Medical ethics guide

Why study medical ethics?

Doctors need to be aware of the ethical foundations in order to make appropriate clinical decisions. Often there is no one right answer, so knowing the concepts and ideas can help you do your best in difficult situations.

Due to the importance of ethics, medical school interviews will dedicate an entire station to assess your understanding of the concepts. So, make sure you know the general principles, the hot topics, and the exceptions to the medical ethics debate.

Where is the information from?

The GMC’s ‘Good Medical Practice’ provides a section on ‘ethical guidance for doctors’. This is a very long document aimed at helping doctors understand how to handle ethical dilemmas. It’s too long to read for an aspiring medic, so instead and the BMA has produced a document called the ‘Ethics toolkit for medical students’ that outlines the key ideas.

The following posts will cover the fundamental principles of medical ethics, how to answer such a question, and common themes that occur in ethics questions.

The four (six) pillars of medical ethics

It is vital that you know the pillars of medical ethics before your interview as they form the basis of every single ethics question you will encounter. Learn them well, recite them until you’re mumbling it in your sleep, and above all mention them in any ethics question you get. Click on the links to read more about each one:

• Beneficence – acting in the best interests of the patients
• Non- Maleficence – the moral duty of a doctor to do no harm 
• Autonomy– the right of competent adults to make informed decisions about their treatment 
  • Another article here
• Justice – that doctors should make decisions and act within the remits of the law 

Other important concepts of medical ethics not covered by the ‘four pillars’

• Confidentiality – that doctors are required by law (and morals) to not disclose any patient information, particularly ensuring that it remains within the medical team, although there are exceptional circumstances where it may be allowed
• Consent– doctors must obtain consent from patients that are competent to provide it
  • Here is a video on consent 
  • And another article on consent

Framework to follow when answering medical ethics questions

You will undoubtedly be faced with an ethics question. To do well at these questions, in addition to knowing the pillars of medicine inside-out, you’ve also got to learn how to apply them. Below is one method for applying your principles and answering these questions

Framework for ethics questions

• Discuss the question in the context of all of the ethical principles
  • Apply them methodically to the question, explain how they do or don’t apply
• Consider the wider implications of each possible decision 
  • For example, with abortion explain clearly what the pros and cons of either legalizing or outlawing it would be
  • Also, consider the implications for doctors. For example with legalising physician-assisted suicide, how would the doctor feel having to 
• Propose a balanced viewpoint then come to a conclusion based on the evidence you have, with sufficient justification
  • Only come to a conclusion once you have done the previous two points
• Discuss what further information you may want to confirm your conclusion 

General tips for answering the questions

• If the words ‘autonomy, beneficence, non-maleficience, justice’ have not pass your lips, your answer is not yet complete!
• Think of these questions as an essay: If you were writing a very short essay, how would you structure it? Try to follow the same flow of arguments. This will make your answers sound very professional and well thought out.
• If you are unsure of the laws behind the question, it is okay to say you don’t know the specifics, but make it clear to the interviewer that you know where to look – name-drop the GMC guidelines

Mistakes to avoid

• Don’t jump to your answer or a conclusion straight away. If you find yourself answering the question in the first sentence, rethink how you structure your answer
• Avoid waffle- if you find yourself waffling try to summarise the key points after you have spoken
• Anecdotes are good but try not to use too many in your answers, otherwise you’ll find yourself getting bogged down with small details and wasting your precious time to shine
• Try to avoid giving your personal opinions – talk about it from a third-person perspective, such as using the phrases ‘some may say’ or ‘some agree that’ to avoid having to discuss difficult topics and to prevent you from going into too much detail about your opinions, especially for controversial topics.

Resources

• This post by the Medic Portal
• This video by 6med:

Popular ethics interview questions

Below we have made a list of some of the common medical ethics topics and provided links to articles on them specifically.

Before you read any further, we highly recommend watching someone else answer example ethics questions to get a feel for how to discuss the following topics. Here is just one example.

• Euthanasia  
  • Here is a video on the topic
  • Questions to consider: What is physician-assisted suicide? What are the current laws on euthanasia? What issues have arisen due to the legalisation in Switzerland? How would physician-assisted suicide differ between a patient paralysed from the neck down and an elderly patient?
• Physician-assisted suicide 
  • Question: What is Dignitas? What is the current law in the UK?

• Abortion 
  • The current law is that abortions are legal if carried out before 24 weeks. Read this article on the current laws on abortion (2019).
• Consent: When can someone not give consent?
  • Questions: What if someone is being coerced? What qualifies as mentally ill? At what age can you give medical consent?
• Can children provide consent?
  • Question: What is the Gillick competence?
  • Underage contraception use / sexual activity
  • What are the Fraser guidelines?
• Refusal of life-saving treatments
• Dishonest or negligent medical colleagues 
• Organ donation: opt-in or opt-out?
• When can you breach patient confidentiality?
• Genetic testing during IVF, e.g. for Down’s Syndrome and deafness, and informing relatives of their increased genetic risk when another family member is diagnosed
• Compulsory vaccines (and another resource here)
• Confidentiality and HIV
  • Questions: Who falls under the remit of ‘the healthcare team’?  What are the circumstances that a doctor can disclose patient information? 
• Using humans in a clinical trial 
• Should doctors go on strike?
• Jehovah’s witnesses
• Child safeguarding

Further resources:

• A 6med guide
• A medic portal guide