Medical School Interviews: A Guide to Answering Ethical Questions
Medical School Interviews
Ethics: 5 Possible Interview Questions and How To Answer Them
Ethical questions and scenarios are a staple of medical interviews, and you will likely be asked about an ethical debate in each interview. They can be daunting at first, however, they all follow similar structures, and the foundation of each answer is the same.
I have written model answers for 5 different questions. The answers are not exhaustive, there are more points that can be added to each question, however, you can see the structure that is used and how the questions are approached.
General Tips
The main thing to remember when approaching these questions, is to try to remain neutral wherever possible. Make sure you give an equal (or as close to equal) number of arguments for and against. Most of the time, there are no right answers when it comes to ethics, and the interviewers know that! They will be looking for your evaluation skills and assessing how you weigh up different dilemmas as those skills are transferable to medicine. You may also come across some of these scenarios in real life as a doctor, and the interviewers will be wanting to see how you approach the scenarios.
The main things to be linking back to are: 4 pillars of medical ethics, GMC guidelines and NHS values, wherever applicable
I have written model answers for 5 different questions. The answers are not exhaustive, there are more points that can be added to each question, however, you can see the structure that is used and how the questions are approached.
What are some of the ethical arguments surrounding abortion?
Abortion refers to the termination of a pregnancy before birth. In the UK, abortion is legal up to 24 weeks, or after in certain circumstances. However, this is not the case worldwide. There are lots of ethical arguments surrounding abortion, and this has led to varying laws surrounding it.
When considering the ethical pillar of autonomy, a woman has the right to make whatever decision she would like, as it would be affecting her and her health. However, it can be argued that the foetus also has autonomy, but cannot voice this, and thus abortion would override this.
When considering the pillars of non-maleficence, as abortion terminates a pregnancy it does harm to the foetus. However, when considering the non-maleficence pillar from the mother’s viewpoint – carrying on with a pregnancy which is harming a person’s mental or physical health is unjust.
Abortions are undertaken for a number of reasons – one of which is the foetus may be found to have a disability. It can be argued that by allowing a foetus to be born with a disability, it could result in a poor quality of life for the child which would be doing them harm.
A child needs a life-saving treatment; however, the parents disagree. What are some of the ethical issues in this scenario?
There are a couple of things to consider in this scenario, the main one being autonomy. The ethical pillar or autonomy states that a patient’s choices should be respected and each person has the right to decide what they want. However, this is often overridden in children, as they are deemed not to have autonomy due to them being young and not deemed competent. Therefore, when considering beneficence and non-maleficence, the doctors should perform the live saving treatment, as they would be acting in the child’s best interests and ensuring no harm comes to them. It could be argued though, that the parents know their child better, and there may be some reasoning behind their disagreement. It could be that the child may not have wanted the treatment, and so following through could be doing harm in the long run. The pillar of justice states the child should be offered the treatments available to everyone else.
The GMC guidelines and the NHS core values state that patients and doctors should work together, and this should be attempted here. The doctors and the patients’ parents should try to come to a mutual agreement. If this is not happening, then the decision may have to be taken to court, where a third party can make an unbiased decision.
You are an F1 doctor. You have accidentally prescribed a higher dose of medication than you should have. The patient has had the medication. You realise your mistake and change the dose to the correct amount. You have also checked on the patient, and they are well. Do you tell them?
The most important factor to consider in this scenario of a wrong prescription is patient safety. The question stem says the patient is currently well, however, you would want to keep an eye on them and make sure they remain well.
When considering whether to tell the patient, if we consider the ethical pillar of non-maleficence, then telling the patient about this mistake may worry them which would be doing their mental health harm. They may also lose trust in the medical team, and this could lead to them not being as forthright in the future about their symptoms which could also lead to a negative impact on their health.
However, when considering the domain of maintaining trust in the GMC good medical practice guidelines, patients should be treated with respect and doctors should act with honesty. Following this, the patient deserves to be kept in the loop regarding their medical care, and this involves telling them about any mistakes. This also fits in with the ethical pillar of autonomy. A patient has the right to make decisions for themselves, and to do this they should be given all the information so they can make an informed decision. This also fits in with the NHS core values of respect and dignity.
Whilst there are a couple of things to consider, in this scenario the patient should be told what has happened, and they should be reassured that the mistake has been fixed and will not happen again.
Many doctors do not recommend extreme sports. Should patients who have injuries due to extreme sports be treated on the NHS?
Extreme sports refer to sports in which people engage in high risk, dynamic moves that often result in injuries. Sometimes, those injuries can be severe and require medical attention. Due to the nature of these sports, they are often not recommended and come with lots of warnings. Following the ethical pillar of autonomy, people have the right to choose what they do. The GMC guidelines indicate that a patient doctor relationship should be a 50/50 relationship. This often involves doctors giving a patient all the information available, and helping the patient to make an informed decision that is right for them. It is important to respect a patients autonomy, and so people should not be penalised for their actions. This also leads onto the slippery slope argument of: when do we stop? If patients are refused medical healthcare on the basis that they did something that was ‘self-inflicted’ and ‘not recommended’, then this argument could be extrapolated to other conditions such as lung cancer caused by smoking or heart disease caused by poor diet.
Refusing medical care would go against the pillar of beneficence and non-maleficence, as we would be leaving patients in a situation where they are in pain, disabled or could potentially die, depending on the severity of the injuries. This also fits in with the NHS core values of improving lives and compassion.
When considering justice, the patients have a right to the same care available for the rest of the population. However, it could be argued when considering justice regarding equal distribution of limited resources, it may not be fair using up finite NHS resources on something that could have been avoided.
A 15 y/o has come to the GP surgery asking for contraception. Do you give it to her?
There are a couple of things to consider in this scenario. This scenario is surrounding a 15 year old girl. It should be noted that in the UK, the legal age of consent in 16. Therefore, in this case, the patient is considered to be a child and the GP should be aware of patient safety.
However, something to consider is whether the patient is Gillick competent. Although she is 16 and so legally under the age of consent, Gillick competency can be used to assess whether the patient is mature enough to consent to treatment. Specifically, in this scenario regarding contraception the Fraser guidelines can also be used.
The ethical pillar of autonomy points towards the patient being allowed to make her own decisions. However, if the patient is not found to be competent, then autonomy can be overridden. This is one of the few times confidentiality can be broken. If I am concerned about the patients well being and she is not competent, then confidentiality may need to be broken when following child protection protocol. However, in this instance confidentiality should not be broken by calling the child’s parents if she asked them not to be involved. If confidentiality is going to be broken, the patient should be told that this will happen beforehand.
Following the ethical pillar of beneficence and non-maleficence, not giving the patient contraception does not mean she will not be sexually active. This would mean that you would be putting her at an increased risk of STIs and unplanned pregnancies. The GP should also be providing health education regarding sexual health and contraception.
When considering the ethical pillar of justice, this patient should be provided with the same health opportunities as everyone else and should not be discriminated against if she is found to be competent.
Final Thoughts
The more you practice, the easier these questions will become. As long as you remember those 4 ethical pillars, and the GMC guidelines you will be able to tackle any question! Mentioning the NHS core values will make you stand out and show you’ve done wider reading, as not everyone thinks to look at those!
If you would like any support while practicing these questions, or generally throughout your interview process, we offer one to one tailored interview coaching with expert tutors. Please, get in touch if you would be interested in booking any lessons. All the best of luck with your interviews.