Medical Ethics and Professionalism
Core concepts
Ethics questions test the four principles - autonomy, beneficence, nonmaleficence, and justice - applied to concrete situations. Know informed consent (capacity, disclosure, voluntariness, understanding), decision-making capacity (understanding, appreciation, reasoning, expressing a choice), and surrogate decision-making (substituted judgment, then best interests). Understand confidentiality and its limits (mandatory reporting, imminent harm, public health), end-of-life care (advance directives, do-not-resuscitate orders, palliative sedation), and research ethics (institutional review board, informed consent, vulnerable populations). Professionalism includes boundaries, conflicts of interest, and honesty in documentation.
Traps
The classic trap is assuming that a patient who refuses treatment lacks capacity. Refusal is not incompetence; assess capacity and, if intact, honor the refusal. Another trap is choosing the surrogate's own preference instead of the patient's known wishes (substituted judgment). Questions also test that a minor's consent rules vary by situation (emancipation, emergency, sexually transmitted infection treatment) and that confidentiality can be breached for reportable diseases and imminent danger. Watch for the difference between ethics consultation (advisory) and legal action, and remember that the patient's autonomous choice generally outweighs family preference in a capable adult.
Worked rule of thumb
For any ethics stem, ask: (1) Does the patient have capacity? If yes, the patient decides. (2) If not, is there an advance directive? If yes, follow it. (3) If not, use substituted judgment - what would the patient have wanted? - then best interests. Example: a capable adult with a treatable infection refuses antibiotics after a full explanation; the correct action is to document the informed refusal and continue to provide other care, not to override the decision or obtain a court order.