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MCQs Ethical Principles

Nazia Asad

Date: 19 March, 2018

Instructions for Candidates: Time allowed to solve MCQs is 20 minutes. Choose one best

answer among five options.

Q.1: A nursing instructor is teaching nursing students about principles of ethics in health care,

and she tells them that the utmost important principle to observe while taking care of patient is

doing no harm.

The principle of Ethics she described here:

a) Beneficence

b) Justice

c) Nonmaleficence

d) Respect for autonomy

e) Veracity

Answer key for question 1 is: (C)

Level of learners: Graduate students

Level of Cognition: C1

Rationale for answer: principles of ethics involve respect for autonomy, Nonmaleficence,

beneficence, and justice together with values and virtues of individual, families, and

communities. Doing no harm is Nonmaleficence that comes; from Hippocratic Oath to

Nightingale Pledge is integral part of code of ethics for all health professionals (American

Nurses' Association, 1985; Beauchamp & Childress, 2001).

Q.2: A researcher tries to invent new vaccine for cancer cure, he injects himself cancer cells to

see its impact on human blood chemistry and then through his own blood samples will further

progress to synthesize vaccine for prevention of occurrence of fatal cancer.

The theory and principle of ethics go parallel here are:

a) Beneficence and theory of virtue ethics.

b) Fiduciary and principlism theory of ethics.

c) Justice and Kantianism theory

d) Nonmaleficence and deontology theory.

e) Respect for Autonomy and critical theory.

Answer key for question 2 is: (a)

Level of learners: Graduate students

Level of Cognition: C1

Rationale for answer: Ideal beneficence and virtues motivate individuals to strive for ideal

philanthropic actions of greatest benefit for humanity and passion for sacrifice oneself to provide

the greatest benefit to humanity (Beauchamp & Childress, 2001; Bowin, 2007; Solum, 1994).

Q.3: A famous movie star after suffering fracture of his cervical two and cervical three vertebrae

due to an accident became quadriplegic; he is paralyzed below neck. He made his advance

directive that clearly states that he no longer wanted to live a life of persistent vegetative state

and so he wants physician assisted suicide. His family is against his decision and wanted to make
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him live that way and hope for further research in stem cells and genomics will find cure for his

quadriplegic state.

Ethical consideration in decision making for that movie star will include:

a) An integrated model: coherence theory

b) Bottom up models: cases and inductive generalization.

c) Four quadrant approach: Aristotle virtue theory

d) Principlism and common morality theory

e) Top- down models: theory and application

Answer key for question 3 is: (a)

Level of learners: Graduate students

Level of Cognition: C2

Rationale for answer: Justified Physician assisted suicide requires many conditions to fulfill

before actual action should take place. No single decision making model or theory could lead to

durable solution where everyone concerns are solved without compromising human rights,

ethical obligations and personal preferences. An integrated model: coherence theory basically

deals with that patient’s benefits come first and then these benefits are seen in coherence with

families, society, community, nation and global perspective of effects on human beings and

humanity in reflection to equity, equality, morality, norms, values, and social justice

(Beauchamp & Childress, 2001; Burkhardt & Nathaniel, 2013; Weir, (Ed.), 1997).
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Q.4: A 25 years old healthy male dies in a fatal road traffic accident; he has advance

directives about his organ donations. Health care rationing of organs take multiple factors

into account for deciding of who will be recipient of organ. Social utility, equity,

equality, distributive justice, beneficence and expected life expectancy after organ

transplantation ,all perspectives play roles in allocating of scarce organs to recipients, as

waiting lists are lengthy and decision is tough.

The most likely recipient of organ will be:

a) A 45 years alcoholic with irreversible liver failure.

b) A 75 years old female with extreme form of dementia and end stage renal failure.

c) A 35 years young entrepreneur with acute renal failure.

d) A 10 years old male with multi organ failure and brain death.

e) A 40 years old female with heart failure and HIV positive.

Answer key for question 4 is: (C)

Level of learners: Graduate students

Level of Cognition: C2

Rationale for answer: rationing of donated Organs is a difficult decision and everybody who is

on waiting list, in his/her own right is the most deserving candidate for that organ, when the

organs are scarce and recipients are more, then queuing and lottery could be one option to make

a decision on bases of chance and not on choice, it will be to some extent fair as no one can
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claim decision is bias that came out of lottery as it is merely on pure chance, and randomization

whose name is picked. But many other factors like life expectancy after organ transplantation

and utilitarian view of how much that recipient do greatest good to society. Quality of life and

social services by the recipients after organ transplantation, and social support system of

recipient all play role in deciding who is the perfect candidate as organ recipient (Beauchamp &

Childress, 2001; Burkhardt & Nathaniel, 2013; Truog, 2005).

