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FM10.{1-6,16-17,20,22-24,28} | Medical Ethics & Professional Conduct — Graded Quiz
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A 35-year-old Jehovah's Witness with a ruptured ectopic pregnancy refuses a blood transfusion on religious grounds despite being informed it is life-saving. She is conscious and competent. The ethically correct action is:
Correct. A competent adult has an absolute right to refuse any treatment, including life-saving treatment. Autonomy overrides beneficence in this context for a competent patient. The doctor's duty is to respect this choice, explore alternatives (cell salvage, synthetic oxygen carriers), document, and continue all non-refused treatment.
Capacity vs refusal: A competent (capacitated) patient has an absolute right to refuse treatment. The doctor must: (1) Confirm capacity (understand, retain, weigh, communicate). (2) Document capacity assessment. (3) Continue other care. (4) Not abandon. Different for incapacitated patients (best interests) and minors (court may intervene).
Competent adult refusal — even of life-saving treatment — must be respected. Overriding it constitutes assault. The doctor must: explore alternatives, document, ensure capacity, and not abandon the patient.
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A doctor discovers that a colleague is practising while impaired by alcohol and has been involved in two adverse patient outcomes. Under the NMC Code of Ethics, the most appropriate action is:
Correct. The MCI/NMC Regulations impose a duty to report a colleague whose conduct endangers patients. The doctor should first warn the colleague if safe to do so, and then report to the State Medical Council/NMC's Ethics and Medical Registration Board if the behaviour continues.
Whistleblowing in medicine: NMC Regulations require reporting colleagues who endanger patients. Doctors are protected from retaliation in good faith reporting. Hospital reporting does NOT substitute for regulatory reporting.
Protecting patients is the primary duty. Turning a blind eye = breach of professional ethics. The NMC EMRB (Ethics and Medical Registration Board) is the appropriate reporting authority.
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A private clinic doctor has been treating a patient for hypertension for 2 years. The patient misses two appointments and does not pay outstanding fees. The doctor writes the patient a letter terminating the professional relationship. Under ethical guidelines, which additional step is MANDATORY?
Correct. A doctor may terminate a professional relationship, but must give adequate notice (usually 30 days) and ensure the patient can access alternative care before terminating. Abruptly stopping long-term medications (antihypertensives) without adequate handover could cause serious harm.
Patient abandonment = professional misconduct. A doctor may choose their patients (non-emergency), but once a relationship exists, withdrawal requires: adequate notice, assistance in finding alternative, continued emergency care. Non-payment alone is NOT justification for abrupt termination.
Terminating a patient relationship requires: adequate notice, assistance in finding alternative care, emergency care until transition, and continued emergency care if no alternative is available. Abandonment of a patient is professional misconduct.
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A patient with newly diagnosed terminal pancreatic cancer asks the doctor: 'Am I going to die?' The patient's family has requested the doctor not to tell the patient their prognosis, stating it will 'break his spirit'. The MOST ethically appropriate action is:
Correct. The patient's right to know (autonomy) takes precedence over the family's preference. However, the doctor should first assess the patient's information preference ('how much do you want to know?'). The patient's own choice about how much to be told must guide disclosure.
Truth-telling and terminal prognosis: (1) Patient autonomy includes the right to know AND the right to choose not to know. (2) First ask the patient how much they want to know. (3) Family preferences are secondary. (4) Therapeutic privilege cannot apply when the patient is explicitly asking — that removes the 'harm of disclosure' argument.
The patient's autonomy — including the right to know (or the right NOT to know if they choose) — overrides the family's preference. Therapeutic privilege is a narrow exception, not applicable when the patient is directly asking.
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A hospital has two kidneys available for transplant and two patients waiting. Patient A is a 40-year-old teacher with young children. Patient B is a 65-year-old retired person. Purely on the justice principle, the MOST ethically defensible allocation criterion is:
Correct. The justice principle requires that allocation of scarce resources be based on objective, morally relevant criteria — clinical matching, waiting time, expected benefit — NOT on social utility (occupation, number of dependants). Social worth assessment is rejected in modern medical ethics.
