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Ethical Scenarios

Ethical scenarios are a well-established staple of Medical School interviews.

In our experience visiting schools and working with prospective medics up and down the country, this is an area many students find challenging.

So, this page will walk you through an example to illustrate the key principals you can to apply to all ethical scenarios. You can see more ethics questions and answers here, visit our page on NHS Hot Topics 2016, or read our Complete Interview Guide: Medical Ethics.

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What Are The 4 Pillars Of Medical Ethics?

The four pillars should form the basis of medical ethics answers at interview. These are:

How Can I Apply These To A Real Scenario?

The example we are going to discuss is euthanasia, otherwise referred to as ‘assisted suicide’ or ‘the right to die.’

We chose this because it has been a source of major ethical debate for a long time, is still current and frequently crops up at interview, and is delicately balanced with lots of compelling arguments both for and against.

How Not To Answer Medical Ethics Questions

The question could be phrased in many different ways.

‘Should people have the right to die?’, or ‘should euthanasia be legalised in the UK?’ are two examples. Whatever the question, the key is to weigh both sides of ethical scenarios, considering all angles, before coming to a balanced conclusion.

If the first word out of your mouth is a definitive ‘yes’ or ‘no’, does it really look like you’ve weighed the debate properly? Or that you have appreciated the subtlety and the shades of grey involved?

Perhaps not. It can be tempting to blurt out an instinctive response, especially if it’s something that you feel strongly about. But you need to keep your emotional response in check.

Applying The 4 Pillars Of Medical Ethics

A better course of action is to first discuss arguments both for and against, before coming up with a balanced conclusion that appreciates the nuances of ethical scenarios. This should be done, where possible, within the framework of the four pillars of medical ethics:

So, let’s look at our example — euthanasia — in the context of the above.

Ethical Scenarios: Legality

It’s often helpful to start with some points of fact in ethical scenarios, before entering the murkier waters of subjective opinion. This lends itself best to Justice, and the question of legality.

Assisting suicide is against the law in the UK under the Suicide Act (1961). In other words, euthanasia is illegal on these shores. That’s a very important point and an excellent one to start with because it is clear. Rule of Law is important for the safe running of society, so both as a law-abiding citizen and a doctor you would have to obey it.

However, there are places where euthanasia is not illegal. The Dignitas Clinic in Switzerland helps many people commit suicide each year, and does so perfectly within the Rule of Law. Moreover, the UK’s Director of Public Prosecutions decreed in 2010 that family and friends who visit Dignitas to aid in this process will not be prosecuted in the UK.

Legally, it is clear that an NHS doctor clearly should not be assisting suicide in the UK as it stands today. But other jurisdictions have said otherwise, and the chances are high that others will follow. So, this alone does not provide a clear answer to the wider point.

You can read more on this topic in our blog post, Medical Ethics Explained: Justice.

Ethical Scenarios: Autonomy

Autonomy is absolutely central to the debate around euthanasia — and many other ethical scenarios, including, for example, DNAR. It is about the right of the patient to decide. If a patient decides they want to die, shouldn’t they be allowed to?

Were autonomy the only factor, perhaps the answer would be yes. But the four pillars must be constantly weighed and checked against each other. In this case, assisting suicide is illegal, destabilising the Justice pillar.

For more information, you can read Medical Ethics Explained: Autonomy.

Ethical Scenarios: Non-Maleficence vs Beneficence

They are also asking, you might say, for the doctor to ‘harm’ them. Suddenly, then, the ‘non-maleficence’ pillar is also creaking. Appreciating these interlinked consequences will help you come up with a refined answer to ethical scenarios.

A lot comes down to the subjectivity involved in defining ‘harm’ for the purpose of establishing ‘non-maleficence’, and ‘benefit’ in order to decide upon ‘beneficence’.

Faced with the same circumstances, one person might say that helping someone to die was harming them and not in their interest. Another may argue that keeping them alive in a vegetative or painful condition was doing the harm, and that ending their life would be highly beneficial.

Our blog posts, Medical Ethics Explained: Beneficence and Medical Ethics Explained: Non-Maleficence cover these topics in depth.

Should I Offer A Conclusion?

With so many contradictions, how to conclude? We would suggest that the best conclusions to ethical scenarios show a succinct appreciation for the conflicting factors at work, rather than trying to artificially reconcile them one way or the other.

In the case of Euthanasia, the law is clear in the UK — but that might change, as it has in other parts of the world. If it were to be legalised the challenge would be in creating clearly defined criteria to capture when and how it would be permitted, making the inherent subjectivity of ‘harm’ and ‘benefit’ as objective as humanly possible.


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