Ethics, Advocacy, and Health Systems
Core content
Ethics and health systems questions test principles, consent, and advocacy. Know informed consent for procedures, parental permission with child assent, and adolescent confidentiality. Emergency exceptions allow treatment without consent when delay would cause harm. Mandated reporting of suspected abuse or neglect is a legal duty. Best-interests standards guide end-of-life decisions, and resource allocation raises justice concerns. Advocacy includes identifying social determinants of health-food insecurity, housing instability, transportation barriers-and connecting families to resources. Know the difference between individual advocacy and system-level advocacy.
Traps
Examiners test the difference between assent and consent: a child’s agreement is not legally sufficient, but it matters ethically. Parental refusal of a life-saving treatment may require ethics consultation or legal involvement, while refusal of vaccines is usually addressed through education, not coercion. Adolescent confidentiality can be broken for safety concerns such as suicidality or abuse. Informed refusal requires understanding of risks and alternatives. Avoid implicit bias in pain assessment and behavioral interpretation.
Worked example
A 15-year-old requests confidential testing for a sexually transmitted infection. Many jurisdictions allow minors to consent to STI care; explain confidentiality and its limits, then provide testing and counseling. Document the conversation and provide confidential follow-up. Rule of thumb: respect adolescent confidentiality unless safety requires disclosure.