Although most students don’t learn about the ethical decision-making principles in medicine until medical school, having an understanding of them for admissions interviews can be beneficial. About 50% of medical schools are now using multiple…
Although most students don’t learn about the ethical decision-making principles in medicine until medical school, having an understanding of them for admissions interviews can be beneficial.
About 50% of medical schools are now using multiple mini interviews as their primary interview evaluation of applications. These mini interviews frequently involve ethical scenarios where one must employ critical thinking skills and objective decision making to work through the various situations.
Using the pillars of medical ethics can help an applicant break down different scenarios into concrete, tangible steps in order to develop a fluid and complete assessment.
This blog will cover the four different principles and how they can be applied to a specific interview scenario.
Sample Scenario: A patient that you are treating for cancer denies conventional medical treatment and decides to rely solely on alternative medicine. Discuss the various considerations you must make as a physician.
Autonomy. Autonomy refers to patients’ right to make decisions for themselves, without any undue influence. When medical practitioners treat patients, they have an obligation to provide them with risks and benefits of a treatment in an understandable manner without trying to persuade a patient. They may make recommendations, but without using any form of coercion.
In essence, the physician provides information and it is up to the patient to make the decision. However, an important caveat to autonomy is that a physician must also make sure the patient has decision making capacity — meaning they must be cognitively aware enough to make a sound decision.
Conditions like dementia, delirium or mental illness can impede normal decision-making abilities, so physicians must account for states such as these when considering a patient’s autonomy.
In the sample scenario, autonomy greatly applies to this scenario. Although the physician is recommending conventional treatment for the patient’s cancer, ultimately it is the patient’s decision to pursue the recommended treatment or not.
In this scenario, an applicant can discuss how the patient has autonomy to make independent decisions, and while the physician must respect this, they must also evaluate the patient’s ability to make such profound decisions.
Beneficence. This pillar refers to the physician’s obligation to always do good for the patient. Essentially, this is the physician always acting in the patient’s best interest, regardless of the patient’s own decisions or direction.
Beneficence applies to the sample scenario, because although the patient is deciding to forgo conventional treatment, the physician should respect this autonomy and support the patient after decision-making capacity is confirmed.
This could include following the patient’s cancer, helping with the treatment of side effects, or referring the patient to appropriate specialists. Although the patient may act against the physician’s wishes, the physician is still obligated to appropriately care for the patient.
Non-Maleficence. Non-maleficence refers to the common saying in medical practice of “first, do no harm.” This is somewhat straightforward but implies that a physician will never harm a patient, and always act to better that patient’s health.
Non-maleficence really comes into play when there are serious procedures that can be offered as treatments, and a physician must critically weigh the risks and benefits of the procedure. If the risk outweighs the benefit, then non-maleficence dictates that they should not proceed with that specific treatment option.
In the sample scenario, the physician must weigh the risks and benefits of the conventional cancer treatment. If he or she deems there are beneficial effects outweighing the risks, then it is appropriate to recommend this treatment to the patient.
With the patient opting to pursue other treatment, the physician is doing no harm to the patient, but has an obligation to inform the patient that the alternative therapies may not achieve results as profound as the conventional therapy.
Justice. Justice refers to equal treatment of all patients. Essentially a physician shouldn’t allocate a special treatment to someone because of their status or influence. Each patient, regardless of age, race, socio-economic status, etc. should be treated the same.
In this scenario: Although justice may not seem like the most applicable pillar in this scenario, it still is. The physician should offer this conventional treatment to all of their patient’s with an applicable diagnosis. In addition, if the patient was worried about access to or cost of the treatment, the physician has a duty to help find resources to assist the patient in getting the appropriate care.
Although there are many aspects to consider in mini interview scenarios, learning and applying the four pillars of medical ethics can significantly help to construct a logical and valid approach. In addition, as an applicant moves through medical school and beyond, these principles will continue to prove useful, not only in treating patients, but in serving as physician advocates.