Path to Practice Series, Vol 2

The Canadian rules you weren’t taught.
Every physician who sits the MCCQE or the NAC already knows medicine. The problem is
different. Canadian medicine operates inside a specific cultural, legal, and institutional
framework that most international training does not include.
The MCC is not asking whether you know patients can refuse treatment. It is asking what
happens next in Canada when they do. Who has authority if the patient loses capacity. What you
must report, to whom, and under which statute. Whether a disclosure is mandatory or
discretionary. These are Canadian rules. If you trained somewhere else, the answers you bring to
the exam may be wrong.
What’s inside
A framework that mirrors how the exam thinks. MCC ethics scenarios fall into three distinct
cognitive demands. Some scenarios ask you to apply a rule. Some ask you to reason through a
tension between two principles. Some ask you to recognize that the rules alone are not enough,
and that the patient’s identity or social position is the clinical data.
The 20 topics in this guide are
organized around those three demands.
Part 1: Apply the Rule. Nine foundational topics: the Four Principles and the CMA Code,
Professionalism, Patient Safety and Disclosure, Consent, Capacity and the SDM Hierarchy,
Confidentiality, Truth-telling, Research Ethics, and the Canadian Healthcare System.
Part 2: Reason Through the Tension. Six high-stakes topics where rules collide: Mandatory
Reporting, End-of-Life and MAID, Conscientious Objection, Reproductive and Adolescent
Ethics, Involuntary Psychiatric Care, and Legal Obligations and Public Safety.
Part 3: Recognize the Context. Five MCC-mandated topics that test whether you see the
structural layer: Indigenous Health, Anti-Oppressive Care, 2SLGBTQQIA+ Health, the Social
Determinants of Health, and Substance Use and Harm Reduction.

“Where Candidates Frequently Go Wrong” in every chapter. Each topic flags the specific
points where international training is most likely to lead you to the wrong Canadian answer, with
the corrected reasoning laid out clearly.

This is for you if;
♦ You’re preparing for the MCCQE Part 1, the NAC, or both
♦ You trained outside Canada and need a single source for Canadian medical ethics
♦ You’ve been piecing ethics together from CMPA advisories, the CMA Code, MCC
objectives, and provincial legislation, and you want it consolidated.

About the author
Dr. Filipe Santos is an anesthesiologist and Assistant Professor at the University of Toronto,
where he teaches medical students and residents. He is the author of the Path to Practice Series.

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