refuse the procedure. A pt can be considered imcompetent for financial issues but still has the ability to make medical decisions.

It is easier to be declared incompetent for financial decisions than for medical decisions. The court recognizes a much lower standard of cognitive ability to reliably consent or refuse procedures compared with financial decisions

18. 45 yr old Mr.Smith consents to a procedure on his left ear. After the pt is anaesthetized Dr.Wright discovers that the right ear is in greater need for surgery. What should the surgeon do??

a.perform the procedure on the right ear as it is more necessary

b wake up the pt & seek consent for the procedure on the right ear

c. seek a second opinion from another surgeon & proceed with the more necessary procedure

d.seek consent from family.

e.perform the procedure on both ears


Ans:b wake up the pt & seek consent for the procedure

You must obtain informed consent for the specific procedure. Consent for another procedure or clear medical necessity cannot infer consent for another procedure.

Neither the medical necessity ,the seriousness nof the condition noe the assumption that any reasonable person would consent is sufficient to assume that consent is given..

U cannot have informed consent without the pt waking up.Each procedure must undergo an individual consent process.

19.An unconscious man is brought to the ER from a car crash. He is hemorrhaging profusely ,hypotensive & stuporous.

U have never met the pt before & the hospital has no records of him . He is wearing a Tshirt œ kiss me I am a Jehovah;s witness( the people who refuse blood & blood products ).

What should u do ?

a.give the blood

b.wait for him to awaken to sign the consent

c.wait for family

d.seek a court order

e.only use IV fluids.


Ans: A give the blood.

Consent is implied in Emergencies.The pt is not conscious to make a decision. He cannot be fully informed to make a choice. There is no family available, no advance directive, proxy or living will etc, to be a substitute for his judgement.,

We must make a decision on the best interests of the pt. A shirt is not sufficient advance directive . You cannot say œ well every Jehovah;s witness refuses blood, so would he. The refusal must be individual.

think of this..... he could have even borrowed the T shirt & you are withholding life saving procedures based on a sign on a T shirt...................

20. A 45 yr old man attempted suicide by driving his car into a pole with an intentional purpose of ending his life . he was found severly hemorrhaging & in the ER he refuses to give consent for surgery to stop the bleeding. He states to end his life. He was recently diagnosed with cancer & he refused surgery to remove it . he states that his life is complete & he wishes to end it .

What should u do about the surgery to stop the bleeding???

a.follow his stated wish & withhold surgery

b perform the surgery

c obtain a court order

d.ask family members for consent.


Ans: B perform the surgery.

The pt™s injury is ,in a sense the same as purposeful drug overdose , jumping off a bridge or shooting himself. In this case, he used a car. Athough an adult pt with the capacity to understand his medical care can refuse treatment ,this is not the same as allowing pts to kill themselves.People actively trying to kill themselves are by definition œ NOT CONSIDERED COMPETENT.

The right to autonomy ends just short of condoning active suicide. At assumption is made that when acute life stressors lead a pt to attempt suicide that they are temporarily incompetent & psychotherapy or pshychopharmacology may help him .If u review the case,u will see that the case never stated that the cancer was incurable or progressive or even fatal.

21.A 60 yr old male physician who is an internist has a female patient for the past 20 yrs. Both of them lost their spouses several years ago . they start spending time together outside the office. The female pt wants to begin a romantic relationship with the physician.

What should he tell her?

a.I can never do that with you ever.

b.We can be social but not sexual

c.We need the ethics board;s approval first

d.I cannot date u & be your doctor. May be in the future we can date, after u get another doctor.

e.Because this is your initiative ,we can begin dating.

Ans: D I cannot date u & be your doctor. May be in the future we can date, after u get another doctor.

Sexual relations between a doctor & a CURRENT pt are never ethically acceptable. At the very least the pt/physician relationship must stop,

For those of u wanting to choose C,There is no ethics board in place to act as a dating service for physicians.