ethics & jurisprudence exam Alberta UPDATED
ACTUAL Exam Questions and CORRECT Answers
1. A provincial health authority implements a mandatory vaccination policy for healthcare
workers, citing patient safety. A nurse refuses on grounds of conscientious objection, invoking
religious freedom. Under the Charter of Rights and Freedoms (and analogous US First
Amendment jurisprudence), which of the following legal frameworks best resolves the tension
between individual rights and public health?
A. Absolute protection of religious belief under s. 2(a) of the Charter, unless the policy constitutes a 'reasonable
limit demonstrably justified in a free and democratic society' under s. 1.
B. The policy is per se unconstitutional because it infringes on the fundamental freedom of conscience and
religion without exception.
C. The nurse must be accommodated unless the accommodation imposes an 'undue hardship' on the employer,
as per human rights legislation.
D. The policy is valid only if it passes the 'strict scrutiny' test, requiring a compelling state interest and the least
restrictive means, as per US constitutional law.
Answer: A
Rationale: Under Canadian Charter s. 2(a), religious freedom is protected but subject to s. 1 reasonable
limits. The Oakes test requires the policy to have a pressing objective and be proportionate. Option A
captures this balancing. Option B is incorrect because Charter rights are not absolute. Option C refers
to human rights accommodation, which is a separate but related analysis; however, the primary
constitutional framework is s. 1. Option D applies US strict scrutiny, which is not the Canadian test.
2. In the landmark case Carter v. Canada (2015), the Supreme Court of Canada struck down the
absolute prohibition on physician-assisted dying. Which of the following statements best captures
the ratio decidendi regarding the interplay between the Charter and criminal law?
A. The prohibition violated s. 7 of the Charter by infringing the right to life, liberty, and security of the person
in a manner that was not in accordance with the principles of fundamental justice.
B. The prohibition violated s. 15 of the Charter by discriminating against persons with disabilities who could
not end their own lives without assistance.
C. The prohibition was a justifiable limitation under s. 1 because it protected vulnerable persons from coercion.
D. The prohibition was ultra vires the federal criminal law power because assisted dying is a matter of health,
which is provincial jurisdiction.
Answer: A
Rationale: Carter held that the prohibition infringed s. 7 rights to life, liberty, and security of the person
because it forced individuals to suffer or end their lives prematurely. The infringement was not in
accordance with the principles of fundamental justice (overbreadth and gross disproportionality).
Option B was argued but the Court did not base its decision on s. 15. Option C is wrong because the
Court found no s. 1 justification. Option D is incorrect; the federal criminal law power was validly
exercised, but the prohibition was unconstitutional.
Page 1
,3. A physician receives a request from a patient's spouse for access to the patient's medical records.
The patient is currently hospitalized and has not provided consent. Which of the following legal
principles governs the disclosure of health information under Alberta's Health Information Act
(HIA) and analogous US HIPAA Privacy Rule?
A. The spouse has an automatic right of access because of the marital relationship, unless the patient explicitly
objected.
B. Disclosure is permitted only if the spouse demonstrates a 'need to know' for the patient's ongoing care, and
the patient has not objected, or if disclosure is required by law.
C. The physician may disclose the information if, in the physician's professional judgment, it is in the patient's
best interests, regardless of the patient's wishes.
D. The physician must obtain a court order before disclosing any information to a third party, including a
spouse.
Answer: B
Rationale: Under HIA (and HIPAA), a spouse does not have automatic access. Disclosure to a family
member is generally permitted if the patient is informed and does not object, and the information is
directly relevant to the family member's involvement in the patient's care or payment. Option A is wrong;
marital status alone does not confer access. Option C is wrong because best interests do not override
patient autonomy and consent. Option D is too restrictive; disclosure can occur without a court order in
specified circumstances.
4. A psychologist is treating a client who discloses a plan to seriously harm a third party. The
psychologist believes the threat is credible. Under Alberta's Health Professions Act and the
common law duty to protect (derived from Tarasoff v. Regents of the University of California),
which of the following actions is ethically and legally required?
A. The psychologist must maintain confidentiality because the threat is a disclosure made in therapy and is
protected by the therapeutic privilege.
B. The psychologist must warn the potential victim and notify the police, but only if the client has a diagnosed
mental disorder that impairs judgment.
