Medical ethics describes the moral principles by which a Doctor must conduct themselves. You need to understand the concept of medical ethics, but you’re not 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.
The “four pillars of medical ethics” is a framework for analysing the best action to take in a given situation. To use this approach, you must consider whether your actions are in compliance with each of these pillars.
The four pillars of medical ethics are:
A good example of an ethical dilemma relating to Medicine is that of surgery.
Imagine that a patient has appendicitis and the surgeons believe that surgery is necessary. Technically, making an incision into the patient’s skin is causing “harm” to the patient; however, this is done with good intent as removing the inflamed appendix eliminates the risk of progression to rupture and peritonitis.
Surgery would be offered to the patient based on their clinical need and they will have the right to make an informed decision. The four principles would, therefore, support performing this surgery.
Consequentialism is an ethical ideology that states the morality of an action is dependent purely on its consequences. A simpler way to phrase this would be that the “ends justify the means”. If your action has an overall benefit, then it does not matter about the action itself.
Example: Your patient has a terminal illness and is not likely to survive the operation she is about to undertake. Just as she is about to be anaesthetised, she asks you: “Doctor, will I be okay?”. A consequentialist ideology supports that lying in this circumstance is acceptable, even though lying itself is not a moral action.
Utilitarianism says the best action is that one that brings about the best increase in utility (benefit). Utility is generally considered on a broad scale, often taking into consideration wider society and not just the patient in question. It’s a form of consequentialism.
Example: You have a sum of money to either fund a very expensive treatment for one patient with a rare disease or five patients with a very common and easy-to-treat disease. Utilitarian ethics dictates that treating the five patients is morally superior as a greater overall benefit is achieved.
Deontology is also known as “duty-based ethics”. This ideology states that the correct course of action is dependent on what your duties and obligations are. It means that the morality of an action is based on whether you followed the rules, rather than what the consequence of following them was.
This is in direct contrast with consequentialism.
Example: If your terminally ill patient asks if they’ll be ok after a surgery they’re unlikely to survive, a deontological approach would suggest you don’t lie to comfort them. That’s because according to this concept, lying isn’t morally acceptable because it’s our obligation not to lie – no matter the consequences.
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.
One of the best ways to develop your understanding of medical ethics is to practice analysing situations using ethical frameworks and ideologies. You can do this on your own, with a teacher, or with a fellow medical school applicant who could give you their perspective and share ideas. Try to compare the outcomes given by different frameworks and consider the implications of this.
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 news.
You’ll also be expected to know about some key hot topics that include ethical issues, such as:
When you answer ethics questions you don’t have to list each of the four principles of ethics and outlining these concepts – instead, pick a couple that are really relevant to show the interviewer that you’re aware of the medical ethics in general.
And remember – may not be expected to make decisions yet. The key thing to do in your interview is to show you understand the issues by discussing how the key ethical principles relate to the question. If the interviewer pushes you for an opinion, make sure you can back up what you choose with some ethical reasoning.
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