Master the board step 3

Section 11
Ethics
Autonomy
Autonomy is the most frequently tested subject on Step 3. The following is the
most fundamental ethical concept:
··
An adult with the capacity to understand his or her medical problems can
refuse any therapy or test.
It does not matter if the treatment or test is simple, safe, and risk-free. It does
not matter if the person will die without the treatment or test. The patient can
refuse the treatment or test.
Respecting autonomy is more important than trying to do the right thing for a
patient. Trying to do the right thing for a patient is called beneficence.
A 35-year-old mentally intact patient is refusing radiation for a stage I lymphoma. The
treatment has a 95 percent chance of cure and virtually no adverse effects. What do
you do?
a. Try to discuss it with him.
b. Honor his wishes.
c. Order a psychiatric consultation.
d. Arrange an ethics committee consultation.
e. Get a court order.
Answer: A. Even though an adult patient with capacity can refuse anything, USMLE
wants you to discuss things first. Even though you may eventually honor his wishes, if
an answer says “meet,” “confer,” or “discuss,” then do that first.
541