Healthcare Ethics

1. Examine personal ethics.

• Ethics refers to rules of conduct that differentiate between acceptable and unacceptable behavior.

• Morals are internal principles that distinguish between right and wrong.

• Personal ethics refers to individual choices and will be impacted by one’s morals.

• Professional ethics refers to ethical standards that have been created by associations for members to follow.

  • Employers also establish professional ethics for employees to follow.

  • A medical assistant must create a plan to separate personal and professional ethics if they conflict.

  • Our personal morals impact our professional performance in other positive or negative ways.

2. Examine professional ethics for physicians and medical assistants.

Professional ethics refers to codes of conduct stated by an employer or a professional association. Many healthcare professional associations have published professional ethics for their members, called codes of ethics.

The code of ethics for physicians has been modernized over the years. The American Association of Medical Assistants (AAMA) developed a code of ethics that provides the principles of ethical and moral conduct for the profession.

3. Analyze how to separate professional ethics and personal ethics.

Procedure 5.1 provides an opportunity to develop a plan for separating personal and professional ethics based on the scenario provided. Procedure 5.1 also provides an opportunity to describe the impact of personal morals and ethics on the delivery of healthcare. It is important that medical assistants recognize the impact personal ethics and morals have on the delivery of healthcare.

4. Analyze how medical assistants can incorporate the ethical principles of anatomy, nonmaleficence, beneficence, and justice into their work life.

There are four ethical principles in healthcare:

• Autonomy: The freedom to determine one’s own actions and decisions

• Nonmaleficence: To do no harm

• Beneficence: To do good

• Justice: To treat patients fairly and give them what is due to them

These four principles need to be considered equally when evaluating ethical issues. The medical assistant has related responsibilities for each of these principles.

5. Examine the ethical issues that relate to genetics.

The chapter discussed the ethical issues involved with cloning, genetic engineering, genetic testing, pharmacogenetics, stem cell transplantation, and gene therapy. Many advances have occurred in genetics, and with them, many ethical issues have surfaced. Refer to each section for the ethical issues related to the topic and the CEJA’s opinion for providers.

6. Examine the ethical issues surrounding assistive reproductive technology and elective termination of pregnancies.

Different types of assistive reproductive technology were discussed. Gamete donation and egg freezing were also addressed, along with elective abortion. Refer to the sections for the CEJA’s opinion.

7. Examine the ethical issues surrounding childhood.

This chapter discussed many different types of adoption. With most adoptions, the child does not have information regarding the parents. This is important for the medical assistant to remember. Ethical issues surrounding adoption, safe haven infant protection laws, and confidential healthcare for minors were addressed. Refer to the chapter sections for the ethical issues surrounding these topics.

8. Examine the ethical issues related to research trials.

This chapter discussed the abuses and influential guidelines and codes of ethics for clinical research. Seven main principles are involved with ethical research: social and clinical value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for potential and enrolled subjects.

9. Examine end-of-life issues, including palliative medicine, hospice

Palliative means to help relieve the symptoms of a serious illness. The providers offer palliative care to patients who are seriously ill, regardless of age. Hospice is a type of palliative care for people who have about 6 months or less to live. The goal of hospice care is to allow patients who are dying to have dignity, comfort, and peace.

9. Examine grieving.

There are stages of grief and dying, as defined by Elisabeth Kübler-Ross:

• Denial: Person refuses to accept the diagnosis or prognosis.

• Anger: Person’s anger can be directed at self or others.

• Bargaining: Person attempts to bargain with the higher power the person believes in.

• Depression: Person feels sadness, fear, and uncertainty.

• Acceptance: Person has come to terms with the situation.

Not everyone goes through all five stages, and people may not go through the stages in the order listed. Some people may switch back and forth between the stages.

10. Analyze the importance of the Patient Self-Determination Act

The Patient Self-Determination Act (PSDA) requires most healthcare institutions at the time of admission to do the following:

• Provide patients with a written document of their rights to make decisions and the facility’s policies respecting advance directives.

• Ask patients if they have advance directives and document the response in the health record.

10. Analyze the importance of advance directives.

Advance directives are written instructions about healthcare decisions should a person be unable to make them. Types of advance directives include the following:

• Living will: Provides instructions about life-sustaining medical treatment to be administered or withheld when the patient has a terminal condition.

• Medical durable power of attorney: Similar to a living will but includes all healthcare decisions. Names a healthcare proxy and can include healthcare wishes.

• Healthcare proxy: Also called a healthcare agent or surrogate. A competent adult can appoint a person (called a proxy or an agent) to make healthcare decisions in the event he or she is unable to do so.

11. Examine ethical issues related to dying, including how death is determined, withholding life-sustaining treatments, and euthanasia.

The Uniform Determination of Death Act (UDDA) served as a guide for state lawmakers to create their own laws.

