AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. August 2004, Volume 6, Number 8.

Test Questions

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Test Questions: Ethical Issues in Neurology

Ethical Issues in Neurology

1.

According to the commentary on the case of the patient with ALS:

A. The most ethically appropriate course for physicians is not to discuss physician-assisted suicide (PAS) with patients, even those who ask about it.
B. Discussing PAS with patients is generally interpreted by them as condoning the practice.
C. The physician should attempt to find out why the patient has requested PAS, what goals and options he or she has for end-of-life care, what he or she fears about the physical symptoms at the end of life, whether he or she is depressed, and what beliefs he or she has about the meaning of life.
D. A and B.

2.

In helping surrogates make decisions for patients who have no decision-making capacity following stroke, neurologists should:

A. Provide realistic prognostic information, including the uncertainty inherent in prognosticating.
B. Discuss treatment goals before discussing treatment options.
C. Communicate with the patients' other treating physicians to minimize confusing the surrogate with contradictory reports and messages.
D. Let surrogates know they have the right to refuse even life-sustaining treatment on behalf of the patient that the treatment does not serve the goals of the patient as understood by the surrogate.
E. All of the above.
F. B, C, and D.

3.

A physician preparing to undertake long-term management, including opioid treatment, of a patient with chronic pain:

A. Runs the unavoidable risk of being sanctioned for over-prescribing of regulated substances.
B. Should have the patient sign an agreement or contract agreeing to use one physician and one pharmacy for all the opioid prescriptions.
C. Has an obligation to discover why other pain management strategies have been ineffective.
D. All of the above.
E. B and C.

4.

The primary ethical issue concerning the use of neural interventions for enhancement at present is:

A. Safety.
B. Their challenge to the concept of responsibility.
C. Their unequal distribution and, hence, potential to exacerbate inequality among the rich and poor.
D. Privacy.

5.

The principal ethical/professionalism message in the analysis of Law v Camp, in which a surrogate decision maker charged the hospital and 2 physicians with negligence and fraud for putting his mother on patient-assisted ventilation, is:

A. To be on the safe side, hospitals should revert to cardio-pulmonary tests for determination of death.
B. If physicians adhere closely to hospital end-of-life protocols, they have nothing to fear from patient surrogates who misunderstand treatment options for the patients they represent.
C. Physicians who find themselves named in medical negligence or fraud claims should file for summary judgment of the case.
D. Communicating with patient surrogates, ensuring that the surrogate correctly understands what is communicated, and, where possible, documenting the conversation are critical steps in avoiding misunderstanding that can lead to claims of negligence or fraud.
E. All of the above.
F. B, C and D.

6.

Use of neurological criteria to determine death in patients who are going to be organ donors has a history of controversy because:

A. Patients who are declared dead by neurological standards appear to share more features with living people than they share with those declared dead by cardiopulmonary criteria (the non-heart-beating dead).
B. Some brain function often exists after the accepted US standards for determining death by neurological criteria have been met.
C. Not all patients declared dead on the basis of neurological criteria are irreversibly unconscious.
D. All of the above.
E. A and B.

7.

Guidelines for presymptomatic testing for Huntington disease and Alzheimer's disease include the following:

A. Only the individual being tested may provide consent for the test.
B. Parents may provide consent to have minors tested.
C. Strict privacy and confidentiality must be maintained.
D. Family members who may share the same genetic inheritance may be informed without the consent of the person being tested.
E. A and C.
F. B and D.

8.

The feature of PVS that distinguishes it most definitively from other brain damage syndromes is:

A. Absence of cortical functioning.
B. Absence of consistent, sustained, and reproducible visual tracking, and visual fixation.
C. Absence of spontaneous respiration.
D. Alternating periods of sleep and wakefulness.

9.

The guidelines on anencephalic newborns and organ donation in the AMA's Code of Medical Ethics:

A. Allows anencephalic newborns to be organ donors after determination of death has been made by in accordance with accepted medical standards, relevant law and regional organ procurement organization policy.
B. Forbids procurement of organs from anencephalic newborns until medical science learns more about their capacity for consciousness.
C. Appeared first in 1992 and has remained unchanged since then
D. B and C.

10.

Ethical issues raised by the neuropharmacological intervention in cognition include:

A. To what extent should such medication be available as cognitive enhancers to those without cognitive disorders.
B. How will the lives of all individuals, including those who choose not to enhance, be influenced by living in a society with widespread enhancement?
C. Will improving cognition pharmacologically undermine the value of improving our performance by hard work and discipline?
D. All of the above.
E. A and B.

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