Chapter 5: Surrogate Decision-Making

Accepting Gifts from Patients Case Description: A 60-year-old patient offers her cardiologist an expensive watch as thanks for successful treatment. The cardiologist knows accepting it might influence future care decisions. Ethical Question: Should the cardiologist accept the gift?

A. Yes, as it’s a gesture of gratitude.
B. No, to avoid a conflict of interest.
C. Yes, but donate it to charity.
D. No, unless it’s of minimal value.

Pharmaceutical Company Incentives Case Description: A drug representative offers a physician a free trip to a conference for prescribing their new medication. The physician believes the drug benefits patients. Ethical Question: Is it ethical to accept the trip?

A. Yes, if the drug is genuinely beneficial.
B. No, as it creates a conflict of interest.
C. Yes, if disclosed to patients.
D. No, unless the trip is educational only.

Treating Family Members Case Description: A 35-year-old nurse’s sister asks her to prescribe antibiotics for a minor infection. The nurse has access to the medication but isn’t her sister’s primary provider. Ethical Question: Should the nurse prescribe the antibiotics?

A. Yes, to help her sister quickly.
B. No, due to professional boundaries.
C. Yes, if it’s an emergency.
D. No, unless supervised by a doctor.

Social Media Disclosure Case Description: A surgeon posts about a complex case on Twitter, praising his skills without patient identifiers. The patient recognizes the case and feels exposed. Ethical Question: Was this a breach of professionalism?

A. Yes, due to potential identification.
B. No, as no identifiers were used.
C. Yes, but only if the patient complains.
D. No, because it’s self-promotion.

Impaired Colleague Case Description: A resident notices a senior surgeon smelling of alcohol before a procedure. The surgeon insists he’s fine and proceeds with surgery. Ethical Question: What should the resident do?

A. Report the surgeon to administration immediately.
B. Confront the surgeon privately first.
C. Do nothing, as he’s senior.
D. Monitor the surgery and report if errors occur.

Financial Interest in Referrals Case Description: A doctor refers patients to a private imaging center where he has a financial stake, even when a hospital option is cheaper and equally effective. Ethical Question: Is this referral ethical?

A. Yes, if the center provides good care.
B. No, due to the conflict of interest.
C. Yes, if disclosed to patients.
D. No, unless it’s the only option.

Boundary Violation with Patient Case Description: A 40-year-old patient flirts with her psychiatrist during sessions. The psychiatrist enjoys the attention and responds playfully. Ethical Question: Is the psychiatrist’s behavior professional?

A. Yes, if it builds rapport.
B. No, it crosses professional boundaries.
C. Yes, as long as it’s not sexual.
D. No, unless the patient objects.

Research Funding Conflict Case Description: A researcher studying a new drug receives funding from its manufacturer. The study results are negative, but the company pressures her to adjust the data. Ethical Question: What should the researcher do?

A. Adjust the data to maintain funding.
B. Publish the true results, risking funding.
C. Delay publication and negotiate with the company.
D. Withdraw from the study.

Overtreatment for Profit Case Description: A dentist recommends extensive procedures for a 50-year-old patient with minor tooth decay, knowing insurance will cover it and boost his income. Ethical Question: Is this recommendation ethical?

A. Yes, if the patient consents.
B. No, it prioritizes profit over need.
C. Yes, if the procedures are beneficial.
D. No, unless the decay worsens.

Colleague’s Unprofessional Behavior Case Description: A nurse overhears a doctor mocking a patient’s weight in the break room, loud enough for staff to hear. The patient isn’t present. Ethical Question: What should the nurse do?

A. Confront the doctor privately.
B. Report it to the supervisor.
C. Ignore it, as the patient didn’t hear.
D. Warn the doctor informally.

Accepting Industry Sponsorship Case Description: A medical conference offers free attendance to physicians sponsored by a device company promoting its product during talks. Ethical Question: Is it ethical to attend?

A. Yes, if the education is valuable.
B. No, due to potential bias.
C. Yes, if the sponsorship is disclosed.
D. No, unless the product isn’t discussed.

Romantic Relationship with Former Patient Case Description: A 30-year-old man, discharged from care a year ago, asks his former doctor out. The doctor is interested and no longer treats him. Ethical Question: Is a relationship permissible?

A. Yes, as he’s no longer a patient.
B. No, due to past power dynamics.
C. Yes, if enough time has passed.
D. No, unless approved by ethics board.

Misrepresenting Credentials Case Description: A physician assistant introduces herself as “Dr.” to patients, believing it builds trust, though she’s not a medical doctor. Ethical Question: Is this professional?

A. Yes, if it boosts patient confidence.
B. No, it’s misleading.
C. Yes, if clarified later.
D. No, unless patients ask.

Conflict of Interest in Teaching Case Description: A professor promotes a textbook he authored to medical students, earning royalties, though cheaper alternatives exist. Ethical Question: Is this ethical?

A. Yes, if the book is high quality.
B. No, due to financial conflict.
C. Yes, if disclosed to students.
D. No, unless it’s the only option.

Refusing Care Based on Values Case Description: A pharmacist refuses to fill a prescription for emergency contraception, citing religious beliefs, delaying the patient’s access. Ethical Question: Is this refusal professional?

