Medical Ethics, Professionalism and Health Law
Core concepts
Ethics questions test principles applied to concrete dilemmas: autonomy, beneficence, non-maleficence and justice; informed consent (capacity, disclosure, comprehension, voluntariness); confidentiality and its limits; surrogate decision-making; minors and assent; end-of-life care; resource allocation; conflict of interest; research ethics; and professional regulation under Afghan medical law and codes of conduct.
Traps
Assuming a signed form equals valid consent; assuming a patient who refuses care lacks capacity; breaching confidentiality for the family without justification; and confusing beneficence with paternalism. Another trap is the do-everything answer at the end of life, which may conflict with non-maleficence and dignity. Also remember that a professional duty to report may override confidentiality, but only where the law requires it.
Worked example
A 70-year-old with delirium refuses surgery. Assess capacity using four abilities: understand the information, appreciate the consequences, reason about the options, and communicate a choice. Delirium usually impairs capacity; treat the cause, involve the family as surrogate decision-makers, and if the condition is immediately life-threatening, act under the emergency doctrine while documenting everything.
Rule of thumb
When autonomy and beneficence conflict in a capacitated adult, autonomy wins: document the discussion, offer alternatives, ensure safe follow-up, and never abandon the patient.