C. The psychologist must take reasonable steps to protect the intended victim, which may include warning the
victim, notifying police, or hospitalizing the client, even if this breaches confidentiality.
D. The psychologist must first seek the client's consent to disclose; if consent is refused, no disclosure is
permissible.
Answer: C
Rationale: The duty to protect, established in Tarasoff and adopted in Canadian law (e.g., Smith v. Jones),
requires a professional to take reasonable steps to prevent harm when there is a clear, serious, and
imminent threat. This may override confidentiality. Option A is incorrect; confidentiality is not absolute.
Option B is wrong because the duty is not contingent on a diagnosed disorder. Option D is incorrect; if
the threat is imminent, consent is not required.
5. A registered nurse is offered a significant gift by a grateful patient's family. The nurse's
employer has a policy that prohibits accepting gifts worth more than $50. The nurse is unsure
whether to accept the gift. Which ethical principle and legal rule most directly apply to this
situation?
Page 2
,A. Beneficence and the legal principle of 'de minimis non curat lex' allow acceptance of small gifts as a token of
gratitude.
B. Non-maleficence and the Criminal Code prohibition on bribery preclude acceptance of any gift from a patient or family.
C. Fidelity and the employer's policy require the nurse to decline the gift if it exceeds the stated limit, to avoid a conflict of
interest or appearance of impropriety.
D. Autonomy and the patient's right to express gratitude permit the nurse to accept the gift, provided the nurse reports it to
the regulatory college.
Answer: C
Rationale: Fidelity (trustworthiness) and professional boundaries require adherence to employer
policies. Accepting a gift over the limit can create a conflict of interest or perception of bias. Option A is
wrong; 'de minimis' does not apply to ethical standards. Option B overstates; the Criminal Code does
not generally apply to such gifts unless there is an element of corruption. Option D is incorrect;
autonomy does not override professional obligations.
6. A social worker in private practice has a romantic relationship with a former client that began
18 months after the termination of the professional relationship. The regulatory college's code of
ethics prohibits sexual relationships with clients for two years post-termination. Which of the
following statements best reflects the ethical and legal analysis?
A. The relationship is permissible because it began after the two-year prohibition period has elapsed, and the
social worker is no longer in a position of power.
B. The relationship is presumptively unethical and may still be considered a boundary violation if the social
worker exploited the former client or if the relationship harms the public's trust in the profession.
C. The relationship is a criminal offense under the Criminal Code of Canada, regardless of the time elapsed.
D. The relationship is allowed only if the social worker obtains written consent from the former client and files
a disclosure with the college.
Answer: B
Rationale: Even after the prohibited period, the relationship may still be unethical if it exploits the former
client or undermines trust. Many codes (e.g., NASW, CASW) require a longer or indefinite prohibition
due to the power imbalance. Option A is too permissive; the code's two-year rule is a minimum, not a
safe harbor. Option C is incorrect; such relationships are not generally criminal unless coercion or
exploitation is involved. Option D is wrong; consent does not cure a boundary violation.
7. A hospital ethics committee is consulted about a case where a patient with advanced dementia
and no advance directive requires a blood transfusion. The patient's adult child, who is the
substitute decision-maker (SDM), refuses the transfusion based on personal religious beliefs,
although the patient had no known religious affiliation. Under Alberta's Personal Directives Act
and the common law, which of the following is the correct standard for the SDM's decision?
A. The SDM must decide based on what the SDM believes is in the patient's best interests, considering medical
benefits and risks.
B. The SDM must decide based on what the patient would have wanted, if known, and in the absence of that
knowledge, based on the patient's best interests.
C. The SDM must follow the SDM's own religious beliefs, as the SDM has the right to make decisions for the
patient.
Page 3
, D. The SDM must defer to the healthcare team's recommendation because the SDM is refusing a life-saving
treatment.
Answer: B
Rationale: Substitute decision-making follows a substituted judgment standard: the SDM should decide
as the patient would have decided, based on the patient's known values and wishes. If those are
unknown, the decision should be in the patient's best interests. Option A is wrong because best interests
is a fallback, not the primary standard. Option C is wrong; the SDM's own beliefs are irrelevant. Option
D is incorrect; the SDM has authority, but must exercise it according to the proper standard.
