AKT – Medical Ethics

Richard Wallace, aged 45, is a GP in a small rural town. He has been approached by his cousin asking for a medical certificate for a week off work due to stress. The cousin does not wish to attend an appointment and insists that Richard knows his situation well enough. Richard is unsure how to proceed.

What is the most appropriate action?

Priya Shah, aged 16, presents alone requesting a prescription for the oral contraceptive pill. She is well-spoken, understands the risks and benefits, and provides a clear history of consensual sexual activity with a peer. She does not wish her parents to be informed. You believe she has capacity.

What is the most appropriate next step?

Anne McGregor, aged 39, is a patient you’ve seen several times over the past year for anxiety and insomnia. She brings a bottle of wine and a thank-you card to her review appointment, stating you’ve helped her immensely. She hands the wine to you and insists you accept it.

What is the most appropriate action?

Daniel Nguyen, aged 34, has been your patient for several years. He recently connected with you on a professional social media platform. You are unsure whether to accept the connection request.

What is the most appropriate response?

Susan Brennan, aged 81, is admitted to hospital with pneumonia and is not responding to treatment. Her daughter insists on ICU transfer, despite a valid advance care directive indicating comfort care only. The daughter is distraught and accuses staff of giving up on her mother.

What is the most appropriate course of action?

Fatima Al-Hassan, aged 28, is a registrar in your practice. She confides in you that her supervisor has made repeated inappropriate comments about her appearance and has touched her arm unnecessarily during consultations. She is distressed but afraid to escalate the matter formally.

What is the most appropriate next step?

John Patel, aged 68, has end-stage COPD. He has declined further hospital admissions and has a documented advance care plan requesting no intubation. He now presents with acute respiratory failure. His son insists that “everything must be done” and demands intubation.

What is the most appropriate action?

Michelle Tran, aged 52, is undergoing chemotherapy and has been prescribed opioids for pain. She requests that you write a prescription under her sister’s name to avoid insurance scrutiny. She reassures you it’s for her own use and fears delays if flagged by insurers.

What is the most appropriate response?

Gabriel Martins, aged 47, has been your patient for years. His 15-year-old son Noah presents requesting STI screening and contraception advice, stating he is sexually active. He asks that his father not be informed. You assess Noah as mature and capable of informed decision-making.

What is the most appropriate action?

Edward Varga, aged 36, is your patient. He is also the local pharmacist and has started sharing clinical opinions about your patients, occasionally correcting or contradicting your advice. A patient recently complained that Edward told her your diagnosis was incorrect.

What is the most appropriate response?

Sophie Langford, aged 25, is an international student who has recently tested positive for chlamydia. She is distressed and insists that her partner not be informed, fearing stigma in their shared cultural community. You explain the importance of contact tracing but she refuses consent.

What is the most appropriate next step?

Matthew Reilly, aged 57, is your patient with stable bipolar disorder. His adult daughter calls the clinic concerned he may be becoming manic again. She requests that you call him and assess him urgently, but he has not contacted you himself and there is no prior consent for disclosure.

What is the most appropriate response?

Joan Frawley, aged 83, lives in residential aged care and has moderate dementia. Her son, the substitute decision-maker, insists she undergo aggressive investigation for unexplained weight loss. The GP believes investigations would be distressing and of limited benefit to Joan.

What is the most appropriate course of action?

Thomas Youssef, aged 42, has been off work for 3 weeks due to back pain. You suspect he is exaggerating symptoms and may be malingering. He requests another certificate stating he is unfit for work for 2 more weeks. Examination shows normal mobility and negative Waddell’s signs.

What is the most appropriate response?

Hannah Kim, aged 31, is a GP registrar completing a palliative care rotation. She is approached by a nurse who expresses concern that one of the senior doctors routinely administers morphine in doses that exceed protocol. The nurse fears this may hasten death in some cases.

What is the most appropriate first step?

Amira Suleiman, aged 24, is a medical student on placement. She witnesses her supervisor falsifying vaccination records for a patient who declined immunisation. The supervisor says, “It’s just easier this way.” Amira is unsure what to do and fears her grade may suffer if she speaks out.

What is the most appropriate next step?

