WBR0281

Author	[[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1] (Reviewed by Yazan Daaboul, M.D.) (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Ethics
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 67-year-old woman presents to the physician's office with complaints of gradually progressing abdominal distension, fatigue, and a 7-kg weight loss over the past 3 months. Her past medical history is significant for well-controlled hypertension and dyslipidemia. On physical examination, the abdomen is markedly distended with a positive fluid wave. Mild abdominal tenderness is noted over the left lower quadrant on soft palpation along with a large firm lower abdominal mass most evident on deep palpation. Laboratory studies reveal elevated levels of carbohydrate antigen 125 (CA-125). Following a thorough work-up, the patient is diagnosed with stage IV ovarian cancer. After educating the patient about her condition and discussing her concerns, the physician offers her a course of palliative chemotherapy. The patient explains that she understands the risks but prefers to live out the remainder of her life without undergoing chemotherapy. The physician agrees to follow her wishes. Which principle of medical ethics does this interaction exemplify?]]
Answer A	AnswerA::Respect for authority
Answer A Explanation	[[AnswerAExp::Respect for authority is not an ethical principle of medicine. Respect of authority refers to a person's abiding by the rules set by authorities. A citizen who abides by the laws set by the government or a child who abides by the rules set by his parents are 2 examples of respect for authority.]]
Answer B	AnswerB::Respect for autonomy
Answer B Explanation	[[AnswerBExp::Respect for autonomy is a principle of medical ethics. Before initiation with chemotherapy for this patient, the physician is required to educate the patient about her condition and obtain an informed consent. A physician's respect for a patient's autonomy, or self-rule, requires that the physician communicates with the patient, discusses all concerns, and answers questions in an evidence-based manner. Adult patients (> 18 years according to US law) who are deemed able to make their own decisions have the right to refuse to be treated, regardless of how significant or trivial the treatment may be for their health.]]
Answer C	AnswerC::Beneficence
Answer C Explanation	AnswerCExp::Beneficence is a principle of medical ethics that refers to a physician's obligations to weigh the risks and benefits of any treatment and choose only those whose benefits exceed their risks.
Answer D	AnswerD::Justice
Answer D Explanation	AnswerDExp::Justice is a principle of medical ethics that refers mostly to large-scale population medicine whereby physicians must allocate resources and healthcare access fairly among patients based on patient needs.
Answer E	AnswerE::Non-maleficence
Answer E Explanation	AnswerEExp::Non-maleficence is a principle of medical ethics that refers to a physician's obligation to do no harm.
Right Answer	RightAnswer::B
Explanation	[[Explanation::Medical ethics are a set of principles that define the ethical practice of modern medicine. There are 4 major principles of medical ethics: Beneficence Non-maleficence Respect for autonomy Justice Beneficence: Physicians must always define the benefit to risk ratio when considering treatment options for patients. All physicians are obligated to provide net benefit to their patients. Non-Maleficence: Physicians are obligated to do no harm to patients. Similar to the principle of beneficence, all management approaches must have the patient's interest first with no intention to harm. The principles of beneficence and non-maleficence are most pronounced in medical research and population medicine, where clear benefit and harm may not be as evident because the true beneficiary may not be the research subject himself. Respect for Autonomy: Physicians must ensure that the priority of all their decisions is the patient's interest. Adult patients (> 18 years according to US law) who are deemed able to make their own decisions have the right to refuse treatment, regardless of how significant or trivial it may be for their health. A physician's respect for a patient's autonomy, or self-rule, requires that the physician communicates with the patient, discusses all concerns, and answers questions in an evidence-based manner. Justice: Justice refers to the set of principles that dictate the ethics of medicine at a population-based scale. All physicians should act on the basis of fair allocation of resources and adjudication between competing claims. Patients should have the right to have equal access to healthcare. Although healthcare resources are limited, physicians must distribute these resources to efficiently meet the needs of those who require them the most. Educational Objective: Respect for autonomy is a principle of medical ethics. A physician's respect to a patient's autonomy, or self-rule, requires that the physician communicates with the patient, discusses all concerns, and answers questions in an evidence-based manner. Adult patients (> 18 years according to US law) who are deemed able to make their own decisions have the right to refuse to be treated, regardless of how significant or trivial the treatment may be for their health. References: Gillon R. Medical ethics: four principles plus attention to scope. BMJ. 1994;309:184. Luce JM, White DB. A history of ethics and law in the intensive care unit. Crit Care Clin. 2009.25(1):221-237. First Aid 2014 page 59]]
Approved	Approved::Yes
Keyword	WBRKeyword::Principles of medical ethics, WBRKeyword::Principles, WBRKeyword::Medical ethics, WBRKeyword::Autonomy, WBRKeyword::Nonmaleficence, WBRKeyword::Beneficence, WBRKeyword::Justice, WBRKeyword::Ethics, WBRKeyword::Non-maleficence, WBRKeyword::Respect, WBRKeyword::Chemotherapy
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