8. A researcher proposes a clinical trial involving a novel gene therapy for a rare pediatric
neurodegenerative disorder. The trial will involve children who are unable to consent. Which of the
following ethical and regulatory requirements (consistent with the Tri-Council Policy Statement
and US Common Rule) is most critical for ensuring the trial's ethical acceptability?
A. The research must offer a prospect of direct benefit to the child participants that outweighs the risks, and
parental permission must be obtained.
B. The research must be minimal risk, and the child's assent must be obtained if the child is capable of providing
it.
C. The research must be reviewed by the institutional review board (IRB) and approved by a national ethics
committee, with no requirement for direct benefit.
D. The research can proceed only if it is intended to benefit other children with the same disorder, and the
parents provide informed permission.
Answer: A
Rationale: For research involving children that presents more than minimal risk, the TCPS and Common
Rule require either a prospect of direct benefit that justifies the risks, or a minimal risk threshold with
potential for benefit to the population. Option A correctly captures the direct benefit requirement.
Option B is too restrictive; minimal risk is not required if there is direct benefit. Option C is incorrect;
direct benefit or minimal risk is needed. Option D is wrong; benefit to others alone is insufficient for
greater than minimal risk.
9. A physician is disciplined by the College of Physicians and Surgeons of Alberta (CPSA) for
failing to maintain adequate medical records. The physician appeals to the Health Professions
Appeal and Review Board (HPARB). Which of the following statements about the standard of
review applied by HPARB is most accurate?
A. HPARB conducts a de novo hearing and substitutes its own decision for that of the CPSA.
B. HPARB reviews the CPSA's decision on a correctness standard, determining whether the CPSA's decision
was correct in law and fact.
C. HPARB reviews the CPSA's decision on a reasonableness standard, assessing whether the decision was
reasonable in light of the evidence and the law.
D. HPARB only reviews whether the CPSA followed procedural fairness; it does not review the merits of the
decision.
Answer: C
Rationale: Under Alberta's Health Professions Act, HPARB applies a reasonableness standard to review
the decisions of regulatory colleges. It examines whether the decision falls within a range of acceptable
outcomes. Option A is wrong; HPARB does not hold a de novo hearing. Option B is incorrect;
correctness is not the standard. Option D is wrong; HPARB reviews both procedural and substantive
Page 4
ACTUAL Exam Questions and CORRECT Answers
1. A provincial health authority implements a mandatory vaccination policy for healthcare
workers, citing patient safety. A nurse refuses on grounds of conscientious objection, invoking
religious freedom. Under the Charter of Rights and Freedoms (and analogous US First
Amendment jurisprudence), which of the following legal frameworks best resolves the tension
between individual rights and public health?
A. Absolute protection of religious belief under s. 2(a) of the Charter, unless the policy constitutes a 'reasonable
limit demonstrably justified in a free and democratic society' under s. 1.
B. The policy is per se unconstitutional because it infringes on the fundamental freedom of conscience and
religion without exception.
C. The nurse must be accommodated unless the accommodation imposes an 'undue hardship' on the employer,
as per human rights legislation.
D. The policy is valid only if it passes the 'strict scrutiny' test, requiring a compelling state interest and the least
restrictive means, as per US constitutional law.
Answer: A
Rationale: Under Canadian Charter s. 2(a), religious freedom is protected but subject to s. 1 reasonable
limits. The Oakes test requires the policy to have a pressing objective and be proportionate. Option A
captures this balancing. Option B is incorrect because Charter rights are not absolute. Option C refers
to human rights accommodation, which is a separate but related analysis; however, the primary
constitutional framework is s. 1. Option D applies US strict scrutiny, which is not the Canadian test.
2. In the landmark case Carter v. Canada (2015), the Supreme Court of Canada struck down the
absolute prohibition on physician-assisted dying. Which of the following statements best captures
the ratio decidendi regarding the interplay between the Charter and criminal law?
A. The prohibition violated s. 7 of the Charter by infringing the right to life, liberty, and security of the person
in a manner that was not in accordance with the principles of fundamental justice.
B. The prohibition violated s. 15 of the Charter by discriminating against persons with disabilities who could
not end their own lives without assistance.
C. The prohibition was a justifiable limitation under s. 1 because it protected vulnerable persons from coercion.
D. The prohibition was ultra vires the federal criminal law power because assisted dying is a matter of health,
which is provincial jurisdiction.
