Empathy and Compassion · Ranking sample

You are a family medicine resident caring for Margaret MacIntyre, an elderly comatose…

Read the scenario, answer it, then compare yourself to the answer key. Every option includes a rationale and a transferable principle.

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Rank in order the following actions for Dr. Vance to take in response to this situation (1 = Most desirable; 5 = Least desirable).

You are a family medicine resident caring for Margaret MacIntyre, an elderly comatose patient experiencing multi-organ failure in a rural hospital. Her clinical condition is deteriorating rapidly, necessitating an immediate and definitive goals-of-care determination. Arthur, her common-law partner of twenty years, tearfully conveys that Margaret explicitly wished never to be maintained on invasive mechanical life support, though no written directive exists. Her estranged adult son, Derek, suddenly arrives from another province, angrily asserting kinship rights and demanding aggressive invasive resuscitation while dismissing Arthur's standing entirely. The interpersonal conflict is escalating outside Margaret's room, causing severe distress to both men as clinical decisions loom. You must resolve this dispute in accordance with provincial substitute decision-maker legislation while supporting a grieving, divided family.

Ranking scale: 1 is most desirable and 5 is least desirable. Use each rank exactly once. Pick one rank per option.

A. Request an immediate urgent ethics consultation and initiate temporary invasive resuscitation until legal clarification is formally provided.

B. Instruct Arthur and Derek to settle their legal dispute outside the hospital before any care decisions are implemented.

C. Reassure Arthur of his legal substitute decision-maker status while notifying Derek that his resuscitation request cannot be accepted.

D. Convene a facilitated meeting with Arthur and Derek to clarify provincial statutory hierarchy and focus on Margaret's values.

E. Meet privately with Derek to acknowledge his grief and explain the statutory hierarchy before facilitating a joint family discussion.

Use each rank exactly once

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Show answer and rationale

A. Request an immediate urgent ethics consultation and initiate temporary invasive resuscitation until legal clarification is formally provided.

Key: 4

Rank 4. Escalating to hospital ethics over-complicates an issue already clearly governed by provincial substitute decision-maker legislation. Furthermore, initiating invasive resuscitation contrary to known verbal wishes subjects the patient to non-beneficial, invasive bodily harm simply to avoid immediate interpersonal confrontation.

Avoid invasive clinical harm merely to defer statutory decision-making and interpersonal conflict.

B. Instruct Arthur and Derek to settle their legal dispute outside the hospital before any care decisions are implemented.

Key: 5

Rank 5. This response completely abdicates clinical leadership and professional responsibility during an end-of-life crisis. Abandoning a dying patient and traumatized family members to resolve statutory conflict unassisted causes severe harm and delays necessary palliative care.

Never abandon vulnerable substitute decision-makers during urgent end-of-life decision-making.

C. Reassure Arthur of his legal substitute decision-maker status while notifying Derek that his resuscitation request cannot be accepted.

Key: 3

Rank 3. Upholding Arthur's legal authority under common-law partner statutory hierarchy correctly honours legislation and the patient's known wishes. However, delivering this unilaterally to Derek without empathetic exploration will likely heighten his sense of alienation and hostility.

Legal statutory clarity must be delivered with empathy to prevent alienation.

D. Convene a facilitated meeting with Arthur and Derek to clarify provincial statutory hierarchy and focus on Margaret's values.

Key: 1

Rank 1. This action combines professional clarity regarding provincial substitute decision-maker legislation with high empathy. Bringing both men together to refocus on Margaret's authentic voice addresses the legal reality while de-escalating interpersonal tension and fostering collaborative closure.

Focus substitute decision-makers collaboratively on the patient's authentic prior values.

E. Meet privately with Derek to acknowledge his grief and explain the statutory hierarchy before facilitating a joint family discussion.

Key: 2

Rank 2. Meeting privately with Derek shows empathy by validating his emotional distress and clarifying legal frameworks without public embarrassment. However, addressing the family separately initially risks creating suspicion with Arthur and marginally delays collective alignment compared to an immediate facilitated joint discussion.

De-escalate distressed family individually before facilitating collaborative decision-making on goals of care.

Exam context: FMProC assesses empathy and compassion alongside three other attributes. This is an unofficial worked example, not a live exam item.

Educational scenario only. Not clinical or professional advice.