AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. February 2004, Volume 6, Number 2.

Test Questions

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Test Questions: Paternalism in Medicine

Paternalism in Medicine

1. Two commentators in Case 1 agree that the threat by the obstetrician, Dr. Anderson, to withhold abortion until her patient consents to a form of long-acting birth control does not satisfy the definition of justified physician paternalism because:

A. Dr. Anderson's actions do not benefit the patient directly or prevent harm that the patient's preferred action would cause.
B. Dr. Anderson's attempt to persuade by withholding treatment qualifies as patient education.
C. Dr. Anderson's action qualifies as beneficence, not paternalism.
D. B and C.

2. Dr. Coral seems unable to persuade his cardiac patient of the immediate need for life-saving bypass surgery. Dr. Coral should:

A. Respect his patient's wish and postpone the surgery since the patient has full decision-making capacity.
B. Encourage the patient to seek a second opinion and ask the patient's permission to share the diagnosis with his wife and others who might convince him to schedule the surgery immediately.
C. Break patient confidentiality and tell his patient's wife because of the life-threatening nature of the condition.
D. Have the patient admitted for surgery against his will.

3. After appropriate testing, Dr. Carmichael does not think that his 11-year-old patient's flu-like symptoms warrant hospitalization. The patient has leukemia that is in remission, and his parents want him hospitalized. Dr. Carmichael should:

A. "Treat" the parents' anxiety but not admit their son.
B. Admit the patient if his parents or their insurance will cover the cost.
C. Admit the patient so that he is not liable if the patient's leukemia becomes acute.
D. Encourage the parents to get a second opinion.

4. Journal authors Chervenak and McCullough believe that some managed care practices add up to a new form of paternalism in medicine because:

A. Managed care organizations do not submit diagnostic procedures to cost-benefit analyses before eliminating them from practice guidelines.
B. Patients are generally unaware that practice guidelines issued by managed care organizations eliminate the use of certain diagnostic tools and treatments.
C. Not offering patients information about tests that have been eliminated from practice standards compromises their exercise of autonomy.
D. None of the above.
E. A and C.
F. B and C.

5. Which of the following choices is not an indication for coronary artery bypass surgery?

A. 40 percent blockage of circumflex artery with mild angina.
B. 95 percent stenosis of the left anterior descending artery and circumflex artery.
C. Greater than 90 percent blockage of right coronary artery, left anterior descending artery, and circumflex artery.
D. Disabling angina with 60 percent blockage of circumflex and left anterior descending artery despite maximal medical
treatment.

6. Weak paternalism—temporary interference with the liberty of autonomous others against their wishes to prevent harm:

A. Requires a heavy burden of proof that the probability and magnitude of the possible harm merits the interference.
B. Requires proof that the means used to intervene are the least restrictive available.
C. Can be a professional duty in medicine in cases where patients have decisional incapacity, demonstrate involuntary
self-destructive behavior, or make choices inconsistent with their expressed life goals.
D. All of the above.
E. A and C.

7. In deciding whether Rachel—a patient with Down syndrome who has been declared incompetent to make medical and other life decisions—should receive hemodialysis, the court attempted:

A. To balance the interests of Rachel with the interests of the state.
B. To determine whether Rachel's physician had been negligent.
C. To determine whether hemodialysis was necessary to save Rachel's life.
D. All of the above.
E. A and C.

8. A physician who prescribes an antibiotic against his or her better medical judgment because the patient believes the antibiotic will help is:

A. Respecting patient autonomy.
B. Allowing the patient to make an uninformed and, hence, nonautonomous decision.
C. Justified in trusting the placebo effect of the therapeutic intervention.
D. A and C.

9. A study quoted in the Medicine and Society feature on physician autonomy, paternalism, and professionalism found that patient autonomy is enhanced when physicians:

A. Reinforce all decision-making behavior on the part of patients.
B. Provide a clear rationale for the decisions they recommend.
C. Acknowledge the patient's feelings and values.
D. All of the above.
E. B and C.

10. According to the Policy Forum article on institutional or legislative patients' rights, these explicit statements of patients' rights:

A. Usually arise in response to inadequate or inappropriate communication.
B. Reflect the lack of emphasis on fairness, mutual respect, and compassion in the patient-physician relationship.
C. Can contribute to difficult patient-physician relationships because they are legalistic and absolute.
D. All of the above.
E. A and B.

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