Ethics, Professionalism, and Governance
Core concepts
Know the four principles of biomedical ethics - autonomy, beneficence, nonmaleficence, justice - and how they apply to informed consent, capacity, confidentiality, and end-of-life care. Understand professionalism: the physician charter (primacy of patient welfare, patient autonomy, social justice), conflicts of interest, and the social contract. Grasp governance: fiduciary duty, board composition, conflict-of-interest policies, and the difference between governance and management. Know the elements of informed consent (capacity, disclosure, understanding, voluntariness) and exceptions (emergency, therapeutic privilege, waiver).
Traps
Capacity is decision-specific and clinical; competence is a legal determination made by a court. A patient with capacity may refuse treatment even if the physician disagrees - autonomy prevails. Informed consent requires all four elements; a signed form alone is not consent. Conflicts of interest must be disclosed and managed, not merely avoided. Another trap: conflating beneficence (act in patient's interest) with nonmaleficence (do no harm).
Worked example / rule of thumb
A competent adult refuses a life-saving transfusion. The physician should respect the refusal after confirming capacity and ensuring the patient understands consequences. Rule of thumb: capacity is clinical and decision-specific; competence is legal; autonomy wins when capacity is intact.
For governance questions, remember board members owe fiduciary duties of care and loyalty - they set strategy and oversee, but do not manage operations.