Free HEC-C Practice Questions

Question 1

The chart labels a patient with expressive aphasia after a stroke as "unable to consent." She follows complex instructions, points to written treatment choices, and becomes frustrated when her husband answers for her. A nonurgent feeding-tube decision is pending; no decision-specific capacity assessment has been completed. Before accepting the chart label, the ethics consultant should:

Accepted Answer

Arrange communication support and assess her understanding, appreciation, reasoning, and ability to express a choice.

Answer

Ask her husband to interpret her gestures and authorize the treatment he believes she prefers.

Answer

Obtain a psychiatric consultation before allowing her to participate in the feeding-tube decision.

Answer

Use her accurate responses to written choices as sufficient evidence that she can consent to treatment.

Question 2

During two earlier admissions, a patient with capacity told her physician and daughter that she would not accept long-term tube feeding if she permanently lost the ability to recognize others. Both conversations were documented. She now has irreversible brain injury that meets those conditions. Her daughter, the authorized healthcare agent, confirms the statements but requests a feeding tube because "I could never forgive myself for saying no." There is no written instruction directive. Which recommendation best respects the patient's decision-making history?

Accepted Answer

Base the decision on her documented wishes while helping the daughter carry them out.

Answer

Use a best-interests assessment because the patient did not execute a written instruction directive.

Answer

Follow the daughter's choice because appointment as healthcare agent gives her discretion to set treatment goals.

Answer

Ask the relatives to reach consensus before relying on the earlier statements.

Question 3

For tomorrow's pain-relieving hip surgery, a patient with capacity wants to modify her orders against resuscitation and intubation. After discussing anesthesia risks, she accepts temporary intubation for the operation but continues to refuse chest compressions. The surgical and anesthesia teams can provide the procedure within these limits. The preoperative ethics recommendation should be to:

Accepted Answer

Document the permitted interventions and specify when the original treatment limits will resume.

Answer

Suspend both orders during anesthesia to permit treatment of reversible complications.

Answer

Leave both existing orders unchanged unless the patient agrees to revoke them beyond the surgical admission.

Answer

Postpone surgery for a formal capacity evaluation because accepting intubation conflicts with refusing resuscitation.

Question 4

An unidentified, unconscious adult has uncontrolled internal bleeding after a collision. The surgeon determines that an operation is needed immediately to prevent death; temporizing measures will not provide a safe delay. No surrogate is available, and a rapid search reveals no applicable treatment refusal. The emergency department asks whether surgery must wait for consent. What is ethically justified?

Accepted Answer

Proceed with emergency surgery and seek authorization for subsequent nonemergency treatment.

Answer

Limit treatment to temporizing measures while staff continue searching for someone authorized to consent.

Answer

Treat the emergency as authorization for surgery and subsequent treatment throughout the same hospital admission.

Answer

Have the ethics consultant authorize the operation after independently confirming the surgeon's assessment of urgency.

Question 5

At enrollment in a randomized cancer-treatment study, a participant accurately describes the major risks and says, "I know neither treatment is guaranteed to help." Assignment is by chance, and the protocol does not permit the oncologist to choose the treatment arm. The participant then explains, "The computer will use my oncologist's judgment to put me in whichever group is best for my cancer." What does this statement reveal?

Accepted Answer

A mistaken belief that research assignment is tailored to the participant's therapeutic needs.

Answer

An optimistic estimate of personal benefit despite understanding how treatment is assigned.

Answer

A willingness to accept greater treatment risk in return for a chance of personal benefit.

Answer

A voluntary decision to delegate an informed treatment choice to a trusted oncologist.

Question 6

An ethics service uses a local satisfaction item scored 1 = very dissatisfied, 2 = dissatisfied, 3 = neither satisfied nor dissatisfied, 4 = satisfied, and 5 = very satisfied. It defines ratings of 4 or 5 as positive. Ninety-four percent of responding referring clinicians give positive ratings. Separately, peer review identifies several consultations in which patients with capacity were excluded from decision meetings despite asking to participate. How should these findings be interpreted together?

Accepted Answer

Referrers report favorable experiences, but that does not resolve the participation defects.

Answer

The high positive-rating proportion supports classifying the excluded-patient cases as successful consultations overall.

Answer

The conflicting findings make the clinician satisfaction ratings unreliable.

Answer

The ratings estimate satisfaction across stakeholders because referring clinicians can assess how the whole consultation went.

Question 7

"He keeps refusing dialysis," a referral states. The patient explains the benefits of dialysis and the risks of missing it, and repeatedly says he wants treatment. Attendance was reliable until his wheelchair-accessible transport service ended; he attended both sessions for which the social worker subsequently arranged a ride. Which interpretation best fits the available evidence?

Accepted Answer

An access barrier is preventing him from obtaining treatment he continues to choose.

Answer

His preferences and behavior are inconsistent, suggesting impaired appreciation of the need for dialysis.

Answer

He is ambivalent about treatment and needs a firmer attendance agreement.

Answer

He has made informed refusals because he understands the consequences of missing dialysis.

Question 8

A 12-year-old is scheduled for revision of a healed facial scar. The surgeon explains that the benefit is cosmetic, postponement poses no medical risk, and waiting will not reduce future treatment options. The child understands the procedure and persistently declines it. His parents have signed permission and ask the surgeon to proceed because classmates may tease him. Which response gives the child's dissent its appropriate ethical weight?

Accepted Answer

Defer the elective procedure and explore the child's objections with him and his parents.

Answer

Proceed on parental permission after explaining why the parents believe the operation will benefit him.

Answer

Seek a court ruling to determine whether the child's refusal can override the parents' permission.

Answer

Request psychiatric assessment to determine whether the child is legally competent to refuse this operation.

Question 9

In a family meeting, a patient's authorized surrogate accurately explains that further cancer treatment will not help. He nevertheless says, "You want me to agree to comfort care, but I promised her I would never give up on her." The clinicians have already answered his questions about prognosis and available treatments. Which reply would best uncover the concern sustaining the disagreement?

Accepted Answer

"When you say giving up, what are you afraid we would stop doing?"

Answer

"Would another explanation of the prognosis help you feel ready to accept the team's recommendation?"

Answer

"Would delaying the decision until every relative agrees make you more comfortable with the proposed plan?"

Answer

"Would you prefer to choose the treatment plan without receiving a recommendation from the clinical team?"

Question 10

In a capacity interview about treatment of an infected foot, a patient accurately explains the diagnosis, proposed amputation, alternatives, and risk of fatal spread. She can compare the burdens of amputation with the consequences of declining it and consistently refuses. However, she insists the risk cannot apply to her because the scans belong to another patient. Identity has been verified, and psychiatric assessment attributes this belief to a fixed delusion. The most specific impairment is in her ability to:

Accepted Answer

Appreciate that the diagnosis and its consequences apply to her own situation.

Answer

Understand the disclosed medical information and available treatment alternatives.

Answer

Communicate a sufficiently clear and stable treatment choice to others.

Answer

Compare the consequences of the available treatment options against her values.

Free HEC-C Practice Questions

Domain 1: Assessment 29% of exam

Question 1

Question 2

Question 3

Question 4

Domain 2: Analysis 28% of exam

Question 5

Question 6

Question 7

Domain 3: Process 27% of exam

Question 8

Question 9

Domain 4: Evaluation and Quality Improvement 16% of exam

Question 10

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