• The act provided a definition of death. Many ethical issues surround end-of-life issues.

• This chapter discussed withholding or withdrawing life-sustaining treatment and euthanasia.

• The CEJA’s opinion and the ethical issues involved with each of these topics were discussed.

12. Examine the ethical issues related to organ donation.

The gap between available organs and those needing organs is increasing. More people need organs than are available. The following organs and tissue can be donated:

• Organs: Kidney, liver, lung, heart, pancreas, and intestines

• Tissue: Hands, faces, heart valves, skin, bones, tendons, bone marrow, cord blood stem cells, blood, platelets, corneas, and eyes

There are different types of living donations, including direct, nondirected, and paired.

If a person wishes to be a potential donor at death, registering in the person’s state is the first step. With organ donation, justice and medical utility are factors that are balanced.

13. Differentiate between the Uniform Anatomical Gift Act and the National Organ Transplant Act.

The Uniform Anatomical Gift Act (UAGA) was enacted in 1968. All 50 states have adopted this law. The purpose of the act was to make it easier for people to donate organs.

The National Organ Transplant Act (NOTA) established the Organ Procurement and Transplant Network (OPTN) to be run by contract by the secretary of Health and Human Services. The act established a national registry for organ matching. NOTA also made it a criminal act to exchange organs for something of value and established the national registry for organ matching.

A medical assistant personally disagrees with a patient’s decision to receive birth control. The medical assistant works at a clinic where patients have the legal right to receive reproductive healthcare. What should the MA do?

A. Refuse to help the patient
B. Tell the patient that birth control is morally wrong
C. Follow professional standards and provide respectful care without imposing personal beliefs
D. Tell the patient’s parents

1. C — Follow professional standards and provide respectful care without imposing personal beliefs.
Personal beliefs should not interfere with professional responsibilities or patient care.

A medical assistant believes that teenagers should not be sexually active. A 16-year-old patient comes to the clinic for an STI screening. What is the most professional response?

A. Refuse to participate because of personal beliefs
B. Provide respectful care while separating personal beliefs from professional responsibilities
C. Tell the patient that they are too young to receive healthcare
D. Call the patient’s parents

2. B — Provide respectful care while separating personal beliefs from professional responsibilities.
The MA must recognize personal bias and avoid allowing it to affect the patient’s care.

Which statement best describes professional ethics?

A. Personal beliefs about right and wrong
B. Rules created by professional organizations or employers that guide professional behavior
C. Religious beliefs
D. Laws that apply only to patients

3. B — Rules created by professional organizations or employers that guide professional behavior.
Professional ethics are standards established by professional associations and/or employers.

A medical assistant is unsure how to respond to an ethical situation involving a patient. Which resource would be most appropriate for understanding ethical responsibilities specific to medical assisting?

A. AAMA Code of Ethics
B. Patient’s insurance policy
C. Patient’s driver’s license
D. Facility’s billing schedule

4. A — AAMA Code of Ethics.
The American Association of Medical Assistants provides a Code of Ethics that outlines ethical principles for medical assistants.

A medical assistant’s personal beliefs conflict with the policies of the medical practice. What should the MA do?

A. Always follow personal beliefs
B. Ignore the agency’s policies
C. Identify the conflict and develop a plan to separate personal beliefs from professional responsibilities
D. Attempt to convince patients to share the MA’s beliefs

5. C — Identify the conflict and develop a plan to separate personal beliefs from professional responsibilities.
Personal ethics should not supersede professional ethics.

A medical assistant allows personal opinions about a patient’s lifestyle to affect the way the MA communicates with the patient. What could be the result?

A. Improved patient care
B. Biased or disrespectful care
C. Increased patient autonomy
D. Better confidentiality

6. B — Biased or disrespectful care.
Personal morals and biases can positively or negatively affect healthcare delivery.

A competent patient refuses a recommended medical treatment after the provider explains the risks and benefits. Which ethical principle supports the patient’s right to make this decision?

A. Justice
B. Beneficence
C. Autonomy
D. Nonmaleficence

7. C — Autonomy.
Autonomy means respecting a competent person’s freedom to make their own healthcare decisions.

A medical assistant notices that a piece of equipment is damaged and could injure a patient. What ethical principle requires the MA to avoid causing harm?

A. Autonomy
B. Justice
C. Beneficence
D. Nonmaleficence

8. D — Nonmaleficence.
Nonmaleficence means “do no harm.”

A medical assistant goes out of their way to help a patient understand instructions so the patient can receive the greatest possible benefit from treatment. Which principle is demonstrated?

A. Beneficence
B. Justice
C. Autonomy
D. Nonmaleficence

9. A — Beneficence.
Beneficence means doing good or acting for the patient’s benefit.

A clinic has limited appointment availability. The staff schedules patients according to medical need rather than giving appointments to friends or people they personally prefer. Which ethical principle is being applied?