Answer: A
Rationale: Carter held that the prohibition infringed s. 7 rights to life, liberty, and security of the person
because it forced individuals to suffer or end their lives prematurely. The infringement was not in
accordance with the principles of fundamental justice (overbreadth and gross disproportionality).
Option B was argued but the Court did not base its decision on s. 15. Option C is wrong because the
Court found no s. 1 justification. Option D is incorrect; the federal criminal law power was validly
exercised, but the prohibition was unconstitutional.
Page 1
,3. A physician receives a request from a patient's spouse for access to the patient's medical records.
The patient is currently hospitalized and has not provided consent. Which of the following legal
principles governs the disclosure of health information under Alberta's Health Information Act
(HIA) and analogous US HIPAA Privacy Rule?
A. The spouse has an automatic right of access because of the marital relationship, unless the patient explicitly
objected.
B. Disclosure is permitted only if the spouse demonstrates a 'need to know' for the patient's ongoing care, and
the patient has not objected, or if disclosure is required by law.
C. The physician may disclose the information if, in the physician's professional judgment, it is in the patient's
best interests, regardless of the patient's wishes.
D. The physician must obtain a court order before disclosing any information to a third party, including a
spouse.
Answer: B
Rationale: Under HIA (and HIPAA), a spouse does not have automatic access. Disclosure to a family
member is generally permitted if the patient is informed and does not object, and the information is
directly relevant to the family member's involvement in the patient's care or payment. Option A is wrong;
marital status alone does not confer access. Option C is wrong because best interests do not override
patient autonomy and consent. Option D is too restrictive; disclosure can occur without a court order in
specified circumstances.
4. A psychologist is treating a client who discloses a plan to seriously harm a third party. The
psychologist believes the threat is credible. Under Alberta's Health Professions Act and the
common law duty to protect (derived from Tarasoff v. Regents of the University of California),
which of the following actions is ethically and legally required?
A. The psychologist must maintain confidentiality because the threat is a disclosure made in therapy and is
protected by the therapeutic privilege.
B. The psychologist must warn the potential victim and notify the police, but only if the client has a diagnosed
mental disorder that impairs judgment.
C. The psychologist must take reasonable steps to protect the intended victim, which may include warning the
victim, notifying police, or hospitalizing the client, even if this breaches confidentiality.
D. The psychologist must first seek the client's consent to disclose; if consent is refused, no disclosure is
permissible.
Answer: C
Rationale: The duty to protect, established in Tarasoff and adopted in Canadian law (e.g., Smith v. Jones),
requires a professional to take reasonable steps to prevent harm when there is a clear, serious, and
imminent threat. This may override confidentiality. Option A is incorrect; confidentiality is not absolute.
Option B is wrong because the duty is not contingent on a diagnosed disorder. Option D is incorrect; if
the threat is imminent, consent is not required.
5. A registered nurse is offered a significant gift by a grateful patient's family. The nurse's
employer has a policy that prohibits accepting gifts worth more than $50. The nurse is unsure
whether to accept the gift. Which ethical principle and legal rule most directly apply to this
situation?
Page 2
,A. Beneficence and the legal principle of 'de minimis non curat lex' allow acceptance of small gifts as a token of
gratitude.
B. Non-maleficence and the Criminal Code prohibition on bribery preclude acceptance of any gift from a patient or family.
C. Fidelity and the employer's policy require the nurse to decline the gift if it exceeds the stated limit, to avoid a conflict of
interest or appearance of impropriety.
D. Autonomy and the patient's right to express gratitude permit the nurse to accept the gift, provided the nurse reports it to
the regulatory college.
Answer: C
Rationale: Fidelity (trustworthiness) and professional boundaries require adherence to employer
policies. Accepting a gift over the limit can create a conflict of interest or perception of bias. Option A is
wrong; 'de minimis' does not apply to ethical standards. Option B overstates; the Criminal Code does
not generally apply to such gifts unless there is an element of corruption. Option D is incorrect;
autonomy does not override professional obligations.
6. A social worker in private practice has a romantic relationship with a former client that began
18 months after the termination of the professional relationship. The regulatory college's code of
ethics prohibits sexual relationships with clients for two years post-termination. Which of the
following statements best reflects the ethical and legal analysis?
A. The relationship is permissible because it began after the two-year prohibition period has elapsed, and the
social worker is no longer in a position of power.
