In recent weeks, with the COVID-19 pandemic on the rise, there is growing concern that medical care may have to be rationed. This means that if the number of patients needing intensive care unit beds or ventilators, for example, is greater than the number of beds or ventilators available, some patients may be denied these resources. This terrible — and largely avoidable — situation demonstrates that the delivery of health care can be fraught with ethical challenges.
How does one decide which of several patients needing respiratory support gets a ventilator? This question is an example of the many ethical dilemmas that providers and health care systems may face. An ethical dilemma is any situation where a decision has to be made and the choices all carry some risk of violating ethical principles.
The good news for aspiring physicians is that when the time comes to make such decisions in the real world, you will likely not make them alone. The not-so-good news is that in your journey to becoming a physician, you may encounter hypothetical ethical questions in medical school interviews and be asked to address them.
Interviewers like to ask ethical questions to get a clearer sense of your thought process and discern how reflective you are. They also want to see if you are aware of some of the ethical issues that come up in the provision of medical care. With proper preparation and few pointers in mind, navigating ethical scenarios that you are confronted with when applying to med school is fairly manageable.
Focus More on the Process Than the Ultimate Answer
Would you prescribe marijuana to a child with a medical condition if you knew that child would respond to the treatment? Would you transfuse blood to the child of a Jehovah’s Witness?
While these questions may be posed in a way to prompt a “yes” or “no” response, often the interviewer is more interested in your thought process than your ultimate answer. Keeping this in mind and recognizing that there is almost never a single right answer to these questions can help you better navigate such questions.
Apply a Set of Guiding Principles
One way to successfully deal with ethical questions is to use what we like to refer to as guiding ethical principles. These are essentially a set of tools that can help you make decisions about what course of action you would take when presented with an ethical quandary.
Some guiding principles that you may apply are to minimize harm, reduce pain and suffering, respect the autonomy of patients and preserve life. These are only a few examples, and we encourage you to consider others that you believe would guide you in making ethical decisions.
If you are asked whether you would prescribe marijuana to a child who suffers from a medical condition, you may apply the principle of minimize harm and reason that in making this decision you would consider whether there are alternatives to marijuana that are less harmful but confer similar benefits.
You may find that the different guiding principles conflict with each other at times. For example, if you are confronted with a question about euthanasia, your desire to respect autonomy in a patient who wants his life to end or your goal of reducing pain and suffering may conflict with your belief in preserving life. In providing a response, it is perfectly acceptable to acknowledge this conflict and show how such a conflict makes this decision difficult.
Avoid Sounding Dogmatic
Ethical scenarios are filled with nuances and require nuanced thinking. This is why it is critical to avoid sounding dogmatic. Even after you have applied the guiding principles described earlier to show your thought process in arriving at a response, avoid presenting your final decision as an absolutism. The language you use can make a difference.
For example, if at the end of your explanation you arrive at the decision that you would prescribe medicinal marijuana, you sound more sophisticated if you say, “Given the facts presented in this situation, I would be inclined to prescribe medicinal marijuana provided that certain conditions are met,” rather than if you say, “I would definitely prescribe medicinal marijuana to this child.” In one, the language reflects the nuanced nature of the problem while in the other, the problem is seen as black and white with no room for gray areas.
Acknowledge Different Sides of the Debate
Ethical questions are a useful way for medical school admissions committees to determine how open-minded applicants are toward the beliefs and views of others, including future patients. In dealing with scenarios involving patients, it’s always a good strategy to show a willingness to listen and to let patients know that you hear and respect their viewpoint.
As you furnish your responses to ethical questions and explain the principles that drive you in your decision-making, acknowledge the position of those who disagree with you. For example, if you are in favor of using embryonic stem cells in medical research, you can say that while to you the pros of using this type of tissue outweigh the cons, you recognize that others feel differently and you understand that there are downsides.
Remember that ethical questions require careful consideration, but they do not have to be daunting. Take the time to read about different issues in health care that may have an ethical bend such as abortion, euthanasia, stem cell research or the rationing of care in the era of COVID-19. Go into the interview with a broad awareness of the topics, a set of principles to show your thought process and an openness to exploring the scenarios presented.
Finally, if a question catches you off guard, take time to gather your thoughts while acknowledging that you need a few moments to reflect. In doing so, you will come across as sincere and genuine to those who are considering you for a spot in their medical school class.
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How to Address Ethics Questions in Medical School Interviews originally appeared on usnews.com