How to Approach Ethical Questions on the Medical School Interview

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The medical school interview trail is filled with great learning opportunities and interesting interactions. It is generally a positive experience overall. You will find that most of your interviews are more conversations than interrogations, and you will often end up having a pleasant conversation with the physician tasked with interviewing you. So rest assured that much of the experience will be positive.

With that said, some components of the interview process can certainly be challenging. One which we recently covered in a thorough blog post is the Multiple Mini Interview (MMI). Along the same lines, another component of interviews which can trip up some applicants are ethical questions.

You may encounter questions regarding challenging scenarios which propose an ethical dilemma and you will be asked to state how you would proceed and why. Many of these questions can be difficult and at times nerve-wracking. What is the best way to approach them?

The 4 Principles of Bioethics

The first step in developing a framework by which to approach these questions is to know the 4 basic principles of bioethics. Most, if not all, medical ethical dilemmas can be systematically evaluated based on one or more of these principles. By understanding them, you can usually reason your way to an appropriate answer. Not all ethical questions have an exact right answer; but by providing sound reasoning based on ethical principles, you can demonstrate a solid foundation of knowledge to guide such decisions. Here are the principles to know:

1 | Autonomy

Any individual who has the capacity to make their own decisions should be able to do so. This is one of the most basic and useful guiding principles of bioethics. The challenge lies in the scenarios when it is difficult to discern whether or not the patient has decision-making capacity.

In the case of unemancipated minors (less than age 18 and still under the supervision or parents of guardians), generally their parents make decisions on their behalf. An exception is when there is clear harm being done to the minor by the guardian.

In scenarios when a patient has a medical or psychiatric condition that alters their mental status, they need to demonstrate that they understand the risks and benefits of any decision they are making in order to have capacity. If able to do so, they can opt for or against medical care autonomously.

2 | Nonmaleficence

This is a simple tenet to understand: it is the responsibility of every physician to first do no harm to the patient. This means not providing or withholding medical care if either decision could potentially harm the patient in question.

3 | Beneficence

The counterpart of nonmaleficence, this is the duty to help patients and provide medical care that will be of benefit to them.

4 | Justice

This principle applies to providing each individual what they are due. It also deals with the issue of appropriately distributing societal resources evenly.

In general, all individuals should be treated equally irrespective of socioeconomic status, gender, ethnicity or other demographic factors. An example for which justice is particularly relevant is with organ donation. Individuals on the transplant list are ranked based on their need (severity of disease) as well as how much they “deserve” the organ (for example, to obtain a liver transplant a patient must be abstinent from alcohol for at least 6 months).

Other Tips for Medical Ethics Questions

Most patient-centered questions can be broken down to one of the above four principles to guide an answer. Outside of these scenarios, follow these basic tips to guide your approach:

1 | Err on the Side of Caution with Your Answers

This means to always side with the more moral, scrupulous approach to a scenario. If there is morally questionable behavior in question, always opt to speak out and stand up against such behavior if feasible.

2 | Evaluate Urgency versus Emergency

In medical emergencies, when the patient’s wishes are not known, the physician should act in the patient’s best interest by providing the appropriate standard of medical care. If the situation is not an emergency and some time is available, the provider should seek out a spouse or family member who is designated as decision maker and ask what their evaluation of the patient’s wishes would be.

3 | Use Bioethics Principles in Order of Importance

In general, use the 4 principles of bioethics in the following order of importance in any given ethical dilemma: patient autonomy > nonmaleficence > beneficence > justice. In the medical school interview, avoid making evaluations of social justice and allocation of resources if possible as this can predispose you to potential prejudiced decision-making. Focus on providing every individual with the same high-quality, compassionate care.

Examples of Medical Ethics Interview Questions

Non-patient-centered:

A respected friend and coworker has been exhibiting erratic behavior at work lately which is puzzling to you. One day you find the individual with alcohol on their breath while at work. How would you deal with this situation?

Patient-centered:

A patient suffers a traumatic injury and is rushed to the hospital. They are bleeding rapidly and will require blood transfusion. Prior to the blood being ordered, a nurse uncovers documentation from the patient which indicates that they are a Jehovah’s Witness and refuse any blood transfusion. You are worried the patient may die if not transfused. What do you do?

Concluding Remarks

As with any other challenging task, it is beneficial to have a framework of reasoning off which to work and deal with a multitude of  ethical scenarios. The above principles and tips provide this. If you need any further assistance with medical school interview questions, please consider the Med School Insiders interview preparation services. Our advisers can provide you specific advice, questions, and even perform mock interviews!

Good luck this interview season!

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