3- You are a psychiatrist, today in your clinic you examined a patient suffering from
severe depression, death wishes, hopelessness, and suicidal thoughts, and You guessed that
this patient might commit suicide.

a- What are the general rules for confidentiality? How can they be applied in such patient? (5
marks)
b- Give examples about violating ethical principles in medicine. (5 marks)

Answers
———

a) Confidentiality is to respect the patient's privacy and autonomy and to prevent the
harm that may result from information disclosure. It extends even after patient's
death. Confidentiality can be broken in certain conditions as:
1. Serious harm to others
2. Possible commitment of suicide
3. Abuse to victims who can't defend themselves ie. Kids.

In this case doctor must break confidentiality as the patient may commit suicide.

b)
– violation of boundaries: crossing the boundaries in the doctor- patient relationship
and having improper sexual or emotional relation with patients or personal financial
gain.
- Mistreatment of the patient: negligence or lack of knowledge and skills.
- Violation of confidentiality: disclose patient's personal information without
consent.
- Violation of the rules of ethical conduct with other members of the profession.
- Illegal activities: illegal abortion or illegal business.

———————————

4- A 26- years old was preparing for her wedding came to your clinic complaining
from a breast mass and was confirmed with the mammography. You advised her that you
should prepare for a surgical operation at once and that she should postpone her wedding
until she undergoes the surgery. 2 days later her fiancée came to your clinic asking about her
condition.

a- What are the ethical dilemmas that you are facing, and how would you solve them? (5 marks)

b- What are the points which you will discuss with her when you are taking the informed consent
from her? (5 marks)

Answers
———
The doctor is facing a conflict between the commitment of confidentiality and
respecting the patient's privacy vs obligation to do good to the patient who needs
immediate surgery.
To solve this dilemma, we should ask ourselves 5 ques to know whether this action is ethical
or not:
1- What benefit& what harm will this action produce?
2- How does it advance the common good?
3- Does it treat everyone the same?
4- Does this action violate any of the moral rights of the affected parties?
5- Is it consistent with the moral virtues?
The ethical action is the one that best fits with these ques.

b) To take a valid informed consent you should fully inform the patient about:
- Her diagnosis.
- The nature of the treatment.
- Possible alternatives for the intervention.
- The risks and benefits of each alternative.
- The prognosis of the intervention.
You should also make sure she is competent and able to make a decision and her decision is
totally voluntary not under any type of pressure.

———————————

5-A 50-years old male suffering from chest pain he needs to do cardiac catheterization
procedure.
a- What are the characteristics of a valid informed consent? (5 marks).
b-What are the exceptions to the requirements of informed consent? (5 marks)

Answers
———

a) A valid informed consent should fulfill the following criteria:
- The patient should be fully informed about:
1. The diagnosis
2. The nature of the treatment
3. The possible alternatives of the intervention
4. The risks and benefits of each alternative
5. Prognosis of intervention
- The patient should be competent to make the decision
- The patient's decision should be voluntary.

b) Exceptions are:
1. When the patient:
- Is unable to give consent (unconscious)
- Is suffering from acute life-threatening crisis
- Is in need for immediate intervention.
2. if the patient isn't competent to make a decision as in children or patient's cognitive
capacity is impaired.
3. Cases in which fully informing the patient can cause serious harm.

———————————

6- A newly married couple worried about the possibility of getting child with inherited
medical condition, especially with the family history loaded with this condition from the wife
side. The wife visited you alone and she asked you to deny this fact in front of her husband

to save her marriage.
a- What are the ethical dilemmas encountered in this situation? (5 marks)
b- How would you manage this condition? (5 marks)

———————————

7_" A drive in school came to a clinic and suffered of epilepsy and wanted the doctor to give him a report that he's medically free and doctor accepted"
A) What are ethical problems related to this case and how to solve it
yourself?
B) What are responsibilities of the physician towards society and humanity

Answers
———

Ethical Problems:

1. Falsification of Medical Records:
• Providing a false report that the patient is medically free from epilepsy is unethical and illegal. It compromises the integrity of the medical profession and can have serious consequences for the patient and others.
2. avoid harm to others:
• Allowing an individual with uncontrolled epilepsy to drive poses a significant risk to public safety. Seizures while driving can lead to accidents, potentially causing harm or death to the driver, passengers, and others on the road.
3. Patient’s Best Interest:
• Issuing a false report does not serve the patient’s best interest. It may prevent the patient from receiving necessary medical treatment and guidance to manage their condition effectively.

To solve those issues

Honest Communication:
- The doctor should explain to the patient the importance of an accurate medical report and the potential risks associated with driving if their epilepsy is not well-controlled.

2. Proper Assessment:
- Conduct a thorough medical evaluation to determine the patient's current condition and whether they are fit to drive. This includes considering the frequency and severity of seizures, medication adherence, and any recent changes in their health status.

3. Referral to a Specialist:
- If necessary, refer the patient to a neurologist or an epilepsy specialist for further evaluation and management.

4. Legal and Ethical Adherence:
- Follow the legal and ethical guidelines set by medical boards and regulatory bodies regarding reporting and fitness to drive for individuals with epilepsy.

B- Responsibilities towards society and humanity
1- Have an obligation of preserving human life
2- Recognize & deal with unethical behavior of colleagues & health care team. 3- Certify only that which he has verified
4- Provide health care based on wise_& appropriate allocations of limited medical resources (avoid prescribing unnecessary medication, investigation, procedure)
5- Obligation of public reporting of significant, medical hazards (epidemic infection)
6- Oblitogtheahetalthiofosonciety. Participate in all efforts to provide, improve & maintain health care quality for society as a whole.

———————————

8- Name examples of malpractice

Answer
———

Dereliction or negligence (deviation from standard care)
Duty: established physician-patient relation-ship that causes: Damage, injury
- Directly to the patient (by negligence, not another factor)

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