Ethics, Professionalism, and Patient Safety: Judgement Under Scrutiny
Priority concepts
Ethical reasoning on this exam rests on autonomy, beneficence, non-maleficence, and justice, applied through consent, confidentiality, capacity, and allocation. Valid consent requires capacity, adequate information, and voluntariness. Capacity is decision-specific and assessed by whether the patient can understand the information, retain it, weigh it, and communicate a choice. A decision that seems unwise is not in itself evidence of incapacity.
Professionalism covers boundaries, conflicts of interest, honest disclosure when harm occurs, and appropriate escalation when a colleague's performance is impaired. Patient safety concepts include human factors, system versus person causation, near misses, root cause analysis, structured handover, and never events.
Traps
The distractor is usually the paternalistic option: proceeding because the doctor believes the choice is best, or withholding information to avoid distress. Equally, confidentiality is not absolute and the exceptions are specific - serious risk to others, statutory reporting, and necessary disclosure to protect the patient. Refusal of treatment by a capacitated adult must be respected even when it will lead to death.
Worked example
A patient with severe depression refuses a limb-saving amputation. Rather than accepting or overriding the refusal immediately, assess capacity; untreated depression may impair the ability to weigh information. Treat the depression, reassess capacity, and involve psychiatry and family. If capacity is retained, the refusal stands.
Rule of thumb
When an ethical question offers several 'reasonable' options, choose the one that preserves the patient's autonomous decision-making while disclosing the risks you know about. Duty to disclose an error to the patient is not optional.