A. Yes, it’s his right to conscience.
B. No, it prioritizes beliefs over duty.
C. Yes, if he refers elsewhere.
D. No, unless the patient agrees.

Advertising Medical Services Case Description: A plastic surgeon runs exaggerated ads claiming “guaranteed youthful results” to attract clients, though outcomes vary. Ethical Question: Is this advertising ethical?

A. Yes, if it draws business.
B. No, it’s misleading.
C. Yes, if disclaimers are included.
D. No, unless results are proven.

Consulting for Industry Case Description: A doctor consults for a stent company while treating patients with stents, not disclosing the relationship to patients. Ethical Question: Is this ethical?

A. Yes, if the stents are effective.
B. No, due to undisclosed conflict.
C. Yes, if disclosed to patients.
D. No, unless he stops using stents.

Patient Request for Unnecessary Tests Case Description: A 45-year-old man demands an MRI for mild back pain, influenced by ads. The doctor knows it’s unnecessary but could bill for it. Ethical Question: Should the doctor order the MRI?

A. Yes, to satisfy the patient.
B. No, it’s unnecessary and profit-driven.
C. Yes, if insurance covers it.
D. No, unless symptoms worsen.

Whistleblowing on Fraud Case Description: A nurse discovers a colleague billing for unperformed procedures. The colleague begs her to stay quiet to avoid trouble. Ethical Question: What should the nurse do?

A. Report the fraud to administration.
B. Keep quiet, respecting the colleague.
C. Confront the colleague and demand correction.
D. Wait for more evidence.

Dual Role Conflict Case Description: A doctor serves as a patient’s primary physician and expert witness in her lawsuit, potentially influencing his medical opinions. Ethical Question: Is this dual role ethical?

A. Yes, if he remains objective.
B. No, due to conflict of interest.
C. Yes, if disclosed to the patient.
D. No, unless he steps down as witness.

Gifts from Industry Case Description: A medical device rep gives a surgeon a luxury dinner for using their product, which he believes is superior anyway. Ethical Question: Is accepting the dinner ethical?

A. Yes, if the product is genuinely better.
B. No, it’s a conflict of interest.
C. Yes, if reported to the hospital.
D. No, unless it’s a small token.

Sexual Harassment by a Colleague Case Description: A resident overhears a senior doctor making inappropriate comments to a nurse, who seems uncomfortable but doesn’t complain. Ethical Question: What should the resident do?

A. Report it to HR immediately.
B. Confront the doctor privately.
C. Ask the nurse if she’s okay first.
D. Ignore it, as it’s not his issue.

Overbilling Patients Case Description: A clinic manager pressures a doctor to code minor visits as complex to increase revenue, though it misrepresents the care given. Ethical Question: Should the doctor comply?

A. Yes, to support the clinic’s finances.
B. No, it’s fraudulent and unprofessional.
C. Yes, if patients don’t notice.
D. No, unless instructed by a superior.

Personal Gain from Patient Referrals Case Description: A physician refers patients to a lab offering him a kickback per test, though the lab’s quality is average. Ethical Question: Is this referral ethical?

A. Yes, if the lab is competent.
B. No, due to financial conflict.
C. Yes, if disclosed to patients.
D. No, unless it’s the best lab.

Treating VIP Patients Case Description: A hospital CEO demands a doctor prioritize his care over others waiting, citing his role in funding the facility. Ethical Question: Should the doctor prioritize him?

A. Yes, to maintain hospital support.
B. No, it violates equal treatment.
C. Yes, if his condition is urgent.
D. No, unless others consent.

Research Misconduct Case Description: A researcher falsifies data to secure a grant, claiming it benefits future patients. A colleague discovers this. Ethical Question: What should the colleague do?

A. Report it to the institution.
B. Confront the researcher first.
C. Ignore it, as it’s for a good cause.
D. Wait for publication to act.

Patient Confidentiality vs. Publicity Case Description: A doctor treats a celebrity and is asked by a magazine to discuss the case anonymously for publicity, without patient consent. Ethical Question: Is this ethical?

A. Yes, if anonymous.
B. No, it breaches confidentiality.
C. Yes, if the patient benefits.
D. No, unless consented.

Conflict with Hospital Policy Case Description: A doctor disagrees with a hospital rule banning personal phone use during shifts but uses it anyway to check on patients. Ethical Question: Is this behavior professional?

A. Yes, if it improves patient care.
B. No, it violates policy.
C. Yes, if discreet.
D. No, unless approved.

Endorsing Products Case Description: A physician endorses a supplement on TV for payment, though evidence of its efficacy is weak. Ethical Question: Is this endorsement ethical?

A. Yes, if he believes in it.
B. No, due to lack of evidence.
C. Yes, if disclosed as paid.
D. No, unless proven effective.

Colleague’s Incompetence Case Description: A surgeon notices a colleague botching procedures but hesitates to report, fearing retaliation. Patients are at risk. Ethical Question: What should the surgeon do?

A. Report the colleague to administration.
B. Confront the colleague privately.
C. Do nothing to avoid conflict.
D. Monitor and report only if harm occurs.