B. The relationship is presumptively unethical and may still be considered a boundary violation if the social
worker exploited the former client or if the relationship harms the public's trust in the profession.
C. The relationship is a criminal offense under the Criminal Code of Canada, regardless of the time elapsed.
D. The relationship is allowed only if the social worker obtains written consent from the former client and files
a disclosure with the college.
Answer: B
Rationale: Even after the prohibited period, the relationship may still be unethical if it exploits the former
client or undermines trust. Many codes (e.g., NASW, CASW) require a longer or indefinite prohibition
due to the power imbalance. Option A is too permissive; the code's two-year rule is a minimum, not a
safe harbor. Option C is incorrect; such relationships are not generally criminal unless coercion or
exploitation is involved. Option D is wrong; consent does not cure a boundary violation.
7. A hospital ethics committee is consulted about a case where a patient with advanced dementia
and no advance directive requires a blood transfusion. The patient's adult child, who is the
substitute decision-maker (SDM), refuses the transfusion based on personal religious beliefs,
although the patient had no known religious affiliation. Under Alberta's Personal Directives Act
and the common law, which of the following is the correct standard for the SDM's decision?
A. The SDM must decide based on what the SDM believes is in the patient's best interests, considering medical
benefits and risks.
B. The SDM must decide based on what the patient would have wanted, if known, and in the absence of that
knowledge, based on the patient's best interests.
C. The SDM must follow the SDM's own religious beliefs, as the SDM has the right to make decisions for the
patient.
Page 3
, D. The SDM must defer to the healthcare team's recommendation because the SDM is refusing a life-saving
treatment.
Answer: B
Rationale: Substitute decision-making follows a substituted judgment standard: the SDM should decide
as the patient would have decided, based on the patient's known values and wishes. If those are
unknown, the decision should be in the patient's best interests. Option A is wrong because best interests
is a fallback, not the primary standard. Option C is wrong; the SDM's own beliefs are irrelevant. Option
D is incorrect; the SDM has authority, but must exercise it according to the proper standard.
8. A researcher proposes a clinical trial involving a novel gene therapy for a rare pediatric
neurodegenerative disorder. The trial will involve children who are unable to consent. Which of the
following ethical and regulatory requirements (consistent with the Tri-Council Policy Statement
and US Common Rule) is most critical for ensuring the trial's ethical acceptability?
A. The research must offer a prospect of direct benefit to the child participants that outweighs the risks, and
parental permission must be obtained.
B. The research must be minimal risk, and the child's assent must be obtained if the child is capable of providing
it.
C. The research must be reviewed by the institutional review board (IRB) and approved by a national ethics
committee, with no requirement for direct benefit.
D. The research can proceed only if it is intended to benefit other children with the same disorder, and the
parents provide informed permission.
Answer: A
Rationale: For research involving children that presents more than minimal risk, the TCPS and Common
Rule require either a prospect of direct benefit that justifies the risks, or a minimal risk threshold with
potential for benefit to the population. Option A correctly captures the direct benefit requirement.
Option B is too restrictive; minimal risk is not required if there is direct benefit. Option C is incorrect;
direct benefit or minimal risk is needed. Option D is wrong; benefit to others alone is insufficient for
greater than minimal risk.
9. A physician is disciplined by the College of Physicians and Surgeons of Alberta (CPSA) for
failing to maintain adequate medical records. The physician appeals to the Health Professions
Appeal and Review Board (HPARB). Which of the following statements about the standard of
review applied by HPARB is most accurate?
A. HPARB conducts a de novo hearing and substitutes its own decision for that of the CPSA.
B. HPARB reviews the CPSA's decision on a correctness standard, determining whether the CPSA's decision
was correct in law and fact.
C. HPARB reviews the CPSA's decision on a reasonableness standard, assessing whether the decision was
reasonable in light of the evidence and the law.
D. HPARB only reviews whether the CPSA followed procedural fairness; it does not review the merits of the
decision.
Answer: C
Rationale: Under Alberta's Health Professions Act, HPARB applies a reasonableness standard to review
the decisions of regulatory colleges. It examines whether the decision falls within a range of acceptable
outcomes. Option A is wrong; HPARB does not hold a de novo hearing. Option B is incorrect;
correctness is not the standard. Option D is wrong; HPARB reviews both procedural and substantive
Page 4
