A COMPREHENSICE COMPILATION OF CASSES IN MEDICAL ETHICS
1. A 25- year old mother refused immunization for her 2-month old son. The social worker spoke to
the mother. (Important for Board examination)
Next step in management: immunization should be given for the benefit of the child.
(CORRECTION)IMMUNIZATION CAN BE WITH HELD FROM THE CHILD IF PARENTS ARE AGAINST IT.BECUZ LACK OF IMMUNIZATION POSES VERY LITTLE THREAT AND IT IS NEITHER LIFE OR LIMB SAVING.HOWEVER IF GLOBAL CAMPAIGN ON IMMUNIZATION REFUSED APPROPRIATE HEALTH AUTHORITIES SHUD BE NOTIFIED{BREAK CONFIDENTIALETY BECUZ POSING RISK TO OTHERS}
2. A 30-year old mother refused surgery for suspected appendicitis for her 6-year old daughter.
The social worker spoke to the mother. (Important for Board examination)
Next step in management: surgical removal of the appendix should be preformed for the benefit of
the child.(RULE
![Tongue Tongue](https://www.usmleforum.com/images/smilies/tongue.png)
ARENTS CANNOT WITHHOLD LIMB OR LIFE SAVING PROCEDURE TO THEIR CHILD)
3. A 16-year old boy was diagnosed with osteosarcoma of the right thigh. The surgeon recommended
amputation. The boy refuses amputation. He is doing very well otherwise. He is aware that death
is certain without surgery. Boy lives alone (Important. Next step in management: amputation should NOT be preformed. Adolescent patients or adults who are competent in making decisions have an absolute right to determine what shall be done with their own bodies. However, most pediatric patients are not competent to make their own decisions. Please remember, children (15 years or older) are usually able to give a genuinely informed consent. Therefore physicians may respond to their request,
except in a case of irreversible sterilization.
4. A 17-year old girl is a Jehovah™s Witness. She refuses a lifesaving blood transfusion. She is
aware of the consequences. she doesn™t live with her parents. She spoke to the social worker.
(Important)
Next step in management: blood transfusion should NOT be given because she is competent to make
the decision.
5. A 5-year old girl is a Jehovah™s Witness. She requires emergency blood transfusion. Her mother
refuses blood transfusion. A social worker along with two physicians spoke to the mother.
(Important)
Next step in management: blood transfusion should be given because the patient is not competent.
Mother cannot refuse her daughter™s treatment. {LIFE SAVING}
6. A 2-year old boy was brought to the ER by his parents for an injury. Physicians made the
diagnosis of child abuse. There are three other children living in the same household. Both
parents confess to child abuse but request the physician to keep it confidential. Social worker
was involved. (Important)
Next step in management: the case should be reported to Child Welfare Agency (CWA). All children
should be removed from the parents by the CWA.physicain cannot take totally prove or disprove
child abuse only CWA can and take the custody of children
7. A 15-year old boy with STD (sexually transmitted disease) came to see a physician. He asked
the physician not to tell his parents. (VERY IMPORTANT)
Next step in management: the physician should treat the patient and notify the appropriate health
authority, but should not tell his parents.
8. A 16-year old boy wants to use a condom. He comes to the clinic for free samples. He requested
the physician, however, not to tell his parents. (Important)
Next step in management: condom should be given and physician should not tell his parents.
9. A 30-year old male patient is recently diagnosed with HIV. He lives with his wife and two
other children but is promiscuous. He requested the physician not to tell his wife. He lost his
job recently. Social worker spoke to the patient. (Very Important)
Next step in management: physician should notify the appropriate authority (e.g. department of
health) for the safety of other specific persons who are engaged in unsafe sexual practices. The
physician however, should ask the patient to divulge the diagnosis to his wife and other sexual
partners.if failed contact the wife personaly
10. A very small premature infant was born in the delivery room by NSVD (normal spontaneous
vaginal delivery). The attending physician decided not to resuscitate the newborn. Physician
spoke to the mother. Mother started to cry. Newborn expired after 30 minutes. Is the physician
liable for the newborn™s death?
