Ethics for USMLE/COMLEX Exam Questions with
Answers
1. Four Quadrant Model of Ethics correct answer: ÏAutonomy correct answer: Respect for the
individual patient and his or her ability to make decisions with regard to their own health and future
in accordance with their own system of morals and beliefs. This is the right to self-determination.
ËE x c o r r e c t a n s w e r : This principle is violated when a surgeon performs surgery on a patient without
direct consent (also considered battery).
ËWhen trying to decide between autonomy and beneficence, autonomy is almost always superior.
Respecting autonomy is more important than trying to do the right thing for a patient (beneficence).
ÏBeneficence correct answer: Doing and promoting good. Action that is intended to bring a good outcome.
ÏNonmaleficence correct answer: Doing no harm. Avoiding harm.
ÏJustice correct answer: Maximizing benefit to patients and society while emphasizing equality.
2. Paternalism correct answer: ÏTreatment of a patient that ignores his/her wishes but aims
at promoting the person's best interest.
ÏOccurs when clinicians override the decision making capabilities of either a patient or surrogate decision-
maker if their decisions are deemed unreasonable or dangerous.
ÏConflicts with a patient's autonomy and should be avoided.
ÏThis happens in situations, for example, such as when a Jehovah's Witness states he/she does not want
a transfusion but the physician orders a transfusion anyway because they feel the patient may not
survive without it. You cannot transfuse a competent adult against his/her will.
ËEven if the patient were pregnant the situation does not change. The prevailing consensus is that
personhood begins after birth. You have to follow through with the mother's wishes. Once the baby is
born, however, she cannot refuse treatment for the baby.
ËT h e situation would be ditterent if the patient were a minor in which case the doctor would be
compelled to transfuse. Parents CANNOT refuse life-saving treatments for their child based on religious
belief. The state has an interest in the welfare of the child that exceeds the parental right to deny
therapy for the child if the child might die. This includes
if a blood transfusion is needed to save the child's life. Denying treatment is this instance would be
considered child abuse.
3. Standard of care correct answer: ÏThe level (objective standard) at which a professional having
the same training and
,experience in good standing in a same or similar community (reasonably prudent physician) would
practice under the same or similar circumstances.
ÏIn other words, from a legal perspective, all patients, regardless of payment, should be treated for their
medical problems with the same diagnostic and therapeutic rigor.
,4. Autonomy- Informed Consent correct answer: ÏInvolves discussing diagnoses and
prognoses with patients as well as any proposed treatment, its risks and benefits, and its
alternatives. Only with such information can a patient reach an informed decision.
ÏIn order for informed consent to be obtained the following elements must be met and explained to the
patient
ËDiagnosis
ËNature of the intervention
ËRisks and benefits of the intervention
ËAlternatives (including non-treatment). The risks of refusing treatment must also be discussed with the
patient.
ËRelevant risks and benefits
ËUncertainties related to each
alternative ËAssessment of patient
understanding
ËAcceptance of the intervention by the patient
ËLastly, the patient must be competent and the decision made without coercion.
If informed consent is not obtained, the patient has the right to sue for medical malpractice.
5. Autonomy- Implied consent correct answer: ÏConsent that is implied by the patient's
compliance. Under emergent circumstances, if a patient's wishes are unknown, consent is
implied.
ÏUsually presumed when the patient enters the consultation room, or calls the doctor to his/her house or
holds his/her arm out for an injection.
ÏEx correct answer: A physician is hired to administer vaccinations that are required to enter the country
on a ship with refugees who do not speak English. Refugees form a line and the physician administers
the vaccination individually. One of the refugees did not want to be vaccinated for religious reasons.
When she approaches the doctor, she extends her arm in a fashion to be given the injection. No words
are exchanged and the physician administers the vaccination. After she leaves the ship, she decides to
sue the doctor. The physician is liable or not-liable and why?
ËN o t liable because consent was given. This scenario is written based on a true lawsuit in which the
physician was found not guilty because consent was implied. By extending her arm, she created an
outward manifestation of consent. Consent can be by words or actions. Since all of the other consenting
refugees were doing everything she did, it is reasonable to believe that she consented as well and
, should have expected a vaccination.
ÏIn emergency situations, consent is implied. Consent is implied in an emergency for a patient without the
capacity to speak for himself. This would not apply to a terminally ill patient with a pre-existing DNR
order. Neither a court order, nor a hospital administrator, nor the ethics committee is required to give
permission before the doctor can administer therapy in an emergency.
