How to Tackle Ethical Dilemmas in Medical School Interviews

Hi everyone,

In this article, I’ll share my insights on structuring responses to ethical dilemmas in medical school interviews.

When faced with any interview question—aside from personal inquiries like “Why medicine?” or “Tell me about teamwork?”—it’s essential to begin by clarifying your understanding of the ethical dilemma presented. This helps set the stage for your argument.

Balanced Argument
It’s crucial to offer a balanced perspective on both sides of the dilemma. Most ethical issues are complex and not merely black-and-white; thus, showing empathy for all parties involved is vital. In medicine, decisions often involve multiple valid viewpoints, and your role as a doctor may require you to navigate these complexities. By demonstrating your ability to evaluate different sides, you’ll not only sound more knowledgeable but also highlight the teamwork aspect of medical practice, as decisions are rarely made in isolation.

After presenting a balanced argument, you must conclude with a decisive answer. The reality of medicine is that difficult decisions are unavoidable, and it’s impossible to satisfy everyone. This is where empathy comes into play. If you have a strong moral or religious perspective, you can use that to justify your stance. Otherwise, rely on the arguments you’ve presented to make an informed decision.

Key Components for a Balanced Argument

1. The Four Pillars of Medical Ethics
   • Beneficence: Your actions should benefit your patients.
   • Justice: Fairness is essential; consider the impact on everyone involved.
   • Non-maleficence: Ensure your actions do not harm patients or others.
   • Autonomy: Patients should have the ultimate say over their bodies.
2. Utilitarianism
   • Consider actions that benefit the greatest number of people.
3. Mental Capacity
   • For consent to be valid, the patient must have mental capacity, assessed under the Mental Capacity Act 2005. This includes the ability to:
     • Understand the information provided.
     • Use this information in decision-making.
     • Communicate their decision.
   • If a patient lacks capacity, decisions made on their behalf must prioritise their best interests and be the least restrictive of their freedom.
4. Gillick Competence
   • This evaluates whether individuals under 16 can make decisions for themselves.
5. Fraser Guidelines
   • These allow healthcare professionals to provide sexual health advice to minors without parental consent under certain conditions.

Signposting Your Answer
In medical school interviews, it’s essential to structure your responses clearly to help the interviewer follow your thought process. When discussing ethical dilemmas, also emphasise your empathetic approach. For instance, if a patient actor is present, you could demonstrate empathy by using non-verbal cues, like raising your eyebrows, and speaking slowly.

Example Scenario
Scenario: A 14-year-old girl requests contraception at your clinic without wanting her parents to know. How would you handle this situation?

Response:
Understanding the Ethical Dilemma: This scenario highlights a common ethical conflict in medicine—balancing the patient’s autonomy and confidentiality against the need to ensure her welfare and involve her parents.

Balanced Argument:

• Autonomy: The patient has the right to make decisions about her health, especially concerning sexual matters where privacy is crucial.
• Beneficence: Providing contraception could protect her from risks associated with unprotected sex, such as unwanted pregnancies or STDs.
• Non-maleficence: While respecting her autonomy, I must consider potential harm from excluding her parents, who might provide support.
• Justice: I need to ensure fairness, weighing the patient’s best interests alongside legal requirements regarding consent for minors.

In this context, I’d assess her Gillick Competence to determine if she can make this decision independently. Additionally, I’d apply the Fraser Guidelines: If she understands the advice, is unlikely to involve her parents, is likely to continue sexual activity, and her health could suffer without contraception, it may be appropriate to proceed.

Definite Answer: After considering both sides, if the patient is deemed Gillick competent and meets the Fraser Guidelines criteria, I would provide contraception. I would document my decision-making process, ensure she understands safe sexual practices, and encourage her to discuss her choices with a trusted adult, even if that’s not her parents. Ultimately, protecting her confidentiality while prioritising her safety aligns with ethical principles and legal guidelines.

Best of luck!