Professionalism, Ethics, Communication and Health System Practice
Professionalism items test legal and ethical reasoning in an Iraqi hospital context: consent, capacity, confidentiality, resource allocation, error disclosure and communication. Answers should be patient-centred and defensible.
Core principles
- Four principles: autonomy, beneficence, non-maleficence, justice. Autonomy governs the competent adult's refusal, even of life-saving treatment.
- Consent must be informed: diagnosis, procedure, material risks, alternatives and consequences of refusal; documented, and taken by someone able to perform or fully describe the procedure.
- Capacity means understand, retain, weigh and communicate. It is decision-specific; 'competence' is a legal status, not a clinical one.
- Emergency exception: treat under necessity when the patient cannot consent and delay would cause harm.
Practice
- Confidentiality is limited by consent, legal obligation and public interest; share only the minimum necessary information.
- Errors: disclose promptly, apologise, explain and document; support a just culture rather than blame.
- SBAR for handover, SPIKES for breaking bad news, WHO checklist for team communication.
- Stewardship: rationing is an ethical decision made transparently at system level, not by an individual at the bedside. Ramadan fasting and religious needs shape perioperative planning.
Worked example
A competent adult Jehovah's Witness refuses blood before elective surgery. Respect the refusal, document it clearly, and plan bloodless strategies: iron, tranexamic acid, cell salvage if accepted, meticulous haemostasis, and agreed limits of care with the team.
Traps
Confusing capacity with compliance; obtaining consent for a trainee's first unsupervised procedure without disclosure; discussing patient details in a corridor; assuming a relative can consent for a competent adult.