Medical Ethics and Law
Ethics and law questions use a short dilemma and ask for the most appropriate action. They test the Patient's Rights Law, capacity, confidentiality, end-of-life rules and mandatory reporting.
Core rules
- The Patient's Rights Law (1996) requires informed consent, access to the medical record, confidentiality, and respect for autonomy.
- Capacity: the patient can understand, appreciate, reason, and communicate a choice.
- A competent adult may refuse treatment, even life-saving treatment; document the discussion.
- The Dying Patient Law (2005) permits advance directives and withholding of futile treatment, but not active euthanasia.
- Termination of pregnancy requires committee approval under the penal code, on defined grounds.
- Mandatory reporting: child abuse, notifiable infectious diseases, and certain wounds.
- Research requires Helsinki Committee approval and informed consent.
Worked example
A competent 70-year-old with end-stage renal disease refuses dialysis after a full explanation. Reasoning: respect the refusal. Assess for depression or delirium, ensure the patient understands the consequences, document, and offer palliative care. The family cannot override a competent patient's decision.
Traps that cost marks
- Accepting family consent for a competent adult.
- Breaching confidentiality without legal basis.
- Missing the minor's right to confidential care in defined situations.
- Failing to document the consent discussion.
- Treating an advance directive as automatically invalid.