A. Autonomy
B. Justice
C. Beneficence
D. Nonmaleficence

10. B — Justice.
Justice means treating patients fairly and giving them what is due to them.

A medical assistant discovers that a sterile instrument needed for a procedure has become contaminated. The provider is in a hurry and wants to begin the procedure. What should the MA do?

A. Use the instrument because the provider is in a hurry
B. Hide the contamination
C. Notify the provider and replace or properly sterilize the contaminated instrument
D. Allow the provider to discover the problem

11. C — Notify the provider and replace or properly sterilize the contaminated instrument.
Using contaminated equipment could harm the patient. This is especially related to nonmaleficence.

A patient asks for genetic testing to determine whether they may have a hereditary disease. The patient is concerned about who might have access to the results. What ethical concern is most relevant?

A. Protection and appropriate use of genetic information
B. Sterile technique
C. Justice in scheduling
D. Hospice care

12. A — Protection and appropriate use of genetic information.
Genetic testing raises ethical concerns involving privacy, discrimination, consent, and appropriate use of genetic information.

A researcher is considering changing genes in an embryo before birth. Why might this raise ethical concerns?

A. It involves questions about the appropriate use and consequences of altering genetic material
B. It automatically violates patient confidentiality
C. It is related only to organ donation
D. It is an example of hospice care

13. A — It involves questions about the appropriate use and consequences of altering genetic material.
Genetic engineering raises ethical questions about how and when genetic material should be modified.

A couple uses donated eggs to help achieve pregnancy. Which ethical topic does this situation involve?

A. Assisted reproductive technology and gamete donation
B. End-of-life care
C. Medical fraud
D. Workplace safety

14. A — Assisted reproductive technology and gamete donation.
Egg donation and other reproductive technologies raise ethical questions involving consent, donors, embryos, parenthood, and access.

A healthcare worker has personal beliefs regarding abortion that differ from a patient’s beliefs. What is the most ethical approach?

A. Shame the patient for the decision
B. Provide respectful professional care while separating personal beliefs from professional responsibilities
C. Refuse all care to the patient
D. Attempt to change the patient’s beliefs

15. B — Provide respectful professional care while separating personal beliefs from professional responsibilities.
A medical assistant should not impose personal moral beliefs on patients.

A 16-year-old patient receives confidential healthcare for an STI under state law. The patient’s parent calls the clinic asking what happened during the visit. What should the MA do?

A. Give the parent the information because the patient is under 18
B. Follow applicable laws and clinic policies regarding confidential minor healthcare
C. Tell the parent everything because they pay the bills
D. Give the parent the patient’s medical records

16. B — Follow applicable laws and clinic policies regarding confidential minor healthcare.
If state law allows confidential healthcare for minors, the MA must follow those confidentiality requirements.

A child who was adopted comes to the medical office. The medical assistant understands that the child may not have access to complete information about their biological parents. Why is this important?

A. It may affect the availability of family medical history
B. It means the child cannot receive healthcare
C. It means the adoptive parents cannot make healthcare decisions
D. It eliminates the need for medical records

17. A — It may affect the availability of family medical history.
Adopted patients may have limited information about their biological family’s medical history, which can be important for healthcare.

A researcher is recruiting participants for a clinical trial. Which of the following is an important principle of ethical research?

A. Participants should not be told about the risks
B. Participants should be selected based only on convenience
C. Participants should provide informed consent
D. Researchers should avoid independent review

18. C — Participants should provide informed consent.
Informed consent is one of the seven major principles of ethical research.

A research study has potentially serious risks but very little potential benefit to participants. Which ethical research principle should be considered?

A. Favorable risk-benefit ratio
B. Justice only
C. Confidentiality only
D. Financial compensation

19. A — Favorable risk-benefit ratio.
Ethical research requires that potential benefits justify the risks to participants.

A research participant has already enrolled in a clinical trial. Researchers continue to monitor the participant’s welfare and respect their rights throughout the study. Which ethical research principle does this demonstrate?

A. Respect for potential and enrolled subjects
B. Scientific validity
C. Fair subject selection
D. Social value

20. A — Respect for potential and enrolled subjects.
Researchers have an ongoing responsibility to respect and protect participants.

A patient with a serious illness receives treatment designed to relieve pain, nausea, and other symptoms. The treatment is provided even though the patient is not necessarily near death. This is:

A. Hospice care
B. Palliative care
C. Euthanasia
D. Organ donation

21. B — Palliative care.
Palliative care focuses on relieving symptoms and improving quality of life for seriously ill patients, regardless of age or prognosis.

A patient has an expected life expectancy of approximately six months and chooses care focused on comfort, dignity, and quality of life rather than curative treatment. This is most consistent with:

A. Hospice care
B. Genetic therapy
C. Clinical research
D. Assisted reproduction

22. A — Hospice care.
Hospice is a type of palliative care generally intended for people with about six months or less to live.

