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, whereby 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 deliberately 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 intended to use the sedatives to kill themselves, and therefore is considered to be assisting suicide.
The important considerations as to why euthanasia is an ethical dilemma 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 question 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.
Abortion is the medical process of ending a pregnancy so it doesn’t result in the birth of a baby. They can take place in England, Wales and Scotland before 24 weeks of pregnancy under the Abortion Act. In certain circumstances, they can be carried out after 24 weeks, for example, if the mother’s life is at risk. Two doctors have to agree that the abortion is less damaging to a woman’s mental or physical health instead of continuing the pregnancy.
|Autonomy||Patients have a right to decide themselves instead of being regulated by laws. As pregnancy comes with many risks to both mental and physical health, a mother should have the choice to decide that they would like to avoid these risks.||The foetus has a right to life. You could argue that an embryo has genetic material and should have rights from week 1.|
|Beneficence||It could be the best option for the mother who might be unable to raise a child. It could be better for the foetus if they may have a congenital disorder that would mean they have a limited quality of life.|
|Non-maleficence||A pregnancy can have physical and mental effects on the mother. The baby might be born with congenital defects so giving an abortion prevents them from future harm.||Abortion could be seen as killing a human being, depending on the definition of when life begins.|
|Justice||In England, Wales and Scotland abortions are legal according to the Abortion Act up to 24 weeks.|
Contraception is a method used to prevent pregnancy. When giving children under 16 years contraception, in accordance with the Fraser Guidelines there are certain requirements that need to be fulfilled, particularly that the child completely understands what comes with being sexually active, taking contraception, and can’t be convinced to tell their parents.
|Autonomy||If the child fulfills the Fraser Guidelines and is therefore deemed competent, then you should respect their decision.||Patient autonomy depends on the patient and can vary at different points particularly in young people.|
|Beneficence||It could be in the child’s best interest to receive contraceptive treatment particularly if they’re likely to continue engaging in sexual activity||Providing contraception without parental consent may not benefit the child as they are now less likely to tell their parents|
|Non-maleficence||Not giving contraceptive advice or treatment could put the patient at greater risk of sexually transmitted infections and pregnancy|
|Justice||In accordance with UK Legislation, if a child fulfills the Fraser guidelines a doctor is legally allowed to provide them with contraception|
Fraser Guidelines – link here
5. Refusing Life-Threatening Treatment
For various reasons a patient or their parents may refuse treatment e.g A Jehovah’s witness may refuse a blood transfusion as it goes against their beliefs. Guidance regarding this scenario varies depending on specific circumstances. In circumstances where the treatment is life-threatening a doctor may make the difficult decision to ignore a patient’s request if the patient doesn’t appear to have competency. Proving that a patient is competent would involve explaining the treatment to the patient and seeing if they are able to weigh up the consequences of refusing the treatment. You may be presented with this scenario as a doctor and it’s important you consider the pillars of medical ethics when making a decision as well as discussing with your colleague, as you wouldn’t make such a massive decision by yourself.
|Autonomy||A patient’s autonomy should be respected so if they refuse treatment, a doctor should respect that choice||The patient’s autonomy varies depending on their competency, so a patient may not be competent for the autonomy to be valid|
|Beneficence||Giving the patient treatment that will save their life would be doing good||If you give the patient the treatment against their will, it may not be in their best interest as they may feel that they aren’t being listened to|
|Non-maleficence||It would be harmful to accept the patient’s decision because they could die by not having the treatment||It could be harmful as something could go wrong during the surgery that negatively impacts the patient|
NHS – Assessing capacity – link here