Medical Interview Preparation: The 4 Pillars of Medical Ethics
1 week ago by Chris
Patients place immense trust in doctors, and doctors can have enormous impacts on their patients. For this reason, doctors are bound to an ethical code that prevents them from misusing their privileged position in ways that might hurt those for whom they care. Given the importance of ethical conduct to good medical practice, this is a common topic of medical interviews, as well as UCAT Situational Judgement questions. As a medical student hopeful, it’s essential to have a good understanding of the ethical principles that govern doctors, both to help you answer interview questions concerning medical ethics and to help you practice ethically in your future medical career.
While medical ethics is a broad area, with doctors, philosophers, and ethicists offering a broad range of often conflicting ideas of what constitutes a “good doctor,” there are four principles which are foundational to the modern medical system, known as the four pillars of medical ethics. These are beneficence, nonmaleficence, autonomy, and justice.
At its most simple, beneficence refers to the notion of doing good for patients. Doctors should always be seeking to act in a way that promotes patients’ well-being and ability to live a good life. While this principle may seem simple, it is not always easy to identify exactly what “the good” looks like in any given scenario. For instance, while a doctor may offer a treatment they know will improve their patient’s health, the patient may choose to reject it, or the patient may request a treatment that the doctor is unwilling to provide.
Interview questions on this topic might ask you to interrogate what a doctor should do in a given scenario to maximise the good for their patient, exploring the ways in which definitions of “the good” differ. For example:
You are a paediatric oncologist working in a major hospital. You are treating Ben, a fifteen-year-old boy with a blood cancer who requires a blood transfusion. Ben is a Jehovah’s Witness, and states that his religious beliefs prohibit him from receiving the transfusion. In your professional opinion, without the transfusion Ben will die within two weeks. You speak to Ben, and he states that he would rather die than receive the transfusion. What would your approach be in this scenario?
Nonmaleficence refers to the duty to not engage in actions that could cause harm to a patient, or allow a patient to come to harm through inaction. In short, as Hippocrates famously put it, it is the duty to “do no harm.” This acts as a corollary to the principle of beneficence. Like with beneficence, it is not always easy to determine what constitutes a harm, or who should be making this decision. In fact, many medical treatments could be said to involve elements of harm, such as chemotherapy drugs that cause considerable damage to healthy tissue in the patient’s body.
Interview questions on this topic might ask you to explore the harms inherent in certain courses of medical action, and whether such harms are justified by ameliorating circumstances. For example:
You are a GP managing Steven, a sixty-year-old man who recently presented to you with a three-month history of abdominal pain and blood in his stool. Imaging results suggest that Steven has a tumour in his colon which will require urgent surgical management. However, when you tell Steven that you think you should talk about his results, he says that he “doesn’t want to hear bad news,” and that if the issue is serious he’d rather not know about it. Instead, he requests simple pain relief. How would you handle this situation?
Autonomy refers to patients’ ability to make independent decisions concerning their own healthcare, free of control or coercion by doctors or others. While medicine historically followed a “patriarchal” model, where doctors largely made decisions for their patients, modern medicine follows a “collaborative” model, where doctors and patients work together to decide on treatment plans. Under this model, patients’ autonomy is respected, since they have the ultimate say on whether they should or should not receive any given treatment. Autonomy is challenged when the patient’s ability to act independently and make decisions on their own care is compromised in some way. Examples include unconscious or comatose patients, patients with severe mental illness, and children below a certain age. For this reason, autonomy is linked with the concept of informed consent, where consent is only valid when the patient has been fully informed of the benefits and risks of treatment and has the mental capacity to make a decision based on this information.
Interview questions on this topic might ask you to examine factors affecting the autonomy of patients to determine how their care should be managed, especially where autonomy has been compromised. For example:
A fourteen-year-old girl presents to your general practice. She tells you that she is sexually active, and requests a prescription for oral contraceptives. She asks you not to tell her parents about this appointment or her request. What issues do you have to consider here, and would you grant the girl’s request?
Justice refers to fair and equitable treatment of patients by doctors and the healthcare system. This can manifest at a number of levels. At the local level, doctors should provide good care to all patients, without discriminating. At the system level, the health system should be constructed in a way that allows people throughout society to receive high-quality care and hence good health outcomes. While doctors endeavour to preserve justice in their practice, health inequities are present throughout society. For instance, Indigenous people in Australia have much poorer health outcomes than non-Indigenous people.
Interview questions on this topic might invite ask you to determine ways in which the health system is unjust, and how this might be modified to provide better outcomes for patients. For example:
Obesity is a major health issue in modern Australian society, and those with obesity are at a much greater risk of numerous other debilitating health conditions, such as diabetes and heart disease. Rates of obesity are much higher among Indigenous Australians than non-Indigenous Australians. Why do you think this may be, and what are some potential solutions to this issue?
You can find many MMI scenarios to practice with, including guidelines for answering them, in MedEntry’s innovative MMI bank.
Written by Callum, a past MedEntry student and current medical student, as well as interview tutor.