Medical ethics is all about making clinical decisions that have moral implications, but unfortunately, there are not always clear right or wrong answers. Understanding medical ethics and the role it plays in clinical practice is a very important aspect of many medical school interviews, and so it is vital that you become familiar with some key terms and principles. This blog will give you a whistle-stop tour through medical ethics, summarising key points that you should be aware of.
The “four pillars” are 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 the following four factors:
Example: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 therefore support performing this surgery.
What is Consequentialism?
This is an ethical ideology which states that 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.
What is Deontology?
This 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. Therefore, the morality of an action is based on whether you followed the rules, rather than what the consequence of following them was.
Example: this in direct contrast with consequentialism. A deontological approach to the scenario above would suggest that lying would not be considered morally acceptable, because it is our obligation not to lie, no matter what the consequences.
What is Utilitarianism?
This ideology supports that the best action is that which brings about the best increase in utility. Utility is broadly defined as benefit, and is generally considered on a broad scale, often including wider society, and not just the patient in question. This is, in fact, a form of consequentialism.
Example: you have a sum of money, and can either fund one patient with a rare disease and very expensive treatment, 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.
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. Finally, don’t forget to keep up to date with topical ethical issues, as well as the classical ones mentioned in the key topics above.
Words: Mariam Al-Attar
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