Professional Ethics and Legal Standards
Core Ethical Principles
Candidates must understand autonomy, beneficence, nonmaleficence, and justice, and how they conflict in practice. Know the elements of valid informed consent: capacity, disclosure, comprehension, voluntariness, and authorization. Understand decisional capacity assessment, surrogate decision-making standards (substituted judgment and best interests), confidentiality and its exceptions, mandatory reporting, and the difference between negligence and malpractice (duty, breach, causation, damages). Know the concepts of standard of care, scope of practice, and documentation as a legal record.
Boundaries and Conflicts
Understand conflict-of-interest disclosure, gifts from industry, dual relationships, and the duty to protect identifiable third parties in limited circumstances. Know that minors and adults with impaired capacity require special consent pathways, and that emergency exceptions permit treatment without consent when imminent harm exists and no surrogate is available.
Traps
Frequent traps: assuming a patient who refuses care lacks capacity, breaching confidentiality without a recognized exception, and accepting consent from a family member when the patient has capacity. Another trap is confusing ethics consultation with legal advice, or assuming a living will covers situations it does not address.
Worked Example
Rule of thumb: capacity is decision-specific and time-specific. A patient who refuses a recommended treatment is presumed to have capacity unless a structured assessment shows otherwise. Assess understanding, appreciation, reasoning, and expression of choice; if capacity is intact, the refusal stands even if the team disagrees.