Beruflich Dokumente
Kultur Dokumente
Ethics
What do you understand about
euthanasia? Does euthanasia have a
place in modern medicine?
Answer Guide:
First things first, what is euthanasia? This is the term given to describe actions taken to
deliberately end someone’s life, often to relieve suffering. There are many different
types of euthanasia, such as active euthanasia, passive euthanasia, voluntary
euthanasia and involuntary euthanasia
Establish the fact that this is a complicated issue with lots of shades of grey and no
straightforward answer
While weighing up both sides, think of the four pillars of medical ethics: justice,
autonomy, benevolence and non-maleficience. All of these play a pivotal role in this
issue
Start with legality, if you know it, since it is the most clear cut. Currently, in the UK active
euthanasia and assisted suicide is against the law. However in Belgium, Luxembourg
and Holland, active euthanasia is legal. In countries such as Switzerland and Germany,
active euthanasia is illegal but assisted suicide and passive euthanasia are both legal.
Make sure keep up to date with any changes
Euthanasia allows the patient to exercise their right to decide their own fate and end
suffering (benevolence). However, arguments against euthanasia include the principles
of the Hippocratic Oath which state a doctor shall “do no harm”, and the related ethical
concept of non-maleficence
Assessing mental capacity and competency of patients (Mental Capacity Act 2005) is
crucial in the discussion of euthanasia, as legalisation of this could potentially put
vulnerable adults at risk
Some cases of patients who have travelled abroad for these end of life services have
also been a hot topic in the media so it would be good to reference any of these cases
that you are aware of
The discussion of euthanasia is a sensitive one and thus it is always best to look to the
ethical guidelines provided by the GMC
Common Mistakes:
Starting with a strong view point one way or the other. It is important to establish that
this is a complicated issue with arguments for both sides and to present these in a
balanced way
Not using the four pillars of ethics. These should be referenced throughout balancing of
the two sides of the argument
Do you agree with abortion? What
are the ethical issues here?
Answer Guide:
Start by acknowledging that this is a complex issue with two sides and lots of shades of
grey. Then walk through both in a balanced way, showing an appreciated of the four
pillars of ethics.
Is it legal? Under current UK legislation (The Abortion Act) an abortion can only be
carried out if certain criteria are met: the pregnancy is in its first 24 weeks, it is carried
out in a hospital or licenced clinic and two doctors must agree that an abortion would
cause less damage to a woman’s physical or mental health than continuing the
pregnancy. In rare situations, an abortion may also be allowed to be carried out after 24
weeks
If we consider patient autonomy, there is a case to say that patients should have the
right to have an abortion if they wish
Considering the ethical concept of beneficence, first, it is important to have the best
interests of the mother at the centre of their healthcare (both psychological and physical
well-being). Secondly, an abortion may be the most loving thing to do in the case of a
foetus with severe deformities, as this presents issues with quality of life
Non-maleficence – it is important to prevent any harm and thus considering the harm to
both the mother and the foetus is important in the discussion of abortion. It is also
important to consider the sanctity of life and some, based on this principle, may
disagree with abortion. But it’s quite subjective
As with all consultations, confidentiality must be upheld in the case of abortions
The discussion of abortion is a sensitive one and thus it is always best to look to the
ethical guidelines provided by the GMC
Common Mistakes:
Starting with a strong view point one way or the other. It is important to establish that
this is a complicated issue with arguments for both sides and to present these in a
balanced way
Not using the four pillars of ethics. These should be referenced throughout balancing of
the two sides of the argument
Common Mistakes:
Not knowing about autonomy. You need to be clear about all of the four pillars of ethics.
This is a key one that trips many people up
Common Mistakes:
Being judgemental. Saying something like ‘14-year-olds shouldn’t be engaging in sexual
activity in the first place’ is a red flag
Common Mistakes:
Not knowing but claiming you do. If you are aware of the above that’s great. If you think
you are, then say that you are not sure but you think it is the case. If you don’t know the
legalities then be honest about it
Using common sense. You can’t just come up with a common sense reply, like ‘logically
you should tell the partner’. You have to be aware of the legal ramifications
Common Mistakes:
Not having read Good Medical Practice or having an appreciation for the standards you
will need to live up to as a doctor or medical student.
Immediately confronting the student without outlining your concerns and the reasons for
your actions.
Reporting the student immediately without considering for why the student is behaving
erratically – are they suffering from mental stress or anxiety?
