What are the four pillars of medical ethics?

Application of the four pillars of ethics in a medical ethics interview. The four pillars of medical ethics underpin the moral compass under which medical professionals should work. They will be discussed here in the context of medical ethics interview questions.

Author: Adi Sen

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Applying the Four Pillars of Ethics in a Medical Ethics Interview.

The four pillars of medical ethics underpin the moral compass under which medical professionals must work. When it comes to answering medical ethics interview questions, these are key concepts that may be very relevant and could be brought up to demonstrate your knowledge of the capacity under which doctors must work. We’ll tackle them here in the context of medical ethics interview questions.

 

What are the 4 Pillars of Ethics? How can they be applied in a medical ethics interview?

AUTONOMY

Autonomy is the idea of self-governance, that an individual has the right to make a decision and act under a self-chosen plan. In medicine, this specifically refers to the fact that patients have the right to deny any treatment that is offered to them or choose between various different treatment options available. Medicine is no longer paternalistic – doctors cannot force patients to undergo particular management options, and patients have the right to decline treatment in themselves.

Note that although patients have autonomy, they cannot demand treatment that is not offered as an option – for example, a patient doesn’t have the right to receive treatment that is not licensed.

Importantly, if a patient lacks capacity, which means that they have a disorder of the brain or mind which means that they cannot understand, retain, weigh up or communicate their decision, their autonomy can be overruled by a doctor. For example, for a patient with dementia, a doctor can overrule their decision to refuse treatment as long as the doctor is acting the patient’s best interests.

 

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Example of medical ethics autonomy interview questions:

An adult patient who is a Jehovah’s Witness, has refused a blood transfusion during a major bleed. What should the team do?

Here, we can discuss that the patient has autonomy for their own decisions as long as they have been shown to have the capacity. You would only doubt this if they had a disorder of the brain or mind and could not understand, retain, weigh up or communicate their decision. Thus, the decision of the patient must be respected even if it isn’t in their best interests.

 

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BENEFICENCE & NON-MALEFICENCE

The idea of beneficence is that doctors should maximise the benefits that medical care has on a patient. Meanwhile, the principle of non-maleficence is the partner to this – the idea of ‘doing no harm’, that is, trying to minimise the harm that medical intervention does to a patient. This means acting in the patient’s best interests, which might not always be as clear as you would assume.

 

 

Example of medical ethics interview questions:

Sally is an 86 year old lady with terminal breast cancer that has spread to her bone. Her daughter wants the primary tumour removed but her son thinks it’s best that she comes home without the operation – what should you do?

You could talk about the fact that doctors must act in the patient’s best interests with beneficence – here, you want to assess whether the operation will do her any good. It would be important to assess her physical health, her fitness for surgery, and to understand how beneficial the effect surgery will have on her prognosis. Given that you don’t want to cause more harm – non-maleficence – and the likelihood that doing surgery is likely to be more damaging than good, it is likely that you would not recommend surgery.

 

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JUSTICE

Justice refers to the idea that any ethical decision should be considered as part of the wider context in society. Note, the patient is in most cases the doctor’s priority, and the duty of a medic is in them. However, if a patient disclosure is likely to cause serious harm to other people, this is one time that doctors must break confidentiality.

 

 

Example of medical ethics interview questions:

A HIV+ patient has not discussed their diagnosis with their partner – what should you do?

Under the principle of justice, doctors must consider the effect issues in medicine affect the society around the patient. Under this principle, you would try to encourage the patient to reveal their diagnosis, after checking their understanding of why this is important. Think about the other pillars of medical ethics – for example, not wanting to do more damage by breaking trust in the patient-doctor relationship by breaking confidentiality (non-maleficence).

For further discussion of the four pillars of medical ethics, read the journal on medical ethics.

Summary

These four pillars of medical ethics can be used to guide and structure your answers in medical ethics interview questions. They are part of the most common medical interview questions so its important to keep in mind these pillars of ethics at your interview.

Remember that all of them can be relevant to each situation proposed to you. Ultimately, balanced answers to medical ethics interview questions should take all into account but justify why in certain cases different pillars preside over others in your opinion.

 

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The Answer to a Successful Medical Interview

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How to Approach the Dreaded Medical Ethics Questions

Medical ethics – it’s most likely that you will have to answer at least one medical ethics interview question in your interview. It’s understandable that this is a question that fills most student with dread. Answering these tricky questions is often a daunting prospect, but it can be easy than you think.

HOW TO STRUCTURE THE ANSWER TO A MEDICAL ETHICS INTERVIEW QUESTION

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