A patient says, “This can’t possibly be happening to me. The doctors must be wrong.” Which stage of grief does this most closely represent?

A. Anger
B. Bargaining
C. Denial
D. Acceptance

23. C — Denial.
Denial involves refusing to accept the diagnosis or prognosis.

A patient says, “If I could just have one more year, I’ll do anything.” Which stage is most consistent with this statement?

A. Depression
B. Bargaining
C. Acceptance
D. Denial

24. B — Bargaining.
Bargaining involves attempting to negotiate for more time or a different outcome.

A patient understands that their illness is terminal and has begun making peaceful arrangements for the end of life. Which stage does this most closely represent?

A. Anger
B. Denial
C. Acceptance
D. Bargaining

25. C — Acceptance.
Acceptance means coming to terms with the situation.

A patient is admitted to a healthcare facility. Which action is required under the Patient Self-Determination Act?

A. The facility must ask whether the patient has an advance directive
B. The facility must force the patient to create an advance directive
C. The facility must make healthcare decisions for the patient
D. The facility must require the patient to appoint a healthcare proxy

26. A — The facility must ask whether the patient has an advance directive.
The PSDA requires most healthcare institutions to provide information about advance directives and ask patients whether they have one.

A patient has a written document explaining which life-sustaining treatments they want or do not want if they develop a terminal condition and cannot communicate their wishes. This is a:

A. Healthcare proxy
B. Living will
C. Medical durable power of attorney
D. Organ donor card

27. B — Living will.
A living will gives instructions about life-sustaining treatment when a patient has a terminal condition and cannot communicate their wishes.

A patient appoints their sister to make healthcare decisions if the patient becomes unable to make decisions independently. The sister is the patient’s:

A. Healthcare proxy/agent
B. Executor
C. Medical assistant
D. Beneficiary

28. A — Healthcare proxy/agent.
A healthcare proxy is someone appointed to make healthcare decisions when the patient cannot make them.

Which advance directive generally allows a person to appoint someone to make healthcare decisions and may also include healthcare wishes?

A. Living will
B. Medical durable power of attorney
C. Organ donor registry
D. Birth certificate

29. B — Medical durable power of attorney.
This can appoint someone to make healthcare decisions and may include the patient’s healthcare wishes.

Which act served as a guide for states in establishing legal definitions of death?

A. UAGA
B. NOTA
C. UDDA
D. PSDA

30. C — UDDA.
The Uniform Determination of Death Act provided a guide for states in defining death.

A patient wants to become an organ donor after death. What is an appropriate first step?

A. Register as an organ donor in their state
B. Sell their organs to a hospital
C. Choose which recipient will receive their organs
D. Give their organs directly to a friend without going through the system

31. A — Register as an organ donor in their state.
State registration is an important first step for someone who wishes to donate organs after death.

Which statement correctly differentiates the Uniform Anatomical Gift Act (UAGA) from the National Organ Transplant Act (NOTA)?

A. UAGA made organ donation easier, while NOTA established the national organ matching network
B. UAGA regulates workplace safety, while NOTA regulates laboratories
C. UAGA defines death, while NOTA regulates hospice
D. UAGA regulates medications, while NOTA regulates genetic testing

32. A — UAGA made organ donation easier, while NOTA established the national organ matching network.
The UAGA focused on making anatomical gifts/organ donation easier. NOTA established the Organ Procurement and Transplant Network and national registry for organ matching.

A visually impaired patient gives the MA $500 for a $402 bill. At the end of the day, the MA discovers that the patient received the wrong amount of change. What is the most appropriate action?

A. Keep the extra money because the mistake was accidental
B. Ignore the mistake because the patient did not notice
C. Notify the supervisor, explain what happened, and work to correct the error
D. Destroy the receipt

33. C — Notify the supervisor, explain what happened, and work to correct the error.
The ethical response is to be honest about the mistake, notify the appropriate person, and correct it.

A medical assistant accidentally contaminates an instrument while preparing a sterile tray. The provider urgently needs the tray. What should the MA do?

A. Use the contaminated instrument because the provider is in a hurry
B. Hide the contamination
C. Notify the provider and replace the contaminated instrument
D. Wait until after the procedure to mention it

34. C — Notify the provider and replace the contaminated instrument.
The patient’s safety is more important than the provider’s urgency.

The MA in Question 34 decides not to report the contaminated instrument. What is the most serious ethical concern?

A. The provider may be inconvenienced
B. The patient could develop an infection or experience harm
C. The MA may have to redo the tray
D. The appointment may take longer

35. B — The patient could develop an infection or experience harm.
Failing to report the contaminated instrument violates nonmaleficence (do no harm) and could directly put the patient at risk.