UNOS (organ allocation) principles exemplify distributive justice: waiting time + medical urgency + expected benefit + HLA matching. Social utility (who is 'more deserving') violates the formal justice principle of treating like cases alike.
Social worth criteria (job, family status) are explicitly rejected under the justice principle. Allocation should be based on objective clinical criteria. Waiting time as a tiebreaker is ethically more defensible than social utility assessments.
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The Ethics and Medical Registration Board (EMRB) is a constituent autonomous board under the NMC Act 2020. Which function does it primarily perform?
Correct. The EMRB under NMC Act 2020 maintains the National Medical Register, issues registration, and adjudicates complaints of professional misconduct against registered medical practitioners.
NMC four boards: (1) UGMEB — UG curriculum. (2) PGMEB — PG curriculum. (3) MEAB — assessment and rating of colleges. (4) EMRB — ethics, registration, misconduct. High-yield MCQ material.
EMRB = registration + ethics enforcement. UGMEB = undergraduate curriculum. PGMEB = postgraduate. MEAB = medical assessment and rating. All four are autonomous boards under the NMC.
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The Declaration of Geneva 2017 revision added which NEW commitment that was absent from earlier versions?
Correct. The 2017 revision of the Declaration of Geneva (WMA, Chicago) added the statement acknowledging the physician's own health — 'I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.' This was new — earlier versions focused entirely on obligations toward others.
2017 Declaration of Geneva key addition: physician wellness/self-care. Context: growing recognition of physician burnout and its impact on patient safety. This is a high-yield 'what's new' question for the MBBS FM examination.
The 2017 addition is about physician self-care and wellness — 'I will attend to my own health, well-being, and abilities.' This was not in the 1948 original. All other options were present earlier.
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A patient requests a copy of their complete medical records from their treating hospital. Under the Consumer Protection Act and accepted medical ethics standards in India, the hospital:
Correct. Patients have a recognised right to their medical records in India under Consumer Protection Act 1986 (healthcare = service), CPA 2019, and various court judgments. Hospitals may charge a nominal copying fee but cannot withhold records without valid legal grounds.
Medical records rights in India: (1) Patient has the right of access (Consumer Protection Act, Supreme Court judgments). (2) Hospital can charge for copies but cannot deny. (3) Records must be maintained for 3 years (MCI Regulations) or longer per court orders. (4) Treating the patient's record request as a legal threat is itself a red flag for professional misconduct.
Patients have a right to their own medical records. Hospitals can charge a copying fee. Cannot withhold based on clinical discretion or claiming hospital ownership — records belong to the patient in terms of the information.
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The Tuskegee Syphilis Study (1932-1972) directly contributed to which of the following ethical frameworks?
Correct. The Tuskegee Syphilis Study (African American men with syphilis denied treatment for 40 years to observe natural history) was a direct driver for establishing the National Commission for the Protection of Human Subjects, which produced the Belmont Report (1979) — the foundation of modern US research ethics.
Belmont Report (1979) three principles: Respect for Persons (autonomy + protection of vulnerable), Beneficence (maximise benefit, minimise harm), Justice (equitable distribution of research burden/benefit). Beauchamp & Childress extended this to clinical ethics adding non-maleficence as a separate principle.
Tuskegee → Belmont Report (1979). Nazi experiments → Nuremberg Code (1947). Broader international research ethics → Declaration of Helsinki (1964). Different scandals drove different frameworks.
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A doctor is asked by an employer to perform a pre-employment medical examination and report the findings including the employee's HIV status. The employee has not consented to disclosure of the HIV status. The doctor should:
Correct. The HIV and AIDS (Prevention and Control) Act 2017 specifically protects against disclosure of HIV status without informed written consent. Disclosure to an employer without consent violates both this specific Act and general medical confidentiality duties.
HIV and AIDS (Prevention and Control) Act 2017: explicitly prohibits disclosure of HIV status without informed consent. Exceptions (only to treating physician, parent of minor, court order) are narrow. Employment context is NOT an exception.
HIV status disclosure requires specific informed written consent — protected by HIV and AIDS Act 2017. Employer does NOT have a right to this information regardless of the employment context.
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