i am having mid term exam tomorrow the examiner told he is gonna give us cases for exam. using this ppt give me cases to solve in mcq type and in general questions
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I've read the entire PDF. Now let me create a comprehensive set of MCQ and general case-based questions covering all major topics from the material.
Health Law - Exam Preparation: Case-Based Questions
SECTION A: MCQ Cases
Case 1 - Patient Autonomy & Refusal of Treatment
A 35-year-old Jehovah's Witness is admitted to a hospital with severe internal bleeding. He is conscious, alert, and of sound mind. He refuses blood transfusion on religious grounds. His wife begs the doctors to proceed with the transfusion anyway, arguing it is the only way to save his life.
Q1. What should the physician do according to Health Law principles and ECtHR practice?
- A) Proceed with transfusion because beneficence overrides autonomy
- B) Respect the patient's refusal, as a competent adult has the right to refuse treatment
- C) Follow the wife's request since she is next of kin
- D) Ask a court to decide before taking any action
✅ Answer: B
Basis: Schloendorff v. Society of New York Hospital (1914); JW of Moscow v. Russia (ECtHR); Article 23, Georgian Law on Patients Rights - a competent, informed patient has the right to refuse at any stage.
Case 2 - Emergency & Informed Consent Exception
A motorcyclist is brought to the ER unconscious after a collision. He requires immediate surgery or he will die within the hour. No family members are reachable. There is no advance directive.
Q2. What is the legal basis for operating without informed consent under EU Health Law?
- A) The principle of beneficence alone is sufficient
- B) Article 8 of the Oviedo (Biomedicine) Convention - emergency exception
- C) The doctor can never operate without consent under any circumstances
- D) The hospital's internal policy is the only relevant authority
✅ Answer: B
Article 8, Oviedo Convention: "When because of an emergency situation the appropriate consent cannot be obtained, any medically necessary intervention may be carried out immediately for the benefit of the health of the individual concerned."
Case 3 - Minor & Informed Consent
A 14-year-old child is brought to the ER in critical condition. His parents are abroad and completely unreachable. Without urgent surgery, the child will suffer permanent disability. The doctor must decide whether to operate.
Q3. According to the Oviedo Convention (Article 6) and Georgian Law (Article 25), the doctor should:
- A) Wait until parents are reached no matter how long it takes
- B) Refuse to operate because the minor cannot consent
- C) Proceed with the intervention in the patient's best interests
- D) Ask police to locate the parents before making any decision
✅ Answer: C
Oviedo Convention, Article 8; Georgian Law on Patients Rights, Article 25 - intervention is allowed when a legal representative cannot be found and delay would result in death or significant deterioration.
Case 4 - Medical Malpractice
Dr. Smith gives a patient an allergy injection intended for a different patient. The patient suffers a serious allergic reaction and sues.
Q4. For a successful medical malpractice (negligence) claim, which THREE elements must be proven?
- A) Fault, Damage, and Causal link
- B) Intent, Damage, and Witnesses
- C) Fault, Intent, and Publicity
- D) Damage, Public knowledge, and Documentation
✅ Answer: A
Medical Malpractice requires: (1) Fault of the doctor, (2) Damage suffered by the patient, (3) Causal link between the breach of duty and the damage.
Case 5 - Confidentiality & Public Interest Exception
A psychiatrist learns that his patient, who has been making credible threats, plans to seriously harm a named individual. The patient explicitly asks the doctor to keep this confidential.
Q5. Based on health law principles (Tarasoff doctrine), the doctor should:
- A) Maintain full confidentiality - doctor-patient privilege is absolute
- B) Disclose the information to protect the potential victim, as non-disclosure endangers life
- C) Wait until the threat is carried out before notifying authorities
- D) Refer the patient to another doctor and take no further action
✅ Answer: B
Confidentiality can be restricted when non-disclosure endangers life/health of a third person (Tarasoff v. Regents of UC; Responsibility to Maintain Confidentiality provisions).
Case 6 - ECtHR & Right to Life (Article 2)
A woman gives birth in a Turkish hospital. Due to known, systemic shortages of neonatal care facilities (which state authorities were aware of), the newborn dies. The family brings a case to the ECtHR.
Q6. Which ECtHR case and article is most directly applicable?
- A) D v. UK - Article 3
- B) Mehmet Senturk v. Turkey - Article 2
- C) Glass v. UK - Article 8
- D) Enhorn v. Sweden - Article 5
✅ Answer: B
Mehmet Senturk v. Turkey: The state knew of neonatal service shortages and failed to intervene - violation of Article 2 (Right to Life). The state is responsible when it fails to provide available healthcare.
Case 7 - Article 3 & Degrading Treatment
A Roma woman is in active labour and experiencing complications. Hospital staff place a consent form in front of her for sterilization. Fearing for her life and under extreme pressure, she signs. The sterilization was not medically necessary. She later files a case with the ECtHR.
Q7. Which ECtHR case and ECHR articles are violated?