Common Mistakes:
Not explaining what an opt-in versus and opt-out system is and therefore not
demonstrating critical knowledge.
Not demonstrating an appreciation for the pillars of medical ethics.
Common Mistakes:
Not knowing the actual meaning of patient confidentiality.
Not knowing the situations that patient confidentiality is applied in. As a medical student,
you will also be bound by the rules of patient confidentiality.
Mentioning incorrect situations where patient confidentiality can be breached or saying
that it can never be breached. It is better not to mention specific scenarios if you are not
confident that they are correct.
A 13 year old patient reveals to you
that they are sexually active and that
their parents do not know. What
would you do as a doctor in this the
situation?
Answer Guide:
You must take the legal aspects of this scenario into account. This patient is below the
age of consent which is 16 in the UK but you must also consider doctor-patient
confidentiality.
Explain that you would encourage the patient to make their parents aware that they are
sexually active.
Consider the 4 pillars of ethics – here you are concerned with beneficence. You must
take into account the effects that being sexually active might have on the physical and
mental wellbeing of your underage patient. You might also have concerns about
whether the young patient is being taken advantage of.
Doctors may provide advice on sexual health and contraception to underage patients as
long as the young person is capable of understanding this advice and their
physical/mental wellbeing will most likely suffer without it. In general, patient
confidentiality must be respected which means the parents must not be informed.
However, if a doctor deems that the safety or physical or mental wellbeing of an
underage patient is at risk, they have a duty to follow child protection protocol which
means breaching patient confidentiality if it is in the patient’s best interests.
NICE guidelines are a useful resource when dealing with ethical questions like this.
Common Mistakes:
Forgetting about the legalities of doctor-patient confidentiality. Even when dealing with a
very young patient, you cannot simply inform their parents of their actions if you are
concerned; you must follow the proper protocol.
Failing to mention the potential risks of such a young patient being sexually active and
the fact that, in some cases, a third party may need to be contacted in order to protect
the patient.
Common Mistakes:
Failing to take into account the legalities involved such as the principle of doctor-patient
confidentiality.
Not considering the 4 pillars of ethics. These can help you to structure your answer and
ensure that you touch on some of the points the interviewers are looking for.
Common Mistakes:
Discussing only one side of an argument.
Jumping straight into giving your opinion without giving a well-balanced overview of the
ethical issues.
Discussing both sides of the argument equally without actually committing to your own
opinion – remember, the interviewer wants to see how you think. There is not
necessarily a right or wrong answer, as long as you can justify it.
Common Mistakes:
Getting too political. Don’t get worked up, and try to be balanced in your arguments,
whilst still giving your opinion.
Only discussing the junior doctor strikes that happened, without any broader
consideration of the issues.
Common Mistakes:
Not making it clear that patient safety is the most important issue.
Failing to report the mistake, or failing to state that you would check the guidelines.
Stating/insinuating that you would help the colleague to cover the mistake up. (This may
seem like an unlikely thing for you to say, but if this question was explored in the form of
a role play, then the actor may put pressure on you to say this). It’s important to
remember that ensuring patient safety overrides any personal or professional loyalties.
You are a GP, and your patient
confides in you that they are
regularly using illicit drugs. What
should you do?
Answer Guide:
In this situation, it is important to be aware of your duty of confidentiality to your
patients. You do not have a legal obligation to report illegal activity unless you believe
that the patient, or someone else, is in immediate danger. In GMC guidelines, it states
that Section 115 permits disclosure to organisations such as the police, local authorities
and probation services but does not create a legal obligation to do so. Information
should only be disclosed if the patient consents, or there is an overriding public interest,
or in response to a court order.
Therefore, your course of action should be advisory rather than legal. You have a duty
to ensure that the patient is aware of the health risks associated with illicit drug use and
explore whether they have considered stopping. You should also make them aware that
drug cessation services are available and refer them as needed. It is also important to
find out whether the patient is experiencing any adverse health effects and advise or
treat the patient accordingly. For example, you may advise the patient about needle
exchange programmes.
If the patient in the scenario has a child, and you feel that they are at risk of being
harmed, then this changes your course of action. In this case, you must say that it is
your duty to inform social services immediately.
Common Mistakes:
Forgetting about confidentiality when it comes to illicit drugs.
Thinking that the duty of confidentiality applies in all circumstances.