Interview Questions: Medical Ethics
What is medical ethics?
Medical ethics is a complex system of moral principles and values applied to the practice of clinical medicine and also used in scientific research. It is based on a set of values that doctors can refer to in cases of confusion, conflict, or where they just are not sure what is best to do.
Being able to understand medical ethics and its use in clinical practice is essential for many medical school interviews. When we think about medical ethics or want to evaluate a clinical situation we need to think about the “four pillars” of medical ethics .
The 4 pillars of medical ethics:
- Autonomy – respecting a patient’s ability to make their own decisions
- Beneficence – a doctor should always act to benefit the patient
- Non-maleficence – a doctor should not cause harm to the patient
- Justice – reference to a consideration of the law and of the overall benefit to society
The four pillars of medical ethics are very important to consider in clinical decision making, as they are often used as a framework for analysing what is the best action to take. It is important to remember that not all clinical decisions will be easy to make, and that is why understanding the medical ethics is so important for all clinicians.
Common ethical debates – what to consider?
At interview it is highly likely you will be asked to discuss a topic on medical ethics. Below we have put together some simple frameworks and model answers to commonly asked medical ethics questions to help get you started.
1. Organ donation – opt in / opt out
The organ donation system in the UK is a HOT TOPIC at the moment, with the new opt-out system set to be implemented in England next year (2020). Currently in the UK we have an opt-in system, where by you need to register yourself as an organ donor. Currently there are roughly 5,000 people waiting on the transplant list, and it is estimated that three people die every day while waiting for an organ transplant in the UK alone. Therefore, it is imperative that we find a way of increasing the number of donated organs to combat this.
|For opt-out||Against opt-out|
|Autonomy||Everyone has the right to decide, however surveys have shown that many wish to donate their organs or wouldn’t be bothered if their organs were donated after death, yet have not registered to be an organ donor.||Everyone has the right to decide if they wish to be on the organ donation list, they will choose to register for it.|
|Beneficence||Having an increase in available donated organs will be beneficial to patients waiting on the transplant waiting list.|
|Non-maleficence||By not finding a way to increase the number of donated organs available, it could be considered as doing harm to those on the transplant waiting list.||Some people do not wish to donate their organs or to receive donated organs, or even blood products from another human. Many of these individuals put this down to religious grounds, such as Jehovah’s Witnesses, while others have this as a personal view. Therefore, it would be detrimental to these individuals to donate or receive another organ.|
Think about the social and mental health implications on these individuals.
|Justice||Wales currently have an opt-out organ donation system that works very effectively.|
Euthanasia or Assisted suicide is the act of deliverately assisting or encouraging another person to kill themselves. It has come to the forefront in the news many times where a relative of a person with a terminal illness has obtained strong sedatives, knowing that the person intentended to use the sedatives to kill themselves, and therefore is considered to be assitsting suicide.
The important considerations as to why euthanasia is an ethical dilema is because currently in the UK it is illegal. However, in some countries euthanasia is legal, hence many seek to travel abroad, can you think of any cases from the news where you have heard about this?
|Autonomy||A person has the right to choose if they wish to end their life before their terminal illness progresses any further. If they choose to have a loved one or relative assist them with this, then who are we to say they shouldn’t.||When considering autonomy we need to consider if a person has the capacity to make their own decisions. Are they in sound mind? Are they legally able to make their own decisions with regards to their healthcare?|
|Beneficence||If a person believes that losing all ability to move (for example) and leave them unable to talk, eat or even breathe unassisted would be detrimental to their own mental health, then are we really being good to our patients letting them become depressed or worse, slowly die?The patient may also feel that is is beneficial to their family and do not want to be seen by their family in a deteriorated state.||It could be considered that by assisting in a patient’s death, as a practitioner you are not being helpful to the patient, in fact you are harming them. Preservation of life is something that doctors believe is very important.|
|Non-maleficence||It is part of a doctor’s oath to “do no harm” therefore it can not be considered right to assist in someone’s death.|
|Justice||Assisted suicide is legal in some countries, including switzerland and Germany. Therefore, why should patients not be allowed to use euthanasia in the UK, or partners be able to travel back from assisting suicide in other countries without prosecution.||It is currently illegal in the UK to assist in euthanasia.|
Euthanasia, like many ethical topics is not straightforward and is something that should be thought about carefully in an answer to a medical school interview quesiton on.
BBC article – euthanasia and physician assisted suicide – Ethics Guide – click here
Don’t be too strong with your argument for one side. It is a debate and on quite a controversial topic. It is better to explain the points on both sides without being too strongly for one side of the argument.