Ethics Questions

Below is a selection of Medical School interview questions on the theme of ‘Ethics’.

The answer guides have been put together by medics who have successfully navigated
interviews at top Medical Schools.
Remember, though, that an interview is about an individual, so there are no hard and
fast rules. The answer guides are only examples and are not exhaustive. They should
be used to stimulate your thinking — not repeated verbatim at your interview.
When dealing with these questions, try to apply the 4 pillars of ethics:
 Autonomy — Does it show respect for the patient and their right to make decisions?
 Non-maleficence — Does it harm the patient?
 Justice — Are there consequences in the wider community?
 Beneficence — Does it benefit the patient?
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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

A patient refuses treatment for a life-

threatening condition. Discuss the
ethical issues involved.
Answer Guide:
 In a scenario like this there are many ethical issues involved. It is important to look at
each one individually, in order to fully understand and weigh up the scenario
 First of all, if we consider the duty of the doctor. In a case like this is it crucial the doctor
fully informs the patient of the benefits of the treatments and the risks associated with
not having the treatment
 If we consider the concept of patient’s autonomy, then doctors must respect the
decision made by a patient. However, patient autonomy is not absolute, particularly if a
patient is not competent
 Beneficence and non-maleficence often link together and this is no exception. The most
beneficial thing to do may be to provide the patient with the treatment they need.
However, if this is against the patient’s wishes this might do more harm than good.
Whatever the patient’s decision may be, doctors must continue to provide the best care
in the patient’s best interests.
 Always be clear that you would adhere to the GMC’s guidelines

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

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A 14 year old patient goes to the GP

and asks for the oral contraceptive
pill. Discuss the ethical issues
involved.
Answer Guide:
 As usual, we start by using the four pillars of medical ethics as a framework
 Currently, under UK Legislation, those under the age of 16 are not able to give consent
to sexual activity. It is always important to consult the GMC and their ethical guidelines
on young people and sexual activity for the most up to date information
 If we begin with the duty of the doctor, they must fully inform the patient of the benefits
of the treatments/protected sex and the risks associated with not having the
treatment/unprotected sex. The doctor also has a duty to society to ensure the safety of
their patients and ensure child protection and safety
 Therefore, competence is a major aspect to consider. Establishing and assessing
competence (Gillick competence) is also very important in a case like this to ensure
sexual abuse is not taking place and for child safety
 Autonomy – doctors must respect the decision made by a patient. However, patient
autonomy is not absolute, again linking to assessing competence, which will be an
important part of this answer
 Beneficence and non-maleficence – doctors must continue to provide the best care in
the patient’s best interests, and their personal views must not interfere with their
professional duties
 It is also important to consider confidentiality and the effect on the doctor-patient
relationship, which is built upon trust

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

A patient diagnosed with HIV reveals

to their GP they have not disclosed
this information to their partner.
Discuss the ethical issues involved.
Answer Guide:
 This is a complex scenario and it’s important to consider and apply each of the four
pillars of ethics
 The doctor must fully inform the patient of the risks associated with not disclosing this
information and encourage them patient to disclose this information to the partner,
themselves. The doctor also has a duty to protect and ensure the safety of society
(justice) and, based on these grounds, may choose to make a disclosure to the patient’s
partner about the patient’s HIV status. However, this would be a last option and the
doctor would need to inform the patient of their actions.
 Autonomy – this links to patient’s autonomy, as doctors must respect the decision made
by a patient. But patient autonomy is not absolute, particularly in a case like this where
society/another patient is at risk. In this case, confidentiality may be broken, which may
also affect the doctor- patient relationship
 Beneficence and non-maleficence – doctors must continue to provide the best care in
the patient’s best interests. When making a disclosure, it is important to weigh up the
benefits (protecting another patient’s health) against harm (could affect the doctor-
patient relationship and future disclosures)
 You can say to the interview panel that it is always important and helpful to consult the
GMC’s ethical guidelines in cases like this