Answer: NO. Please remember, no physician in the USA has ever been found liable for withholding
or withdrawing any life sustaining treatment from any patient for any reason. ideally he shoudl have
asked for consent or DNR from parents
11. A physician picked up a car accident victim from the street and brought him to the ER in his
car. He did not want to wait for an ambulance because the patient™s condition was critical.
Physical examination in the ER reveals quadriplegia. Is the physician liable for this
consequence? (Very Important)
Answer: YES, because the physician did not protect the neck of the patient resulting in
quadriplegia. also good Samaritan laws not fully fulfilled. the physician should have stayed on the
site till relieved by appropriate people.
12. A policeman brought an alcoholic patient to the ER. The policeman asked the physician to give
him a sample of gastric contents by putting a nasogastric tube for laboratory study. The patient
refused insertion of a nasogastric tube. (Very Important)
Next step in management: nasogastric tube should not be placed. Blood alcohol level however
should be preformed. The policeman should not give orders to a physician.
13. A 60-year old man with a history of myocardial infarction (MI) suddenly develops ventricular
tachycardia. A physician from another department was present. The patient needs resuscitation.
(Very Important)
Next step in management: the physician must resuscitate that patient. Physician should not refuse
treatment because he belongs to another department.
14. A 15-year old homosexual boy wanted to change his sexual orientation. He was not successful.
He needed help. He requested the physician not to tell his parents. (Important)
Next step in management: physician should help him avoid homosexual activities. Physician should
not tell his parents about his homosexual activities.
15. A 15-year old homosexual boy is brought by his parents to a physician. His parents do not
accept their son™s sexual orientation. The boy refuses to change. (Important)
Next step in management: physician should tell his parent that homosexual activity is considered
as an alternative life style. Parents should talk to his son but should not force him to change
his homosexual activities.
16. A 16-year old girl becomes pregnant. Her mother wanted her to abort this pregnancy. The girl
wanted to continue her pregnancy despite difficulties. Her boyfriend is a high school drop out.
(Important)
Next step in management: physician should advise to continue this pregnancy because the girl is
partailly competent to make this decision only about her pregnancy.(controversial, diff states
diff rules, so unlikely to be tested on exam)
17. A 15-year old girl recently becomes pregnant. She went to a doctor for abortion. She told the
doctor not to tell her parents about this pregnancy. (Important)
Next step in management: abortion should be done and parents should not be notified. Please
remember, strict requirements for parental consent may deter many adolescents from seeking health
care.(abortion contraversial.diff states diff rules.so unlikely to be tested on exam)
18. Can a physician provide sterile needles for intravenous drug abusers? (Important)
Answer: YES. It reduces the risk of acquiring HIV or hepatitis. The patients should be referred
to appropriate health facilities.
19. A 26-year old pregnant woman went for antenatal check up. Sonogram revealed a 27-week old
fetus with erythroblastosis fetalis. Doctor recommended intrauterine fetal blood transfusion. She
refused the procedure. Social worker discussed the case with the mother. (Important)
Next step in management: doctor should receive a court to do the procedure which will help the
fetal condition.( A HIGHLY DEBATABLE ASPECT.MOTHER IS LIABLE FOR WITH HOLDING LIVE SAVING
PROCEDURE TO VIABLE FOETUS WHICH DOESNT PUT THE MOTHER AT RISK OF SERIOUS DAMAGE.HOWEVER AMERICAN OBSTETRIC ASSOCIATION MENTIONS NOT TO DO ANY OBS PROCEDURE ON REFUSAL OF MOTHER.MOTHER SHUD BE TOLD THAT SHE IS COMMITING AN ASSAULT AND THE CASE BE TAKEN IN COURT.
20. A 20-year old man tells his doctor that he is going to kill girlfriend. She lives in the
university dormitory. Doctor called the university alerted them about the threat and notified the
police. However, university security people did not protect her. She was killed by her boyfriend.
