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 Kaplan ethics question  



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Author14 Posts
  #1

Its a q on physician assisted suicide.

Q. 65 yo man makes a consult since he want to commit suicide and need prescription for pain. He was recently diagnosed with colon ca through a screening colonoscopy and is evaluated for staging the disease. He is not depressed and his mood is normal. He is not in pain or nauseated. He want those prescription so that he can take it at a later time when he is debilitated.

whats most appropriate?
a. give pain medication as appropriate but not to end life.
b. have him undergo psychological screening first.
c. In patient psychiatric evaluation for suicidal ideation.
d.Start anti depressant
e. refer.

What do you think is the answer. Answer they gave is A. But i think it could be B. Any opinion or does anyone know why its A?





  #2

error *not prescription for pain but for suicide. Sorry


  #3

Q. 65 yo man makes a consult since he want to commit suicide and need prescription for the same. He was recently diagnosed with colon ca through a screening colonoscopy and is evaluated for staging the disease. He is not depressed and his mood is normal. He is not in pain or nauseated. He want those prescription so that he can take it at a later time when he is debilitated.

whats most appropriate?
a. give pain medication as appropriate but not to end life.
b. have him undergo psychological screening first.
c. In patient psychiatric evaluation for suicidal ideation.
d.Start anti depressant
e. refer.


  #4

What do you guys think?


  #5

2010usmle wrote:
Its a q on physician assisted suicide.

Q. 65 yo man makes a consult since he want to commit suicide and need prescription for the same. He was recently diagnosed with colon ca through a screening colonoscopy and is evaluated for staging the disease. He is not depressed and his mood is normal. He is not in pain or nauseated. He want those prescription so that he can take it at a later time when he is debilitated.

whats most appropriate?
a. give pain medication as appropriate but not to end life.
b. have him undergo psychological screening first.
c. In patient psychiatric evaluation for suicidal ideation.
d.Start anti depressant
e. refer.

What do you think is the answer. Answer they gave is A. But i think it could be B. Any opinion or does anyone know why its A?


this is a strange question. the steam clearly says "He is not in pain.....". then how can they say the answer is A ??!!!??? especially when his underlying reason to get the prescription is for suicide. where is this ques. from? can you please post their explanation so we can see where they're going with this.


  #6

I was just trying to go through various question in ethics.
The reasoning wasn't good enough. And nothing was said about option B. I think we need to know the indication for psychological evaluation.
The answer might have been reached through exclusion. Don't know.



  #7

2010usmle wrote:
I was just trying to go through various question in ethics.
The reasoning wasn't good enough.


well, plz do post it. i know i'd like to see what they said.


  #8

i think they have applied RULE NO 09 FROM ETHICS(CONSULT KAPLAN STEP 2OR STEP 1 BOOK)....DO ALL YOU CAN DO RELIEVE PATIENT SUFFERING EG GIVE PAIN MEDICATION......
But in the stem it is written that HE IS NOT IN PAIN...i think it is adistractor...
where is forum gur on this imp ETHICS QS???


  #9

he is clearly suicidal.. so even though it says he's not in depression.. 'c' should be the right answer.


  #10

I agree. C should be done first.


  #11

guys,look for their exprimation:give pain medication AS APPROPRIATE but not to end life,so you can prescribe him or not and you can prescribe a certain quantity.. he's not depressed,his mood is ok so why B or C?


  #12

why would pain meds be appropriate now condidering the fact that he is not in pain at present? since he expresses desire to commit suicide he must be evaluated for the same or have a psychiatric screening


  #13

The Q is like this:

A 65-y/o man comes to see you because he wants your help in commiting suicide. He has been diagnosed with with metastatic colon cancer but he is not in pain or nauseated. He denies depression and seems to have a normal mood. He is asking for a prescription of combination medication that he can take to end his life. He says he will wait for a few weeks or months until he starts to feel weak and then he wants to end his life before he becomes debilitated, bed-bound, or a burden to his family. Which of the following is most appropriate in this case?

A. provide the pain medication as appropriate but not the means to end his life

B. provide the patient with medications he wants to end his life

C. have him undergo a psychological screening first

D. refer him to a specialist in this area

E. in-patient psychiatric evaluation for suicidal ideation

F. start antidepressants



The correct answer is A. Physician-assisisted suicide is always considered unacceptable (choice B). The patient is not acutely depressed so antidepressants are unnecessary (choice F). His form of reasoning does not need a psychological or an inpatient psychiatric evaluation (choice C and E). Try never to refer patients on board questions for anything. There is no "specialist" that can certify a patient as a good candidate for assisted suicide (choice D).


  #14

where is this question from ? i doubt it has a reliable source anyhow.i can not acceptA (neither legally nor ethicly ) ,,the only choice that i can force myself to accept would be C ...when patient asks for a medication that has potential to be abused ,while there is no indication for that specially in patient who might has plans in his mind(he does not necessary tell you he has plans), and a strong motive (cancer),,we should be more carful about just giving him that medication.





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