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

You are a medical student at this

School. One day in the teaching
hospital, you see one of your fellow
students putting medical equipment
from the stock room into their bag.
When you ask them about it, they
say they only want to practise their
clinical skills and not to tell anyone.
What would you do?
Answer Guide:
 This question is designed to examine your awareness of the duties of a medical school
and a doctor according to the GMC publications Good Medical Practice and Tomorrow’s
Doctors.
 The first thing you must do when answering this question is explain what the dangers of
the situation are: practicing clinical skills without supervision could lead to the student
seriously harming themselves; taking equipment from a hospital is a serious breach of
ethics and could risk lives (if that equipment leads to a shortage of supplies); the
student’s actions (while well-meaning) are not in keeping with the professional
standards of a doctor; if you do not report this act, you are also not acting in accordance
with these standards and risk being sanctioned or removed from the Medical School.
 You should also explain the risks of the situation: if you confront the student, they may
react negatively; the student may have received permission from someone to do this
(unlikely, but possible); such an incident could damage the ties between the teaching
hospital and the university.
 Acknowledge what your authority is and therefore how you should approach the
situation. You are not a doctor, nor are you a Faculty member. You therefore need to
approach the student in a calm and supportive manner and not threaten them with
negative outcomes.
 I would encourage the student to see the danger of their actions, to come clean about
what they have done and support them emotionally with any difficulties that might have
led them to such a drastic act.
 If the student refused to act, I would then approach a Faculty member and discretely
report the situation.

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?

Organ donation should be an opt-out

system rather than an opt-in system
in this country. Do you agree or
disagree?
Answer Guide:
 Before launching in the standard medical ethics answer framework, set the scene for
the topic by explaining what the question is about!
 In December 2015, NHS Wales moved from an opt-in system (where consent for organ
donation must be given or asked for) to an opt-out system (where consent must be
actively removed). The rest of the NHS still operates on an opt-in system – but
the BMA actively campaigns for an opt-out system.
 Each year around 1,000 patients die while waiting for a transplant. The UK has one of
the highest family refusal rates for organ donation of any developed nation – 43% of
families refuse consent following a relative’s death.
 According to public polls around 90% of the population believe in organ donation – but
only around a third of people are on the organ register.
 After setting the scene, move into the standard ethics answer framework!
 Autonomy: An opt-out system obviously has the potential for someone who does not
want to donate an organ to become an organ donor, simply because they did not opt-
out. In Wales it was estimated that up to 30% of the population did not know the system
had changed. On the flip side, at the moment only a third donate organs despite 90%
believing it is the right thing to do – so perhaps the opt-in system is the one removing
patient choice?
 Other autonomy arguments: Under the current system, families can refuse to allow
organ donation. This means that families have the power to potentially over-turn the
wishes of the patient, in an emergency situation where the patient cannot express their
view. On the flip side, an opt-in system treats the human body as property of the State
and (it could be argued) goes against the idea of individual sovereignty.
 Beneficence and Non-Maleficence: Quite straightforward here. Opt-out systems mean
more organ donors, which means more organs to save more patient lives. It could be
argued that since the organ donor is already deceased, no maleficence can be enacted
upon the donor. But non-consented organ donation would harm the family.
 Justice: Patients on the active transplant list require on-going treatment while they wait
for a new organ (such as dialysis). These are expensive treatments. It could be argued
by increasing the rate of organ transplants, we could reduce the NHS deficit – or
redistribute saved treatment costs to support other treatments, services or health
research.
 Remember to finish by planting your flag. Do you agree or disagree? And why have you
reached that conclusion?

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.

What does ‘patient confidentiality’

mean? When would it be appropriate
to breach this?
Answer Guide:
 Have an understanding of what patient confidentiality means and what kind of
information it covers.
 Briefly mention the purpose of having patient confidentiality and how it builds trust in the
doctor-patient relationship.
 If you have an example from your work experience where you were shown how patient
confidentiality works, be able to reflect on this.
 Then go on to mention different situations where patient confidentiality can be
breached. This may be where the patient poses a significant risk to health of
themselves or others.
 Countries may have differing guidance in place about this. Know what your country
recommends by consulting the appropriate literature. An example of an organisation
who sets such guidance is the General Medical Council in the UK.
 You may wish to mention implied consent, where a patient is aware that a doctor will
share information about them to other individuals in the healthcare team to provide the
patient with the best possible care.
 Mention how it is important to have a conversation with a patient about confidentiality as
a doctor or even medical student.
 Mention how one is duty bound as a doctor to abide by the regulations that are in place
to protect patient confidentiality and that professional duty should always come above
personal beliefs.

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.

A depressed patient who has

refused treatment has mentioned
having suicidal thoughts and you
are concerned about his well-being.
Discuss the ethical issues involved.
Answer Guide:
 When addressing an issue like this it is important to consider the 4 pillars of ethics,
especially non-maleficence, beneficence and patient autonomy in this case.
 Mention that it is important to ensure that the patient is aware of and understands the
treatment options available to them so that they can make an informed decision.
 Autonomy – in this case, the patient has chosen to refuse treatment and, in general,
their decision should be respected.
 Beneficence and non-maleficence – in this situation, you are concerned about the
patient being a danger to themselves which means that the risk to their wellbeing must
be weighed against the harm that could come from breaching patient confidentiality in
order to protect the individual.
 Consider mentioning the possible repercussions of informing a third party of your
concerns. For example, the patient might be less open about their mental health issues
in the future, having lost trust in their doctor.