- A) Pretty v. UK - Article 8 only
- B) VC v. Slovakia - Articles 3 and 8
- C) Glass v. UK - Article 5
- D) D v. UK - Article 3 only
✅ Answer: B
VC v. Slovakia: Forcible sterilization during labour without informed consent violated Article 3 (degrading treatment) and Article 8 (right to private life/physical integrity).
Case 8 - Right to Refuse Treatment (Doctor's Perspective)
A surgeon is asked to perform an abortion. He refuses on moral and religious grounds. There is no emergency, and the patient can be referred to another physician who is available.
Q8. Under Health Law, the surgeon's refusal is:
- A) Always illegal regardless of personal beliefs
- B) Legal only if he reports it to police
- C) Legal, provided there is no emergency, continuity of care is ensured, and another physician can provide the service
- D) Legal only with written approval from a hospital ethics committee
✅ Answer: C
Right to Refuse Treatment: Physicians may refuse when there is no emergency, continuity of care is possible, and the patient can access treatment through another provider. The doctor must notify the patient and give reasons.
Case 9 - AAAQ Framework
In a rural province, the government-run hospital lacks essential medicines, has no specialist doctors, and charges fees that poor families cannot afford. A patient advocacy group files a complaint.
Q9. Which AAAQ principle(s) is/are violated?
- A) Only Acceptability
- B) Availability, Accessibility (economic and physical), and Quality
- C) Only Quality
- D) Only Availability
✅ Answer: B
CESCR General Comment #14: AAAQ - Availability (insufficient facilities/medicines), Accessibility (physical and economic barriers), and Quality (lack of trained personnel and medicines) are all violated.
Case 10 - International Complaint Mechanism
A single woman in China is denied the right to freeze her eggs because national law restricts fertility treatment to married couples. She has exhausted all domestic remedies and wishes to bring an international complaint.
Q10. Which international committee(s) would be competent to hear her case?
- A) Only the UN Security Council
- B) CEDAW Committee and/or ICESCR Committee
- C) Only the WHO
- D) The International Court of Justice only
✅ Answer: B
Teresa Xu case analysis: CEDAW Committee (women's reproductive rights), ICESCR Committee (Article 12 - right to health), and potentially the UN Human Rights Committee.
Case 11 - Criminal vs. Civil Medical Liability
A doctor repeatedly prescribes the wrong medication due to laziness and poor record-keeping, causing a patient significant harm. In another case, a surgeon intentionally harms a patient during surgery.
Q11. Which statement correctly distinguishes civil and criminal liability?
- A) Both cases lead to criminal liability only
- B) The first case leads to civil (negligence) liability; the second, due to intentional misconduct, may lead to criminal liability
- C) Neither case involves legal liability
- D) Both cases are civil matters only
✅ Answer: B
Civil liability occurs when there is a breach of duty of care. Criminal liability applies when the doctor's misconduct reaches recklessness or intentional harm.
Case 12 - Force-Feeding
A prisoner goes on a hunger strike. Prison authorities order force-feeding despite medical staff stating it is not medically necessary. The feeding is carried out with excessive force.
Q12. Based on Nevmerzhitsky v. Ukraine, this constitutes:
- A) A justified intervention under the public interest exception
- B) A violation of Article 3 ECHR (inhuman and degrading treatment)
- C) A justified exercise of state authority - prisoners have no right to refuse
- D) Lawful under Article 5 ECHR as a restriction on liberty
✅ Answer: B
Nevmerzhitsky v. Ukraine: Force-feeding that is NOT medically necessary and carried out with excessive force violates Article 3 ECHR.
SECTION B: General Open-Ended Case Questions
General Case 1 - Autonomy vs. Best Interests (Robert Jordan)
Robert Jordan, 40, has terminal cardiovascular failure. He consented to be on a transplant waiting list. On the day of the transplant, while still conscious, he refuses the operation. His wife and children beg the medical team to proceed.
Questions:
- Does international/EU Health Law recognise a patient's right to refuse life-saving treatment? Cite relevant instruments.
- What would change legally if Robert were unconscious at the time?
- Under what exceptional circumstances could doctors override his refusal?
Model Answer Guide:
- Yes - Article 9 of the Oviedo Convention (previously expressed wishes); Article 23 Georgian Law on Patients Rights; JW of Moscow v. Russia (ECtHR - Article 8); Schloendorff principle.
- If unconscious - Article 8 Oviedo (emergency exception) applies; Article 9 on previously expressed wishes would become relevant.
- Exceptions: therapeutic necessity (Bogumil v. Portugal); protecting rights of others (compulsory vaccination, infectious disease).
General Case 2 - Confidentiality & Public Safety
Dr. Ana treats a patient who reveals he is HIV-positive and continues to have unprotected sex with multiple partners without disclosing his status.
Questions:
- What is the general rule on medical confidentiality?
- Can Dr. Ana disclose this information? What legal basis supports this?
- What is the doctor's obligation regarding informing the patient before disclosure?