Q.5: Miss M, a 34 years old female, comes to emergency reception (ER) with her 20 days old

baby boy, suffering a lesion in his groin. Mother tells that her baby is not his usual active. Baby

has Mycoscoriasis fungal infection of neonates. ER physician on physical examination finds

baby alert, pink and active; sends him back to home. Although Nurse in ER had noticed the

lesion in groin and suspects that her previous experience is that such lesions in neonates, if not

treated timely, led to fatal outcomes. Baby returns in ER after 24 hours with many lesions on his

trunk, severe breathlessness, cyanosed and unconscious.

Health care providers were liable to commit the form of harm to the patient:

a) Advertent negligence

b) Assault

c) Battery

d) Inadvertent negligence

e) Malpractice

Answer key for question 5 is: (a)

Level of learners: Graduate students

Level of Cognition: C2

Rationale for answer: advertent negligence involves when health care providers know that

consequences of not performing reasonable required actions in particular situation could be fatal

for patient (Beauchamp & Childress, 2001; Burkhardt & Nathaniel, 2013).

E.g. a nurse does not check patient’s blood pressure admitted with malignant hypertension as

per advice and patient suffers Cerebral Vascular Accident (CVA) and irreversible hemiplegia

due to raised blood pressure. This example clearly shows the advertent negligence on part of a

nurse as she knew the consequences of not checking timely blood pressure will cause delay in

identifying early warning signs of increased blood pressure; will ultimately delay in treating

High blood pressure and will result in fatal outcomes (Jones & Lyons, 2008).

Q.6: A 35 years old male, athlete admits with pain in Right knee, investigations reveal that he is

suffering from end stage osteosarcoma, and needs extensive chemotherapy, radiotherapy to treat

the cancer. Athlete’s father died with osteosarcoma in his fifties. His mother died due to breast

cancer in her forties. He has a living will that if he ever diagnosed with cancer, not wanted to be

aggressively treated by chemotherapy, radio therapy and other therapies. Physician is consistent

to treat him with all sorts of treatment possible to cure his cancer.

Physician is exercising:

a) Act of Paternalism

b) Ideal beneficence
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c) Obligatory beneficence

d) Specific beneficence

e) Surrogate decision maker

Answer key for question 6 is: (a)

Level of learners: Graduate students

Level of Cognition: C3

Rationale for answer: paternalism on part of physician is only justifiable in health care

situations when general public or society as a whole is adversely affected by the consequences of

actions of physicians. Paternalism was prevalent in 18th and 19th century, when less

consideration was on respect for autonomy, so in the name of beneficence acts of paternalism

was highly regarded in health care in previous centuries. But with the beginning of industrial era

and technological revolution, emphasize shifted, on respect for autonomy and human rights and

actions of paternalism were being questioned by many, as they were against patients, and

families’ wishes and preferences and were contradictory to their religious and cultural values.

Paternalism is no longer advocated by many only in the name of beneficence (Beauchamp &

Childress, 2001; Burkhardt & Nathaniel, 2013; Childress & Mount Jr, 1983).

Q.7: A 30 years old pregnant woman with 37 weeks of gestation admits in maternity ward with

complaints of starting labor pains, she is human immunodeficiency virus (HIV) positive. Her

previous two children are HIV positive. She delivers healthy baby boy weighing 3.5Kg.

She is not willing to test her baby for HIV screening and left the ward against medical advice.
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To save public from preventable HIV transmission, policies developed by health care policy

makers must address the policy:

a) Compulsory and voluntary screening for HIV for all.

b) Mandatory HIV screening of all newborns.

c) Mandatory screening of all pregnant women for HIV.

d) Mandatory screening for HIV for all irrespective of low and high risk groups.

e) Voluntary selective screening for HIV, indulge in unsafe sexual practices.

Answer key for question 7 is: (b)

Level of learners: Graduate students

Level of Cognition: C3

Rationale for answer: New born have to undergo many types of screening for genetic disorders

and more after birth in United States of America, debate is that HIV screening should be

mandatory for all newborns but social stigma attached to being HIV positive, is a biggest barrier

in implementing this mandatory screening to aware and save general public (Beauchamp &

Childress, 2001; Burkhardt & Nathaniel, 2013; Post, 1994).

Q.8: A 2 days old baby girl is admitted in neonatal intensive care unit; she is suffering from

early onset neonatal sepsis accompanied with multi organ failure. She has to put on mechanical

ventilator support; her respiratory status is moderately working, pupils are fixed dilated, motor

and sensory responses are absent and her heart is having regular sinus rhythm. Physician

counsels parents, about brain death; and explains that it is of no use to keep the baby alive with
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evident brain death, and asks for parents’ permission to off the artificial mechanical support. But,

Parents are stubborn to continue life support.

Social and ethical principles come in conflict with health care system are:

a) Cost related to futile treatment and medical concerns.

b) Parents’ wishes and futile medical treatment

c) Respect for autonomy of surrogate decision maker.

d) Religious and cultural beliefs to not to end life.

e) Virtue ethics and ideal beneficence versus medical realities.

