Medical Ethics Interview Questions -The Four Pillars Explained.
Ethical stations are almost universal amongst medical school interviews. A strong interview answer requires good background knowledge of medical ethics. This guide will provide you with the fundamentals of medical ethics and the techniques needed to craft an excellent answer!
We here at MasterMedPrep have a particular interest in medical ethics. Dan, Cameron, and Jordon have an MSc in Healthcare Ethics and Law. Dan worked with Prof Søren Holm on a research paper and is going to be speaking at the World Congress of Bioethics in July 2022 in Switzerland. We have a wealth of academic, real-life, and teaching experience with medical ethics.
It is a common concern for students and we have devised a series of medical ethics lessons for any students who want to learn more about medical ethics by booking a 1-1 interview coaching session. Please get in touch if you have any questions about medical ethics for your medicine interview!
The Four Pillars of Medical Ethics
The four pillars of medical ethics stem from a school of thought known as principlism. Principlism is an approach to biomedical ethics that uses these pillars to justify moral decisions. The four pillars form the principles of medical ethics that guide the moral decision making of doctors but can also be applied to general society.
When answering medical ethics interview questions, applying the four pillars of medical ethics will enable you to form well rounded and balanced answers.
The pillars are as follows:
Respect for autonomy
Beneficence
Non-maleficence
Justice
Respect for Autonomy
Autonomy is an individual's ability to make their own decisions free from the influence of internal or external factors.
Internal factors are aspects of an individual that reduces their ability to exercise their autonomy. This could be delirium secondary to sepsis, or a learning disability for example. These factors can stop an individual from being able to fully weigh up a situation.
External factors are pressures coming from other people or an individual's environment. For example, the relatives of an elderly patient pressure them to refuse life-sustaining care in order to reduce their care bills. The pressure from the relatives.
Beneficence
Beneficence is acting in the best interests of a patient. This means doctors must make decisions that promote the health of a patient and reduce the possibility of them coming to harm. An example of beneficence is a doctor choosing a course of treatment because it is proven to be effective for a patient's condition.
Significant debate on beneficence arises when considering topics such as Euthanasia for the terminally ill. Arguably, allowing an individual to live in intolerable suffering is not in their best interests, however, the alternative (euthanasia) will lead to the ultimate harm (death).
Non-Maleficence
Non-maleficence is the principle of doing no harm. An example of a doctor violating this principle would be breast surgeon Ian Paterson, who performed unnecessary operations on hundreds of women after falsely telling them they had cancer. This is an example of violating non-maleficence as the surgeries had no clinical benefit and therefore constituted harm.
This principle commonly comes into conflict with Beneficence. Medical treatments commonly carry side effects. For example, many surgeries will have extended periods of painful recovery.
The Doctrine of Double Effect
Allows for navigating these situations where, for example, a medical treatment such as chemotherapy has the ultimate goal of saving a life from cancer (beneficence), but carries harmful side effects such as fatigue, vomiting and hair loss. This principle holds that the harmful side effects caused by a treatment are allowable as long as it is not the intended consequence, and the good created outweighs the harm.
When applied to the Ian Paterson case, the harm caused by breast surgery (disfigurement, painful recovery and operative risk) is not permissible as there was no benefit to the patient. If the patient had been suffering from breast cancer, the doctrine of the double effect would come into play and allow the harmful side effects of surgery as the overall outcome would be positive (removing the cancer).
Justice
The principle of justice holds that all patients must be treated equally and equitably, this means that resources must be allocated fairly, and patient groups cannot be discriminated against. This is a founding principle of the NHS which requires patients to be treated based on their clinical needs rather than their ability to pay.
NICE (National Institute of Clinical Excellence) is forced to make decisions regarding justice on a daily basis. Resources are limited and therefore systems are in place to aid the fair allocation of resources. NICE uses the QALYs (Quality Adjusted Life Year) to allocate resources.
A QALY measures the state of health of a person or group in which the benefits, in terms of length of life, are adjusted to reflect the quality of life. One QALY is equal to one year of life in perfect health. (nice.org.uk) When justifying the cost of a treatment, the amount of QALYS commonly factors in the decision-making process.
Crafting the Perfect Answer to a Medical Ethics Station in Your Medicine Interview
Medical ethics answers require careful thought, they are about showing you understand multiple perspectives and can balance the interests of the involved stakeholders.
Thinking before you speak is essential to creating a rounded answer. When giving an answer, using the four pillars will ensure that multiple aspects are considered. When using the pillars, avoid simply listing them as this does not show any understanding, instead explain what you understand by each one and why it is relevant to the answer. For example, when considering voluntary euthanasia, some points could be:
Autonomy: by allowing the patient to choose euthanasia, we are respecting their right to autonomy. However, it is important to consider whether they have mental capacity and whether they are being influenced by others.
Beneficence: this is difficult to evaluate in relation to voluntary euthanasia. Say the patient is terminally ill and in intolerable suffering, perhaps it is not in their best interests to continue suffering. However, other options such as pain relief may be more appropriate and will allow the patient to continue living
Non-maleficence: irrespective of motivation (to ease suffering for example), euthanasia contains an element of harm. Again, it may be more appropriate to look for alternative options to ease symptoms.
Justice: does not feature in this answer, however, you could use the word ‘justice’ as a reminder to mention the law in the UK. Currently, euthanasia is illegal, and doctors are bound to follow the law.
As seen, using the four pillars can create a balanced and well-reasoned answer. Explaining the relevance of each point is essential to showing the interviewer your understanding.
Get in touch if you have any questions about medical ethics for your medicine interview. Or book a lesson below where one of our medicine ethics experts can teach you how to ace the ethics stations every time!