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.

Do you think the NHS should fund

treatment for smokers?
Answer Guide:
 A question like this is different to “discuss the issues that arise when considering
whether the NHS should fund treatment for smokers”. This is a direct question about
your opinion, and therefore the interviewer eventually wants a yes or no answer from
you.
 However, this does not mean that you should jump straight into your opinion. The best
way to answer this question is to give a broad, well-balanced overview of the ethical
issues that arise, and then give your opinion, with justifications.
 On one side of the argument, it can be said that the NHS should provide care for
everyone indiscriminately, as supported by the ethical principle of justice. This is also in
line with the ethical principle of autonomy, which means that patients have the right to
make decisions for themselves.
 However, the NHS has limited resources. In an ideal world, all treatment would be
funded for all patients, but unfortunately, this is simply not feasible. Thus, making
decisions about resource allocation is not optional. The ethical theory of utilitarianism
deals with the best way to maximise the use of resources, for the greater good of
society. The question, therefore, is: why shouldn’t smokers receive funding for
treatment?
 Some may believe that their illness is self-inflicted, and therefore such patients are less
“worthy” of funding than those who had no control over their disease. However, this
 does not take into consideration the complex psychosocial factors that lead to smoking.
It is well known that smoking is more common amongst the lowest socioeconomic
groups. Would such a funding decision simply serve to further worsen the health
inequalities that already exist in society?
 These arguments are very topical and so it is important to be familiar with them. It is
also worth reading the NHS constitution principles.
 When you feel you have adequately discussed both sides of the argument, outline your
opinion on the matter, using justifications from ethical principles/theories if you can.

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.

Is it ever ethically acceptable for

NHS doctors to go on strike?
Answer Guide:
 This is a topical issue because of the junior doctor strikes that took place in 2015-2016.
However, this does not mean that your discussion has to be shaped by the events that
took place. Whilst it is important to mention them in order to show your awareness of
current affairs, you do not have to be limited by this.
 Firstly, what is a strike, and why is it morally problematic? A strike is defined as a
refusal to work as a form of protest. The most obvious issue with this, in the case of
doctors, is the potential for patients to be harmed. This goes against the ethical principle
of non-maleficence and therefore, some would argue, cannot be justified.
 This barrier could be overcome; a strike may be designed so that emergency care
would still be covered, and only elective treatments would be delayed. However, this is
still disruptive for patients. In order to decide whether it is morally acceptable, we must
know what the reason for the strike is. Do the benefits outweigh the risks? This
approach is called “consequentialism” and considers whether the outcome of something
justifies the means by which is it achieved.
 If doctors decided to strike because they wanted better food in the cafeteria, this could
not be justified. However, if the reason was because they believed it would make a
difference to their working conditions, then this has more potential to be justifiable.
 Deontological ethical theory states that doctors have a duty of care to their patients.
This could be interpreted to mean that doctors should never strike, as no matter what it
is they want, they should put their patients first. Conversely, it could be argued that the
duty of care to patients is dependent on an ethical duty of self-care. Detrimental effects
on doctors’ personal welfare will have a direct detrimental effect on patient safety, and
therefore in this context, striking may be justified.
 Therefore, to answer the question: striking can be ethically acceptable, but it depends
on the reasons, circumstances and potential outcomes of the strike.

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.

What would you do if you saw a

colleague making a mistake with a
patient’s medication?
 Answer Guide:
 This is a situational question that wants you to consider what you would do in a practical
situation. It is therefore imperative that you are aware of the GMC guidelines in place for
doctors.
 GMC guidelines state that you have a duty to raise concerns if you believe that patient
safety or care is compromised. This is the most important part, and is applicable in this
scenario as you have seen a colleague make a mistake with patient medication.
 The first step would be to report the mistake. The best way to do this is to actually talk
to the colleague who has made the mistake, and encourage them to report it
themselves.
 This should be done in a non-confrontational way, making it clear that this is a matter of
patient safety and continual professional development, rather than a personal attack.
 However, if you do not feel comfortable doing this, or if the colleague refuses to report
their own mistake, then you must escalate the situation to a senior colleague.
 The NHS wants to encourage candour and transparency in the work environment, and
this replies on non-threatening policies around errors, based on openness and continual
development, rather than blame and punishment.
 GMC guidelines have a specific section on “Raising and acting on concerns about
patient safety”; since this is a common theme for interview questions, it is a good idea to
be familiar with this.
 Don’t forget, even as a doctor you are not expected to know everything; if you are not
sure what the guidelines are, simply saying you would look them up and act on them
may be sufficient.

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.