Who should be responsible for this killing? (Important)
Answer: the 20-year old man is responsible. Doctor did the right thing by notifying the
university and the police. The university is also responsible because they did not take any
preventive measures.
21. A 20-year old pregnant woman refuses cesarean section for complete placenta previa. Fetus is
full-term and healthy. Social worker spoke to mother. (Important)
Next step in management: doctor can go to court to get permission for cesarean section for the
benefit of the fetus.FULL DESCRIPTION ABOVE.
22. A 30-year old pregnant woman ingested alcohol and illicit drugs (e.g., cocaine, crack) which
are harmful to the fetus. What should a physician do? (Important)
Answer: the physician should be careful in reporting this case because the pregnant woman may not
come back for prenatal care, which is important for both the mother and the fetus. However, if
the baby™s urine toxicology test is positive for illicit drugs, case should be reported to CWA
(child welfare agency).
23. A physician wants to study a group of children aging from 10-12 year old. Physician already
got the consent from the parents. However, he didn™t discuss the study with the children. A child
refused to participate. Should the physician force the child to participate? (Important)
Answer: no, because a child can refuse to participate in a research study.
24. A 40-year old schizophrenic patient needs hernia repair. Surgeon discussed the procedure with
the patient who understood the procedure. Can the patient give consent? (Important)
Answer: yes. If a psychiatric patient understands the procedure, he or she can give the consent.
25. A 65-year old schizophrenic patient needs coronary angiography because of suspected
myocardial infarction. Cardiologists explained the procedure to the patient who did not
understand the procedure. Who can give the consent on behalf of the patient? (Important)
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.
26. A 25-year old woman developed postpartum psychosis. The newborn developed cyanosis due to
congenital heart disease. The newborn needs cardiac surgery. Surgeon discussed the procedure with
the mother. She understood the procedure. Can she give the consent? (Important)
Answer: yes, because she understood the procedure.
27. A newborn is diagnosed with either trisomy 18 or 13 with TE (tracheoesophageal) fistula which
requires surgery. Mother request surgeon to repair the TE-fistula. What should a surgeon do?
(Important)
Answer: surgeon should refuse to do the reparative surgery because these conditions (trisomy 18
or 13) are nonviable. If the patient survives, surgeon can put a gastrostomy feeding tube for
nutrition. However, please remember that a patient with trisomy 21 (Down syndrome) with TE
fistula should be operated on. (LAW OF MEDICAL FUTILITYAPPLIED HERE)
28. A 45-year old terminally ill patient wanted to die. He has pancreatic cancer and has been
suffering from constant pain. He asked the physician to give him some medication which can
expedite his death. What should a physician do? (Very Important)
Answer: physician cannot give any medication which will expedite the death. However, physician
can prescribe medication to minimize the pain. The dose should be appropriate. Physician-assisted
suicide is illegal everywhere (except in the state of Oregon).IEAALY PT REQUEST PHYSICIAN
ASSISTED SUICIDE IF a-DEPRESSED b-IN PAIN.IF THESE SITUATIONS RESOLVED NOT REQUESTED BY PT.ON USMLE NEVER GO FOR PHYSICIAN ASSISTED SUICIDE.THOUGH IT IS CONTRAVERSIAL.
29. A 47-year old man came to a doctor for chronic low back pain and dysuria. The diagnosis of
metastatic prostate cancer was made after appropriate investigation. Should the doctor tell the
bad news to the patient? (Important)
Answer: yes physician must tell the truth to the patient.
30. A surgeon wanted to perform cholecystectomy on a patient. The surgeon is not sure whether the
patient has decision-making capacity. What is the next appropriate step? (Important)
Answer: consultation with a psychiatrist or neurologist may be helpful. Sometimes it is necessary
to discuss the case with hospital attorneys, ethic committees, or ethic consultants. In a
difficult case, the ultimate judge of a patient™s competency is a court.