ethics/patient autonomy

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Question 1 / 3

689e7488fb44f3cd6134f5ef

Ethicolegal

ethics

patient autonomy

Case History

A 32-year-old self-employed graphic designer, Ms. Eleanor Vance, presents to her family physician, Dr. Chen, with persistent fatigue, night sweats, and significant lymphadenopathy. Investigations reveal a diagnosis of aggressive non-Hodgkin lymphoma requiring urgent multi-agent chemotherapy and immunotherapy. Dr. Chen thoroughly explains the diagnosis, the aggressive nature of the disease, the high success rate of the recommended treatment, and the severe prognosis without immediate intervention. Ms. Vance, who is of sound mind and clearly understands the medical information, expresses her desire to delay the initiation of treatment by six months. Her rationale is that she has secured a prestigious, once-in-a-lifetime art commission overseas that she feels she cannot postpone or delegate, and she is concerned that chemotherapy side effects would compromise her ability to complete it. She reiterates her understanding of the potential for rapid disease progression and reduced treatment efficacy with delay. What is the MOST appropriate next step for Dr. Chen?

Lab Parameter	Value	Reference Range

A ) Respect her decision and document her refusal thoroughly, advising her of the importance of prompt follow-up for symptom progression.

B ) Immediately consult with legal counsel to determine if a court order can be obtained to compel her to undergo life-saving treatment.

C ) Reiterate the urgent medical necessity, thoroughly re-explain the specific risks of delay, and strongly recommend she seek a second opinion from an oncologist, while continuing to offer support.

D ) Inform her that if she delays treatment, Dr. Chen will no longer be able to manage her care, due to the high risk involved.

E ) Contact her emergency contact person to ensure they are aware of her decision and can provide support or influence her choice.

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Question 2 / 3

689e7488fb44f3cd6134f654

Ethicolegal

ethics

patient autonomy

Case History

A 78-year-old gentleman, Mr. Singh, of South Asian descent, is accompanied by his adult daughter, Ms. Kaur, to your outpatient memory clinic. Mr. Singh has been experiencing subtle memory lapses for the past year. Following a comprehensive workup, including neuropsychological testing and imaging, you confirm a diagnosis of early-stage Alzheimer's disease. During the consultation to discuss the findings, Ms. Kaur, speaking on behalf of her father and with his apparent tacit agreement, requests that you not explicitly disclose the diagnosis of Alzheimer's disease to her father. She explains, "Our family believes this news would cause him immense distress and he might lose hope. We've always protected him from bad news, and we can manage his care without him knowing the specific label." Mr. Singh appears calm but defers to his daughter when asked directly if he understands the nature of the visit. He is observed to be oriented to person, place, and time, and appears to follow complex instructions. Which of the following is the most appropriate initial step for the physician in this situation, considering ethical and legal standards?

Lab Parameter	Value	Reference Range

A ) Arrange a private meeting with Mr. Singh to directly assess his capacity to understand his diagnosis and his preference regarding disclosure, clearly explaining your professional obligation.

B ) Accede to Ms. Kaur's request and inform her about the diagnosis and management plan, while discussing care with Mr. Singh in general terms without using the specific diagnosis.

C ) Invoke therapeutic privilege and withhold the diagnosis from Mr. Singh, providing care based on the family's wishes to prevent potential distress.

D ) Initiate a formal capacity assessment by a consulting psychiatrist for Mr. Singh, given his apparent passive demeanor during the consultation.

E ) Suggest that Ms. Kaur and her family engage a cultural liaison or community elder to help facilitate the discussion about the diagnosis with Mr. Singh.

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Question 3 / 3

689e7488fb44f3cd6134f656

Ethicolegal

ethics

patient autonomy

Case History

A 38-year-old woman is admitted to a general internal medicine ward at a publicly funded hospital in Nova Scotia with a complex, chronic autoimmune condition currently experiencing an acute exacerbation. Her attending physician, assigned through the standard departmental rotation, is a male internist. The patient, citing deeply held spiritual and religious convictions, expresses significant discomfort with receiving direct physical examinations or intimate medical care from a male physician and requests to be seen exclusively by a female physician. She states that while she understands the need for medical attention, her beliefs prevent her from fully cooperating if a male physician is directly involved in her personal care. The hospital's policy on physician assignments emphasizes a rotation system to ensure equitable workload and consistent coverage, making gender-specific assignments generally challenging. Her condition, while not immediately life-threatening, requires regular monitoring and management to prevent rapid deterioration. What is the most appropriate initial course of action for the attending physician in this situation, considering ethical and legal obligations in Canada?

Lab Parameter	Value	Reference Range

A ) Immediately notify the patient that the hospital's policy does not permit gender-specific physician assignments and that she must accept the assigned physician or seek care elsewhere.

B ) Document the patient's refusal and continue to provide all necessary medical care, including physical examinations, as per standard protocol, explaining that medical care supersedes personal preferences.

C ) Explore the possibility of accommodating the patient's request by seeking a suitable female physician for her direct care, while ensuring the patient's immediate medical needs are met by the current team in a respectful manner, prioritizing essential, non-intimate care if required.

D ) Transfer the patient to another hospital with a known policy for gender-specific physician requests, even if it delays her immediate care.

E ) Consult with the hospital's legal counsel immediately to understand the ramifications of the patient's refusal before taking any further action.

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