Ethical Questions in Medicine: How to Tackle Them

Ethical questions are a staple of medical school interviews. Don’t panic - you don’t need to have a “perfect” answer. What interviewers are looking for is clear thinking, balance, and the ability to reflect on multiple perspectives.

The first thing to remember: don’t jump straight into your opinion. Save your conclusion until the end. Interviewers generally do like candidates to take a side - as long as it’s consistent with the arguments you’ve laid out and you can justify it.

Topics You Should Be Familiar With

While interviewers may avoid extremely “triggering” issues like abortion, it’s still important to know the laws and ethical principles behind them. Common topics include:

• Consent & Capacity

  • Understand what valid consent looks like: the patient must understand, retain, weigh up, and communicate a decision.

  • For children under 16, know Gillick competence: whether a minor can consent to treatment independently (but can’t refuse?)

  • Be aware of age of consent for sexual health and contraception — would a doctor ever give out contraception to a 14 year old? (answer is yes, but why?)

• Assisted Dying vs Euthanasia

  • Know the legal distinction: assisted dying is legal in very few jurisdictions and involves providing means for a patient to end their own life; euthanasia is illegal in the UK and involves a third party directly causing death.

  • Be familiar with the Doctrine of Double Effect: where an action (e.g., giving high-dose analgesia) may hasten death as an unintended but foreseen consequence. See our article on assisted dying for more.

• Confidentiality

  • Doctors must generally maintain patient confidentiality, but there are exceptions: when a patient is at risk of serious harm to themselves or others, or where the law requires disclosure.

  • Be able to give examples and reflect on the balance between autonomy and protection.

• Organ Transplantation & Allocation

  • Ethical dilemmas about who should receive scarce resources, e.g., a liver: principles of justice, fairness, urgency, and utility come into play.

  • Understand the need to balance need with likelihood of benefit.

• Other Hot Topics

  • Emerging technologies like AI in healthcare

  • Vaccination ethics and mandates

  • End-of-life decisions

  • Public health ethics (e.g., resource allocation, pandemic responses)

  • Is it ever acceptable for doctor’s to lie to patients

How to Structure Your Answer

Think of it like a driving test. Just like you signal, check mirrors, and show the examiner you know what you’re doing, you should make your thought process explicit in the interview:

1. State your approach:

   “To answer this question, I’m going to run through the four pillars of medical ethics.”

2. Work through the pillars (and optionally, add Consent as a fifth pillar)

   • Autonomy: Respecting the patient’s choices (link to capacity, consent, and Gillick competence)

   • Beneficence: Acting in the patient’s best interests

   • Non-maleficence: Avoiding harm

   • Justice: Fairness and equality, especially for resource allocation like organ transplantation

   • Consent (optional fifth pillar): Reflects understanding, retention, weighing risks, and communication

3. Provide balanced arguments

   • For each pillar, discuss both sides: the pros and cons of an action, the conflicting principles, and stakeholder perspectives.

   • Example: Assisted dying: autonomy supports allowing choice, beneficence could support relief of suffering, but non-maleficence raises concerns about harm.

4. Conclude with your justified opinion

   • Now you can state your position, ensuring it aligns with the arguments you’ve just discussed.

   • Strong candidates reflect on the nuances rather than giving an overly simplistic “yes/no” answer.

Tips for Success

• Think aloud: Interviewers want to see your reasoning. Say what you’re considering, even if you’re weighing different sides.

• Be balanced: Show you can appreciate different viewpoints. This demonstrates maturity, empathy, and reflective thinking.

• Know the law and guidelines: Even if the topic isn’t directly tested, knowing the legal and professional context (e.g., GMC guidance, age of consent, assisted dying legislation) shows you’re informed.

• Use real-life examples: If possible, link to clinical experiences or news stories to make your points concrete.

• Practice consent and capacity questions: These come up frequently and often link to ethical dilemmas.

Example Phrases to Use

• “To answer this, I’m going to consider the situation through the four pillars of medical ethics…”

• “Under autonomy, the patient has the right to make decisions, but we also need to consider whether they have capacity…”

• “From a justice perspective, we must think about fairness and allocation of limited resources…”

• “Considering the doctrine of double effect, it’s possible that the intervention could cause unintended harm…”

• “Balancing all these factors, my view is… because it aligns with both patient welfare and ethical principles.”

Further Reading & Example Case

For a worked example of this approach, see our blog post on the Assisted Dying Bill currently passing through Parliament, which walks through:

• How to apply the pillars of medical ethics

• How to provide a balanced for-and-against argument

• How to conclude with a reasoned, justified opinion