Lachlan Byrne, aged 63, has terminal lung cancer and requests information about voluntary assisted dying (VAD). Your personal beliefs are opposed to VAD, and you do not wish to be involved. VAD is legal in your jurisdiction.

What is the most appropriate course of action?

Peter Chung, aged 37, is a GP. His friend and neighbour approaches him after-hours for a quick prescription for benzodiazepines, citing anxiety and poor sleep. Peter is aware that the friend has previously struggled with alcohol use but insists it’s a one-off.

What is the most appropriate response?

Jenny Roberts, aged 44, has metastatic breast cancer. Her 19-year-old daughter contacts you after-hours requesting details of her mother’s prognosis and recent scan results. Jenny has not consented to this and has previously stated she wants to protect her daughter from distressing news.

What is the most appropriate response?

Ali Hassan, aged 38, recently diagnosed with HIV, asks you not to record his diagnosis in My Health Record due to fear of stigma and potential employment issues. He is otherwise well and engaged in care.

What is the most appropriate response?

Daniela Marino, aged 49, attends for a routine check-up and asks you not to document anything about her sexual history because her husband has access to her My Health Record. She is concerned about his reaction if he sees she discussed previous partners.

What is the most appropriate response?

Rohan Malik, aged 70, attends with his wife for cognitive screening. During the consult, she repeatedly answers on his behalf and insists she always manages his medications. Rohan appears quiet but alert, and you are unsure about his capacity for medical decisions.

What is the most appropriate next step?

Mark Webb, aged 61, presents with worsening depression. You learn that he recently purchased a firearm. He denies suicidal ideation but appears withdrawn and hopeless. You are concerned about risk but unsure if he meets criteria for breach of confidentiality.

What is the most appropriate action?

Linda Zhao, aged 31, is a refugee who presents with ongoing pelvic pain. On further questioning, she discloses that she underwent female genital mutilation (FGM) in childhood. She does not wish for anything to be reported and is reluctant to discuss it further.

What is the most appropriate next step?

Geoff Norton, aged 74, has moderate dementia and resides in supported accommodation. A junior doctor documents a medication error that resulted in a missed dose of anticoagulant. The nursing staff ask you to amend the notes to avoid upsetting the family.

What is the most appropriate response?

Emily Waters, aged 33, presents requesting termination of pregnancy at 6 weeks gestation. You are personally opposed to abortion and feel conflicted. However, you are practising in a jurisdiction where termination is legal and accessible.

What is the most appropriate course of action?

Christopher Yee, aged 46, is diagnosed with early-stage colon cancer. He insists that you do not tell his wife or children because he wants to protect them from worry. His wife later calls, anxious after overhearing part of his phone call, and asks you directly what is happening.

What is the most appropriate response?

Sarah Quinlan, aged 59, is recovering from alcohol dependence and has been abstinent for 6 months. She is applying for a position as a commercial pilot and asks you to omit her alcohol use history from the medical assessment form, saying it was never formally diagnosed.

What is the most appropriate response?

Olivia Baxter, aged 30, is a newly diagnosed patient with schizophrenia who has just commenced antipsychotic treatment. Her employer calls the clinic requesting verification of her diagnosis as part of a workplace assessment process. Olivia has not given consent for this release.

What is the most appropriate response?

Terry Nolan, aged 77, has advanced dementia and limited verbal communication. He is in residential care. You observe signs of possible neglect, including weight loss, poor hygiene, and bruising. The staff explain it’s due to his progression and frequent falls.

What is the most appropriate next step?

Natalie Jensen, aged 27, is a GP registrar. During a shared consult, you notice her making frequent errors in prescribing and documentation. When approached, she becomes tearful and admits she is struggling with anxiety and hasn’t been sleeping well. She begs you not to report her.

What is the most appropriate action?

James O’Shea, aged 50, has been diagnosed with a motor neuron disease and is rapidly deteriorating. He asks for assistance to travel interstate to access voluntary assisted dying, which is not yet legal in your state. He requests documentation and support for travel.

What is the most appropriate response?

Lilian Chan, aged 35, is applying for insurance and asks you to complete a medical report. She requests you to downplay her previous anxiety diagnosis, explaining it was “just a phase” and she doesn’t want higher premiums. You have seen her for anxiety multiple times in the past two years.

