Medical ethics interview questions, and how to reason through them

Ethics stations worry applicants more than any other, usually because they feel there must be a right answer. Most of the time, the assessor is not looking for a particular conclusion. They are listening for a fair, structured way of reaching one, and a decision you can justify.

The four principles

Most medical ethics teaching in the UK uses four principles. You do not need to name them in every answer, but you should be able to use them:

• Respect for autonomy: people with capacity have the right to make decisions about their own care, even ones others disagree with.
• Beneficence: acting in the patient’s best interests.
• Non-maleficence: avoiding harm.
• Justice: fairness, including how limited resources are shared.

Good answers show the principles in tension. Respecting a refusal can conflict with doing good; treating one patient can affect what is available for others.

Capacity

In England and Wales, the Mental Capacity Act 2005 sets out how capacity is assessed. A person is assumed to have capacity unless it is shown otherwise, and capacity is judged for a particular decision at a particular time. To have capacity for a decision, a person should be able to:

1. understand the information relevant to the decision,
2. retain it long enough to make the decision,
3. use or weigh it as part of deciding, and
4. communicate their decision.

An unwise decision is not, by itself, a sign that someone lacks capacity. That point comes up again and again in interviews.

Consent

Valid consent needs to be voluntary, informed, and given by someone with capacity. In an interview, that usually means saying you would make sure the patient understands the options, the risks and benefits, and what happens if they do nothing, and that they are not being pressured.

Young people

Questions about under-16s are common. A young person under 16 can consent to treatment if they are judged to have enough understanding and maturity to understand what is involved, often called Gillick competence. For contraceptive advice specifically, doctors also use the Fraser guidelines, which include encouraging the young person to involve their parents. Safeguarding concerns always take priority.

Confidentiality

Confidentiality is central to trust, but it is not absolute. It can be broken in limited circumstances, for example where there is a serious risk of harm to others, a legal requirement, or with the patient’s consent. In an interview, say that you would try to encourage the patient to share the information themselves first, and that you would seek senior advice before breaking confidentiality.

A worked example

1. Name the issue: a refusal of potentially life-saving treatment, and a relative asking you to override it.
2. Check capacity: can the patient understand, retain and weigh the information, and communicate a decision? Capacity is assumed unless shown otherwise.
3. Make sure the refusal is informed: explain the risks, explore their reasons, and check for alternatives they might accept.
4. Respect a capacitous decision, even though it is not the one you would make, and explain this kindly to the partner.
5. Involve seniors, document carefully, and keep exploring acceptable alternatives.

Ethics questions to practise

1. A patient asks you not to tell their family they have a terminal diagnosis. What do you do?

   Respect the wish, explore it, and think about how to support them.

2. Should organ donation be opt-out?

   Autonomy, consent, family wishes and saving lives.

3. A 15-year-old wants treatment without telling her parents. How do you approach it?

   Competence, confidentiality, safeguarding and encouraging involvement.

4. Two patients need the last intensive care bed. How should the decision be made?

   Clinical need and likely benefit, fairness, and not deciding alone.

5. A colleague comes to work smelling of alcohol. What do you do?

   Patient safety first, then support for the colleague and escalation.