Ethics, Advocacy, and Patient Safety
Core concepts
Ethical practice rests on autonomy, beneficence, nonmaleficence, and justice. Autonomy drives informed consent and respect for patient wishes, including the right to refuse treatment. Decision-making capacity is task-specific and assessed clinically (understanding, appreciation, reasoning, and expressing a choice); it differs from competence, which is a legal determination. When capacity is lacking, use the least restrictive approach and involve the designated surrogate. Recognize elder abuse and neglect (physical, emotional, financial, sexual, neglect, self-neglect) and mandatory reporting. Safety includes restraint minimization, fall prevention, and infection control. Advocacy means protecting dignity, privacy, and access to care.
Traps
Questions test whether you respect autonomy and assess capacity rather than assume incapacity from age or diagnosis. A trap is overriding a patient's refusal because a clinician disagrees, or missing signs of elder abuse. Watch for distractors that use restraints or coercion as a first resort.
Rule of thumb
Capacity is decision-specific-a patient may lack capacity for complex finances but retain capacity for a treatment decision. Always use the least restrictive option.
Worked example
A patient with mild dementia refuses a procedure. The best action is to assess decision-making capacity for that specific decision and honor a capable refusal, rather than assume she cannot decide because of her diagnosis.