What is medical ethics?
Medical ethics is a sophisticated set of moral standards and ideals utilised in both clinical practice and academic study. It is founded on a set of principles that medical professionals can turn to when faced with a dilemma, a disagreement. Or when they are just unsure of the right course of action.
Many interviews for medical schools require candidates to demonstrate their understanding of medical ethics and how it applies to clinical practice. We should consider the “four pillars” of medical ethics whenever we consider medical ethics or seek to assess a clinical issue.
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. a fair and equitable distribution of health resources. Doctors often determine these by the overall benefit to society and legislation
The four pillars of medical ethics are crucial to take into account when making clinical decisions. They are frequently applied as a framework for determining the optimal course of action. It is crucial to keep in mind that not all clinical judgments will be simple. Which is why it is crucial for all practitioners to grasp medical ethics.
Common ethical debates – what to consider?
Tutors will almost certainly ask you to speak on a medical ethics subject during the interview. We have included some basic frameworks and sample responses to frequent medical ethics concerns below.
1. Organ donation – opt in/ opt out
England has recently introduced the new opt-out mechanism two years ago (2020). This makes the UK’s system for organ donation a hot topic. The opt-in system that was previously in place in the UK required citizens to register as an organ donor. Approximately 5,000 individuals are now on the transplant waiting list. It is thought that three people pass away every day in the UK while on the organ transplant waiting list alone. In order to fight this, we must immediately figure out how to increase the quantity of donated organs.
| 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 would not be bothered if someone donated their organs after death. Yet they have not registered to be an organ donor. Hence, having an opt-out mechanism would increase the number of organ donors without compromising the autonomy of most people. Those who feel strongly against it still have the option to opt out of the system. | Everyone has the right to decide. Some people might not be aware of this opt-out system. They might not know that they are registered as an organ donor. Hence, you could view this as a compromise in autonomy due to the lack of informed consent. |
| Beneficence | Having an increase in available donated organs will be beneficial to patients waiting on the transplant waiting list. Receiving an organ transplant would be life-changing for patients who require it. | |
| Non- maleficence | For most people to be on the organ transplant waiting list, their health condition or disease would have to reach a pretty critical stage. They would only having an expected amount of years to live. Or they have to receive painful procedures regularly such as dialysis. Hence, not receiving an organ when they need one can lead to them passing on due to the lack of a fully functioning organ. | Having an organ transplant surgery is not a miracle cure for people who require organ transplant surgery. As with any major operation, including that of organ transplant surgeries, there are huge risks and complications that could arise. An extreme example could be a patient dying on the operating table due to complications. Furthermore, rejection of organs post-surgery is also common. This could further worsen or complicate the patient’s health instead of improving it. |
| Justice/ Legislation | Wales currently have an opt-out organ donation system that works very effectively. | Organ transplant surgeries are costly as it is a major surgery. Suppose the number of organ transplant surgeries increases due to the number of organs available while remaining accessible to the patient under NHS. In that case, the funding would come from another aspect of the NHS due to the limited resources available. If doctors could use the same amount of money in a smoking cessation programme that reduced smokers by 10,000, you could argue the opportunity cost of saving one life via organ transplant. |
2. Euthanasia
Euthanasia, often known as assisted suicide, is the purposeful aiding or prodding of another person to end their own life. It is frequently written in the press that a family member of someone who has a terminal disease received potent sedatives with knowledge that the individual intended to use the sedatives to kill themselves. People often regard this as aiding suicide.
Euthanasia presents an ethical conundrum because the UK prohibits it. However, many people desire to travel overseas because euthanasia is allowed in some nations. Can you recall any instances from the news where you have heard about this?
| For | Against | |
| 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 should not. | 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 | Suppose a person believes that losing all ability to move (for example) and leaving them unable to talk, eat or even breathe unassisted would be detrimental to their mental health. Are we being good to our patients, letting them become depressed? Or, worse, slowly die? The patient may also feel that it benefits their family. They do not want to be seen by their family in a deteriorated state. | You could consider 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 | Prolonging someone’s life when they no longer wish to continue living could severely compromise their quality of life. One could see this as doing harm to the patient as it would worsen their mental health. They see no end to their disease. They could feel like a liability, but they do not even have the option to end their lives. | 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/ Legislation example | 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 is a complex ethical issue that requires careful consideration before responding to a question about it during a medical school interview.
Extra reading:
Click here to read a BBC report about physician aided suicide and euthanasia.
Top tip:
Be careful not to oversell your case for one side. It is a discussion and the subject is extremely contentious. It is preferable to discuss both sides’ arguments without favoring one side over the other.
