Medical Ethics

Ethics in Medicine

Medical ethics describes the moral principles by which a Doctor must conduct themselves. You need to understand the concept of medical ethics when you’re applying for Medical School, but you aren’t expected to be an expert.

It’s worth being aware that medical ethics is a changing ideal. Something that might have been considered ethical 30 years ago may not be today – and what we think is ethical right now may change in the future.

Why Is Medical Ethics Important?

Doctors deal with life or death decisions every day and it is vital to have a universal framework to help make these choices. The decisions you make must always have the patient as the focus.

Four Pillars of Medical Ethics

The four pillars of medical ethics are:

1. Beneficence (doing good): e.g. You have just finished your shift as a resident doctor on the ward and your colleague taking over is stuck in traffic, meaning they will be an hour late. Beneficence dictates that you stay on the ward for an extra hour to ensure the patients are safe until your colleague arrives and can take over.
2. Non-maleficence (to do no harm): e.g. A patient is requesting antibiotics for an infection that you suspect is viral. Non-maleficence dictates that you do not prescribe antibiotics as the patient will not benefit and may be at risk of developing resistance in the future due to inappropriate usage.
3. Autonomy (giving the patient the freedom to choose freely, where they are able): e.g. You are an oncologist and your patient has diagnosed breast cancer and needs a mastectomy in order to survive. You give them all of the information about the surgery including the risks and benefits and they decide not to go ahead with it. According to autonomy, given the patient has capacity to make the decision, you should respect their decision.
4. Justice (ensuring fairness): e.g. You are a dermatologist. Justice dictates that you must learn how different skin
   conditions present on every skin colour to ensure that patients of different races do
   not receive different standard of care.

You can use the four pillars as your infrastructure for any ethical question that you are asked at interview, and it’ll impress your interviewer if you reference which pillars you are basing your answer on.

Further Concepts in Medical Ethics

In some scenarios it may be helpful to develop your ethical arguments with further theories alongside the four pillars of medical ethics. Some well-known theories are as follows:
1.  Consequentialism: “The ends justify the means’, meaning whether something is ethically right is dependent on the outcome. e.g. You are a surgeon and you are about to anaesthetise a patient with a terminal illness for an operation, when they ask “am I going to be okay?”. Consequentialism dictates that it is okay for you to tell them they will be fine as this will not change the outcome, even though lying is not a moral action.

2. Utilitarianism: Actions that cause the most happiness and pleasure for the most amount of people are ethical, and actions that cause unhappiness or harm or not. This theory is based on trying to better society as a whole and not the individual. e.g. There is a common ethical problem that demonstrates utilitarianism well. A train is about to run over five people tied to the tracks. You have the choice to pull a lever and change the tracks so that it runs over one person tied to the tracks in the other direction. The ethical problem is that while changing tracks will save four lives it requires an active decision. Utilitarianism says that changing the tracks in the correct ethical decision as it is more beneficial to save more lives.

3. Deontology: The stark difference between right and wrong, also known as duty- based ethics. Deontology contradicts consequentialism in that it doesn’t matter what the outcome is if something is inherently unethical. e.g. If we consider the same example from part i, deontology dictates that it is fundamentally unethical to lie, so the surgeon should tell the patient the truth that they are going to die.

Generally speaking, consequentialism may be the most relevant guide to thinking about the broad aims of healthcare – and deontology-based guidance is the one most commonly seen in Medicine.

Generally speaking, consequentialism may be the most relevant guide to thinking about the broad aims of healthcare – and deontology-based guidance is the one most commonly seen in Medicine.

How To Develop Medical Ethics Knowledge

One of the best ways to develop your understanding of medical ethics is to practice analysing situations using ethical frameworks and ideologies. It’ll impress your interviewer if she can look at a scenario through the lenses of multiple different ethical theories.

Make sure you stay up to date with the latest health news – and see how these ethical frameworks apply to what’s currently in the headlines as interviewers with favour real-life dilemmas over imaginary scenarios.

Medical Ethics Examples

At Medical School interviews, medical ethics is a big part of the selection process. It’s highly likely that you’ll be asked ethics questions or face an MMI station designed to test your understanding of these concepts.

There are multiple real life examples where medical ethics is important to consider and have even played a role in litigation in some unfortunate circumstances. Some key topics include:

• The Charlie Gard and Alfie Evans cases
• Medicinal cannabis
• The handling of the COVID-19 pandemic
• Abortion
• Euthanasia
• Organ donation

Interviewers may choose to ask you directly about previous cases and will expect you to know the basic details of what occurred. Along with the topics listed above ensure you have reviewed any well-known court cases where medical negligence and ethics plays a key role.

When you answer ethics questions, you don’t have to list each of the four principles of ethics and outline these concepts – instead, pick a couple that are really relevant to show the interviewer that you’re aware of medical ethics in general.

Remember- in an interview scenario you only have to give a final opinion if asked. “Do you agree with abortion” and “Discuss the ethically argument for and against abortion” are two very different questions and it’s safest not to give an opinion unless you need to. If you must, most answers are valid as long as they are backed up with the relevant ethical framework.

Further Reading

The following books involving medical ethics will be useful to read in your medical school interview preparation:
– My Sister’s Keeper by Jodi Picoult
– When Breath Becomes Air by Paul Kalanithi
– Medical Ethics: A Very Short Introduction by Tony Hope