Model Answer Guide:
- General rule: Article 10 Oviedo Convention, Article 8 ECHR - patient information is confidential and should not be shared without consent.
- Disclosure is permitted when non-disclosure endangers life/health of third parties. The HIV reporting obligation exists under national laws.
- Doctor must inform the patient of the intention to disclose.
General Case 3 - Healthcare Provider's Right to Independent Judgment
The health ministry issues a directive ordering all hospital doctors to prescribe only the cheapest available drug for a condition, regardless of individual patient needs. Dr. Chen believes a more expensive drug is medically necessary for her patient.
Questions:
- What right of the healthcare provider is at stake?
- What does Health Law say about external interference in medical decisions?
- Can the ministry lawfully issue such a directive?
Model Answer Guide:
- Right to Independent Professional Judgment - doctors must be guided by patient interests, free from undue influence.
- "In no circumstances can either an official or private person demand a physician to act against professional ethics." Doctors are entitled to prescribe any medication in the patient's best interest.
- Such a directive would conflict with this right; professional associations also have a role in setting standards.
General Case 4 - ECtHR Article 3 & Abortion
A woman discovers her foetus is severely malformed. She seeks an abortion but doctors repeatedly delay and obstruct access to the procedure, subjecting her to humiliating treatment. She is denied access to genetic testing confirming the malformation.
Questions:
- Which ECtHR case is directly on point? What were the key findings?
- Which article(s) of the ECHR were violated and why?
- What does the P. and S. v. Poland case add to this analysis?
Model Answer Guide:
- RR v. Poland: Denial of access to genetic testing + degrading treatment by medical staff = violation of Article 3.
- Article 3 (degrading treatment/humiliation); Article 8 (right to private life and bodily integrity).
- P. and S. v. Poland adds that considerable pressure on a young patient not to have an abortion, without regard to her views and feelings, violates Article 3.
General Case 5 - Medical Malpractice vs. Iatrogenic Injury
A patient is given a drug that causes a known side effect (listed in the consent form she signed). She suffers the side effect and sues the doctor for malpractice. In a separate case, a doctor prescribes the wrong drug to a patient due to failing to check the chart, and the patient is harmed.
Questions:
- Distinguish between medical malpractice and an iatrogenic injury in these two cases.
- What three elements must be proven for a negligence claim?
- How does New York Supreme Court (2022) distinguish Ordinary Medical Negligence from Medical Malpractice?
Model Answer Guide:
- Case 1: Iatrogenic injury - a known risk that occurred despite proper care. Case 2: Medical malpractice - failure to meet the standard of care.
- Fault + Damage + Causal link.
- Medical Malpractice involves matters of medical science requiring special skills. Ordinary negligence can be assessed by common everyday experience of ordinary persons.
General Case 6 - Right to Health (AAAQ) & SDGs
Country X has public hospitals but they are located only in the capital city, charge fees that rural poor cannot afford, are staffed with untrained personnel, and the staff refuses to treat certain ethnic minorities.
Questions:
- Analyse this scenario using the AAAQ framework.
- Which SDG is most directly relevant?
- What obligations does ICESCR Article 12 place on the state?
Model Answer Guide:
- Availability (hospitals not distributed across country), Physical Accessibility (rural populations can't reach them), Economic Accessibility (unaffordable fees), Non-discrimination (ethnic minorities refused), Quality (untrained staff) are all violated.
- SDG 3: Good Health and Well-being.
- ICESCR Article 12(2)(d): creation of conditions assuring medical service to all in event of sickness; states must progressively realise the right to highest attainable standard of health.
Quick Reference: Key Cases for the Exam
| Case | Article | Key Issue |
|---|---|---|
| Schloendorff v. NY Hospital (1914) | - | Foundation of patient autonomy |
| JW of Moscow v. Russia (ECtHR) | Art. 8 | Right to refuse treatment |
| Glass v. UK (ECtHR) | Art. 8 | Informed consent of minors |
| VC v. Slovakia (ECtHR) | Arts. 3 & 8 | Forced sterilization |
| RR v. Poland (ECtHR) | Arts. 3 & 8 | Abortion, genetic testing denial |
| P. and S. v. Poland (ECtHR) | Art. 3 | Pressure on young patient re: abortion |
| Mehmet Senturk v. Turkey (ECtHR) | Art. 2 | Systemic healthcare failure/death |
| Nevmerzhitsky v. Ukraine (ECtHR) | Art. 3 | Force-feeding without necessity |
| D v. UK (ECtHR) | Art. 3 | Deportation of AIDS patient |
| VO v. France (ECtHR) | Art. 2 | Unborn child - right to life |
| Tarasoff v. UC Regents | - | Confidentiality vs. duty to warn |
Good luck on your exam tomorrow! The key pattern in cases: always identify (1) which right is at stake, (2) which instrument/article applies, and (3) which ECtHR case is the precedent. Most scenario questions test whether you can apply these three steps.
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