What is the most appropriate response?

Harvey Tran, aged 17, attends alone and confides that he is being emotionally abused at home. He does not want you to tell anyone, fearing things will get worse. He is visibly anxious and withdrawn, but denies immediate danger or physical harm.

What is the most appropriate next step?

Barbara Knox, aged 89, lives at home with support from her son. You suspect he may be mismanaging her medications and finances. She seems confused at times but insists she is fine and refuses additional help. She becomes agitated when you suggest involving external services.

What is the most appropriate next step?

Dominic Rinaldi, aged 58, is being discharged after a myocardial infarction. He refuses all follow-up and medication, stating he “doesn’t believe in pills” and wants to treat himself naturally. He understands the risks but remains adamant in his choice.

What is the most appropriate response?

Ana Ferreira, aged 32, is 12 weeks pregnant. She discloses that her partner is controlling, physically intimidating, and monitors her communication. She asks you not to write anything in the record that might reveal domestic violence, in case he accesses it.

What is the most appropriate action?

Tomás Varga, aged 40, is in the final stages of ALS and has appointed his sister as medical power of attorney. He loses capacity and his sister insists on continuing artificial feeding, despite clear documentation from Tomás expressing his wish to stop all life-prolonging treatments at this point.

What is the most appropriate action?

Priyanka Malhotra, aged 46, is a new patient who has been seeing multiple GPs requesting opioid prescriptions. She claims her previous records are unavailable but insists she has chronic back pain and needs oxycodone to function. You are suspicious of drug-seeking behaviour.

What is the most appropriate next step?

Elaine Bourke, aged 62, has moderate Parkinson’s disease and attends with her adult son, who answers every question for her and becomes defensive when asked to wait outside. Elaine looks hesitant but nods when asked if she wants him present. You suspect coercion but aren’t sure.

What is the most appropriate next step?

Rachel Stone, aged 29, is a junior doctor who presents for a mental health review. She confides she has been experiencing suicidal thoughts and sometimes drinks heavily after shifts. She insists on confidentiality and does not want her employer to find out.

What is the most appropriate response?

Ahmed Dawood, aged 67, has end-stage renal failure. He requests that you not discuss his health with his adult children, fearing they will insist on aggressive treatment. He asks that you tell them he is ‘fine’ if they inquire.

What is the most appropriate action?

Leanne Farmer, aged 73, recently diagnosed with pancreatic cancer, declines further investigation and treatment. Her daughter insists that you order a biopsy and refer for oncology care. Leanne appears well-informed and calm in her decision.

What is the most appropriate response?

Kevin Baxter, aged 42, was recently discharged from psychiatric care and attends for review. You find inconsistencies in his account and suspect he is not taking prescribed medication. He becomes defensive and threatens to complain if you “interfere.”

What is the most appropriate course of action?

Clare Donaldson, aged 61, is a retired nurse and requests medical cannabis for chronic osteoarthritis pain. You’re unfamiliar with the current regulations but believe her request is reasonable. You’re unsure whether you can prescribe it yourself.

What is the most appropriate response?

Yasmin El-Rashid, aged 36, attends for a cervical screening test. During the consultation, she reveals she is experiencing marital rape but is afraid to report it due to her cultural and visa situation. She requests confidentiality and declines referral to police or support services.

What is the most appropriate next step?

Leonard Holmes, aged 84, has mild cognitive impairment. His nephew asks for a copy of his recent CT scan and blood results. Leonard has not formally appointed the nephew as his decision-maker but has previously brought him to appointments.

What is the most appropriate action?

Mina D’Souza, aged 22, is a medical student and your patient. She asks for a medical certificate stating she was unwell during an exam last week, even though she did not attend or seek care at the time. She insists it’s “just one time.”

What is the most appropriate response?

Omar Latif, aged 55, is diagnosed with lung cancer. He insists on no further treatment and requests that his diagnosis not be shared with his adult children. His daughter calls you directly asking if everything is okay with her father.

What is the most appropriate response?

Harriet West, aged 39, brings her 14-year-old son Oliver to discuss initiating testosterone for gender-affirming therapy. Oliver has already socially transitioned and is distressed by his developing breasts. You are unsure of the legal and ethical implications in your state.

What is the most appropriate next step?