The ICU was quiet except for the rhythmic sound of the ventilator. Two respiratory therapists stood by the bedside of a patient who had no family, no advance directive, and no clear prognosis. The attending physician looked to the lead RT and asked, “Would you continue the current level of support?”
This kind of ethical decision-making is no longer confined to hospital ethics committees—it’s part of everyday respiratory care. And starting with the 2027 NBRC Respiratory Therapy Examination, ethics and professional conduct will be evaluated alongside clinical judgment on the 2027 NBRC exam, rather than appearing as isolated, stand-alone questions.
Why Ethics Is Now a Core Part of the Exam
The NBRC’s 2025 Jimmy Young Memorial Lecture emphasized that technical skill alone no longer defines a competent respiratory therapist. Modern healthcare demands professionals who balance clinical precision with moral reasoning, empathy, and patient advocacy—especially as 2027 pharmacology updates introduce new therapies requiring careful ethical and clinical judgment.
The new exam integrates ethics across all domains, including patient safety, cultural competence, and clinical judgment. This change reflects what’s expected in real practice—RTs are often the ones who catch ethical conflicts first, whether it’s about consent, confidentiality, or end-of-life decisions.
Where Ethical Reasoning Appears on the 2027 Exam
Ethical reasoning is embedded within clinical judgment and professional practice items. Instead of standalone “ethics questions,” expect realistic scenarios where the correct answer demonstrates both clinical knowledge and moral responsibility.
Common Themes Tested
- Patient Autonomy and Informed Consent – Knowing when to advocate for patient choice, even when making decisions about new drugs added to the NBRC exam that may affect risks, outcomes, or treatment burdens.
- Confidentiality and HIPAA Compliance – Understanding what can and cannot be shared during handoffs, social media, or with family.
- End-of-Life Care – Recognizing when continuation of therapy may conflict with a patient’s goals or advance directive.
- Professional Accountability – Identifying unsafe practices, reporting errors, or questioning inappropriate orders.
- Cultural and Religious Sensitivity – Respecting beliefs that may affect care decisions, including ventilation withdrawal or organ donation.
Example Scenario: Ethical Decision-Making in Action
You are caring for a 78-year-old woman with end-stage COPD who is intubated and sedated. Her son tells you his mother previously stated she never wanted “to live on machines.” The physician orders continued full ventilatory support until further notice.
What is the most appropriate action for the respiratory therapist?
A. Follow the physician’s order without question
B. Inform the son that only the doctor can make that decision
C. Report the patient’s previously expressed wishes to the care team
D. Begin weaning the patient from mechanical ventilation independently
Correct Answer: C
Rationale: Ethical practice requires the RT to communicate known patient wishes to the team. The therapist should not alter treatment independently but must advocate for patient autonomy and appropriate end-of-life discussions.
Ethical Pitfalls RTs Commonly Overlook
- Breach of privacy: Casual hallway discussions about patient cases are still HIPAA violations.
- Overstepping authority: Making clinical decisions without a provider’s order, even with good intent, can be both unethical and unsafe.
- Failure to report: Ignoring unsafe practice or falsified documentation can lead to patient harm and professional misconduct findings.
- Bias and judgment: Providing unequal care due to personal views, language barriers, or appearance violates professional ethics standards.
How to Prepare for Ethics and Professional Conduct Questions
- Know the AARC Code of Ethics. The NBRC bases its expectations on this framework.
- Study realistic scenarios. Ethical items are now situation-based, not theoretical.
- Practice moral reasoning. Ask, “What action best protects patient safety and dignity?”
- Review institutional policies. Many exam scenarios mirror actual hospital procedures on consent, error reporting, and cultural respect.
- Connect ethics to clinical judgment. Every decision—ventilator changes, weaning, transport—has ethical implications.
What the NBRC Is Looking For
Examiners aren’t testing philosophy—they’re assessing how future RTs balance competence with conscience.
The correct answer often represents:
- Protection of patient rights
- Accountability for actions
- Honesty and transparency in communication
- Respect for interdisciplinary collaboration
To develop this type of judgment, you need NBRC exam prep materials that reinforce ethical reasoning within realistic clinical scenarios.
Key Takeaway
Ethics and professional conduct are no longer side topics—they’re central to how the NBRC defines safe and effective respiratory therapy practice. Cultural and trauma-informed scenarios on the 2027 NBRC exam also require respiratory therapists to recognize how past trauma and cultural beliefs affect communication, consent, and patient trust.
Every question on the 2027 exam is an opportunity to show that you not only know what to do, but why it’s the right thing to do. Now is the time to prepare for the updated NBRC exam with practice tools that mirror the new ethical and judgment-based format.