3. Abortion
The medical termination of a pregnancy so that a child is not born is called an abortion. The Abortion Act permits them in England, Wales, and Scotland before 24 weeks of pregnancy. They may happen in some instances after 24 weeks, such as when the mother’s life is in danger. It takes two doctors to concur that having an abortion rather than prolonging the pregnancy would be less harmful to the woman’s physical or mental health.
| For | Against | |
| Autonomy | Patients have a right to decide for 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 also be better in cases where the foetus has a congenital disorder that would mean they have a limited quality of life. | Banning abortion can preserve the foetus’ lives. In certain perspectives, one can see this as benefitting the baby as preserving one’s life is commonly cited as the main aim of a doctor. |
| Non- maleficence | A pregnancy can have physical and mental effects on the mother. The baby might be born with congenital disabilities so giving an abortion prevents them from future harm. | One could see abortion as killing a human being, depending on the definition of when life begins. |
| Justice/ Legislation | In England, Wales and Scotland abortions are legal according to the Abortion Act up to 24 weeks. |
4. Contraception
You can avoid pregnancy with contraception. According to the Fraser Guidelines, someone must show several conditions before providing contraception to minors under the age of 16. Most notably, the child must fully know the risks associated with sexual activity, using contraception, and being unable to persuade them to notify their parents.
| For | Against | |
| Autonomy | If the child fulfils 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. | Some people might argue that at that age, children might not be able to fully understand the risks involved with using contraception, which could affect their health. |
| Justice/ Legislation | In accordance with UK Legislation, if a child fulfills the Fraser guidelines a doctor is legally allowed to provide them with contraception |
Extra Reading
Fraser Guidelines – link here
5. Refusing Life-Threatening Treatment
A patient or their parents may refuse treatment for a variety of reasons. For example, a Jehovah’s witness may object to receiving a blood transfusion because it conflicts with their beliefs. Depending on the individual situation, someone may give different advice on this topic. If a patient does not appear to be competent and the therapy is life-threatening, a doctor may have to make the tough choice to disregard the patient’s request. It would be necessary to explain the recommended course of therapy to the patient. You would then assess their capacity to consider the possible negative effects of doing nothing. As a doctor, you could face this situation. It is necessary to think about the principles of medical ethics and consult with a colleague before choosing. You wouldn’t make such a significant decision by yourself.
| For | against | |
| Autonomy | A doctor should respect a patient’s autonomy 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 treat the patient 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. |
| Justice |
Extra Reading
NHS – Assessing capacity – link here
Example Medical Ethics Interview Question and Response
Interview Question:
“A patient recently diagnosed with HIV confides in their general practitioner (GP) that they have not informed their partner about their diagnosis. How should the GP address this sensitive situation, balancing confidentiality with the ethical duty to prevent harm?”
Sample Response:
“In addressing this complex situation, the GP should initially reinforce the importance of confidentiality, a cornerstone of the patient-GP relationship. This ensures the patient feels supported and understood. The GP’s primary responsibility is to maintain the patient’s confidentiality while also considering the duty to prevent harm to others, in this case, the patient’s partner.
They should encourage the patient to disclose their diagnosis to their partner. They should also highlight the benefits of openness for both their partner’s health and their relationship’s trust. The GP can offer support and guidance on how to have this conversation. This could include providing information on HIV transmission and prevention. The GP might also suggest involving a counsellor or a specialist service that can provide support to individuals in disclosing such information.
This approach is effective because it respects the patient’s autonomy, allowing them to make their own decision about disclosure. It also fulfils the GP’s ethical duty to prevent harm. It navigates the balance between confidentiality and public health. This ensures the patient feels supported throughout the process. Moreover, by offering practical support and advice, the GP empowers the patient to take positive action, potentially strengthening the relationship and health outcomes for both the patient and their partner.”
Explanation
This response is strong because it carefully balances the ethical principles involved. It includes respect for patient confidentiality and autonomy, beneficence (acting in the best interest of the patient), and non-maleficence (avoiding harm to others). It underscores the GP’s role in providing support and guidance to the patient. This encourages them to act responsibly and considerately of their partner’s health, thereby addressing the ethical dilemma with sensitivity and professionalism.
Question 2
“Imagine you are a junior doctor. You become aware that a senior colleague has made a significant error in prescribing medication to a patient. This has not yet caused harm but could potentially be dangerous. How would you handle this situation in line with the four pillars of medical ethics?”
Sample Response:
“First, I would address the principle of non-maleficence, which obligates me to prevent harm to the patient. This means I must take immediate action to rectify the prescribing error before the patient experiences any adverse effects.
Next, considering the principle of beneficence, I have a duty to act in the best interest of the patient. This involves not only correcting the error but also ensuring that the patient receives the necessary care to manage any potential risks associated with the incorrect prescription.
The principle of autonomy requires respect for the patient’s right to be informed about their care. Therefore, it is essential to consider how and when to inform the patient of the error in a way that respects their right to know and is sensitive to their well-being.
Finally, the principle of justice mandates fairness and equality in medical treatment. This means ensuring that all patients receive safe and effective care. Also that measures are in place to prevent similar errors in the future.
In practical terms, I would first ensure the patient’s immediate safety by consulting with a pharmacist or another senior colleague to correct the prescription. Then, I would report the incident through the appropriate clinical governance channels within the hospital to ensure a thorough review and to prevent similar incidents. Someone should decide to inform the patient about the error in consultation with senior colleagues and should consider the patient’s well-being and the potential impact on their trust in healthcare professionals.”
Explanation:
This answer effectively navigates the ethical dilemma by prioritising patient safety and welfare (non-maleficence and beneficence) while respecting the patient’s rights (autonomy) and ensuring fairness in medical practice (justice). The answer outlines a clear, actionable plan that addresses the immediate risk to the patient. It acknowledges the importance of systemic improvement to prevent future errors. It also respects the patient’s right to know in a manner that considers their well-being. This balanced approach showcases the candidate’s ability to apply ethical principles pragmatically and compassionately in a clinical setting.
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