Answers
1. Four Quadrant Model of Ethics correct answer: ÏAutonomy correct answer: Respect for the
individual patient and his or her ability to make decisions with regard to their own health and future
in accordance with their own system of morals and beliefs. This is the right to self-determination.
ËE x c o r r e c t a n s w e r : This principle is violated when a surgeon performs surgery on a patient without
direct consent (also considered battery).
ËWhen trying to decide between autonomy and beneficence, autonomy is almost always superior.
Respecting autonomy is more important than trying to do the right thing for a patient (beneficence).
ÏBeneficence correct answer: Doing and promoting good. Action that is intended to bring a good outcome.
ÏNonmaleficence correct answer: Doing no harm. Avoiding harm.
ÏJustice correct answer: Maximizing benefit to patients and society while emphasizing equality.
2. Paternalism correct answer: ÏTreatment of a patient that ignores his/her wishes but aims
at promoting the person's best interest.
ÏOccurs when clinicians override the decision making capabilities of either a patient or surrogate decision-
maker if their decisions are deemed unreasonable or dangerous.
ÏConflicts with a patient's autonomy and should be avoided.
ÏThis happens in situations, for example, such as when a Jehovah's Witness states he/she does not want
a transfusion but the physician orders a transfusion anyway because they feel the patient may not
survive without it. You cannot transfuse a competent adult against his/her will.
ËEven if the patient were pregnant the situation does not change. The prevailing consensus is that
personhood begins after birth. You have to follow through with the mother's wishes. Once the baby is
born, however, she cannot refuse treatment for the baby.
ËT h e situation would be ditterent if the patient were a minor in which case the doctor would be
compelled to transfuse. Parents CANNOT refuse life-saving treatments for their child based on religious
belief. The state has an interest in the welfare of the child that exceeds the parental right to deny
therapy for the child if the child might die. This includes
if a blood transfusion is needed to save the child's life. Denying treatment is this instance would be
considered child abuse.
3. Standard of care correct answer: ÏThe level (objective standard) at which a professional having
the same training and
,experience in good standing in a same or similar community (reasonably prudent physician) would
practice under the same or similar circumstances.
ÏIn other words, from a legal perspective, all patients, regardless of payment, should be treated for their
medical problems with the same diagnostic and therapeutic rigor.
,4. Autonomy- Informed Consent correct answer: ÏInvolves discussing diagnoses and
prognoses with patients as well as any proposed treatment, its risks and benefits, and its
alternatives. Only with such information can a patient reach an informed decision.
ÏIn order for informed consent to be obtained the following elements must be met and explained to the
patient
ËDiagnosis
ËNature of the intervention
ËRisks and benefits of the intervention
ËAlternatives (including non-treatment). The risks of refusing treatment must also be discussed with the
patient.
ËRelevant risks and benefits
ËUncertainties related to each
alternative ËAssessment of patient
understanding
ËAcceptance of the intervention by the patient
ËLastly, the patient must be competent and the decision made without coercion.
If informed consent is not obtained, the patient has the right to sue for medical malpractice.
5. Autonomy- Implied consent correct answer: ÏConsent that is implied by the patient's
compliance. Under emergent circumstances, if a patient's wishes are unknown, consent is
implied.
ÏUsually presumed when the patient enters the consultation room, or calls the doctor to his/her house or
holds his/her arm out for an injection.
ÏEx correct answer: A physician is hired to administer vaccinations that are required to enter the country
on a ship with refugees who do not speak English. Refugees form a line and the physician administers
the vaccination individually. One of the refugees did not want to be vaccinated for religious reasons.
When she approaches the doctor, she extends her arm in a fashion to be given the injection. No words
are exchanged and the physician administers the vaccination. After she leaves the ship, she decides to
sue the doctor. The physician is liable or not-liable and why?
ËN o t liable because consent was given. This scenario is written based on a true lawsuit in which the
physician was found not guilty because consent was implied. By extending her arm, she created an
outward manifestation of consent. Consent can be by words or actions. Since all of the other consenting
refugees were doing everything she did, it is reasonable to believe that she consented as well and
, should have expected a vaccination.
ÏIn emergency situations, consent is implied. Consent is implied in an emergency for a patient without the
capacity to speak for himself. This would not apply to a terminally ill patient with a pre-existing DNR
order. Neither a court order, nor a hospital administrator, nor the ethics committee is required to give
permission before the doctor can administer therapy in an emergency.