Answer key for question 8 is: (C)

Level of learners: Graduate students

Level of Cognition: C3

Rationale for answer: Futile treatment for brain dead cases, and humongous costs attached to it

are cause of concerns in current medical realities. Because many factors play its role like, social

and cultural norms and values regarding life and death scenarios, legal concerns attached to these

situations, political and economic perspectives further add to complications in making decisions

for these kind of prolongation of artificial ventilation on brain dead cases. Laws, society,

economy, political leaders and medical teams have had to device a system that will end futile

treatments for brain dead cases with mutual consensus (Beauchamp & Childress, 2001;

Burkhardt & Nathaniel, 2013; Schneiderman., Jecker., & Jonsen, 1990).

Q.9: A public hospital of developing country is having a large number of unreported incidents of

needle stick injuries and workplace violence and no reporting system and compensation for

health care providers is in place for such incidents. As contrast patients are well protected against

harassment and spread of Hepatitis B and C infections.

Victims of maleficence here are:

a) Communities

b) Employees

c) Families

d) Patients

e) Stakeholders

Answer key for question 9 is: (b)

Level of learners: Graduate students

Level of Cognition: C2

Rationale for answer: Health care organizations are responsible for employees’ safety and

health. Occupational and safety health acts (OSHA) give employees rights to safe and secure

environment in any organization. If health care institutions do not take care of their employees

then victims of maleficence are employees and they can make employer realize and blow whistle

to have employees’ rights met (Beauchamp & Childress, 2001; Burkhardt & Nathaniel, 2013;

Occupational Safety and Health Administration, 1985).

Q.10: A 75 years old male patient suffering from metastatic cancer of prostate is admitted in

hospice for palliative comfort care. He requests doctor to increase the dose of narcotics

analgesics to relieve his pain and suffering. Physician is reluctant to increase the dose as patient

is already have maximum possible dose of analgesics and further increase in dose will only

hasten patient’s death. Under the rule of double effect (RDE), to maximize comfort and to

decrease pain and suffering, analgesics’ dose could be increased.

Physician can take decisions only if it satisfies the following:

a) All b, c, d, and e conditions must be fulfilled to justify that benefits outweigh harm.

b) Proportionality between good effect and the bad effect.

c) The nature of the act.

d) The agent’s intention.

e) The distinction between means and effects.

Answer key for question 10 is: (a)

Level of learners: Graduate students

Level of Cognition: C2

Rationale for answer: rule of double effect could be implemented if the agent’s intention is to

relieve suffering and not killing of the patient. The nature of act is not vicious but it is for to

promote good. The transparent line must be visible between means and effects and it should

satisfy the ethical principles. Furthermore good effect must outweigh the bad effects of action
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e.g. every medicines used in cure has side effects yet it is approved by regulatory bodies on the

ground that harm is less as compare to good from these medicines (Beauchamp & Childress,

2001; Burkhardt & Nathaniel, 2013; Quill., Dresser., & Brock, 1997).
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References:

American Nurses' Association. (1985). Code for nurses: with interpretive statements. The

Association.

Bowin, J. (2007). Aristotelian infinity.

Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford University

Press, USA.

Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Nelson

Education.

Childress, J. F., & Mount Jr, E. (1983). Who should decide? Paternalism in health care.

Hsieh, E., Smith, P. B., Jacqz-Aigrain, E., Kaguelidou, F., Cohen-Wolkowiez, M., Manzoni, P.,

& Benjamin Jr, D. K. (2012). Neonatal fungal infections: when to treat?. Early human

development, 88, S6-S10.

Jones, M. A., & Lyons, M. (2008). Medical negligence (pp. 652-74). London: Sweet & Maxwell.

Mendeloff, J. M., & Kagey, B. T. (1990). Using Occupational Safety and Health Administration

accident investigations to study patterns in work fatalities. Journal of occupational

medicine.: official publication of the Industrial Medical Association, 32(11), 1117-1123.

Nightingale, F. (1992). Notes on nursing: What it is, and what it is not. Lippincott Williams &

Wilkins.
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Occupational Safety and Health Administration. (1985). Training requirements in OSHA

standards and training guidelines. ERIC Clearinghouse.

Post, L. F. (1994). Unblinded Mandatory HIV Screening of Newborns: Care of

Coercion. Cardozo L. Rev., 16, 169.

Quill, T. E., Dresser, R., & Brock, D. W. (1997). The rule of double effect—a critique of its role

in end-of-life decision making.

Sokol, D. K. (2008). The “four quadrants” approach to clinical ethics case analysis; an

application and review. Journal of medical ethics, 34(7), 513-516.

Schneiderman, L. J., Jecker, N. S., & Jonsen, A. R. (1990). Medical futility: its meaning and

ethical implications. Annals of internal medicine, 112(12), 949-954.

Solum, L. B. (1994). Equity and the Rule of Law. Nomos, 36, 120-147.

Truog, R. D. (2005). The ethics of organ donation by living donors. New England Journal of

Medicine, 353(5), 444-446.

Weir, R. F. (Ed.). (1997). Physician-assisted suicide. Indiana University Press.