Ethical issues are one of the most frequently asked medical interview questions. Instead of meticulously going through each potential ethical scenario, it might be more useful to learn the mindset that can be applicable to nearly all of the questions. To give an example of such a mindset, we will use the example of abortion. This might come up in your interviews given the heated debate over abortion laws in view of the recent affairs of a Northern Irish woman being rejected the free abortion NHS treatment.
Whilst students often fret when asked what their take is on abortion, eyeing the interviewers to see whether they are on the pro-abortion or anti-abortion team before stammering out their answer, it is of utmost importance to remember that there is no one absolute answer. Even the Hippocratic Oath on this matter has been disputed over: Anti-abortionists have pointed to the text saying “I will give no deadly medicine to anyone if asked … in like manner, I will not give to a woman an abortive pessary,” whilst pro-abortionists have challenged that it was only that particular method of abortion, abortive pessary (putting a soaked piece of wool into the vagina to trigger abortion), was disapproved of, as it could cause lethal infections and put the mother at risk.
Therefore, you may have realised by now that this question is not designed to evoke a correct answer, but to look at your thought process and how you handle challenging ethical situations. A potential mindset of a doctor may be as follows:
Examination of the medico-legal aspect:
Is the abortion legal? Under the current NHS guidelines, abortion should usually be carried out before 24 weeks of pregnancy. Beyond this are usually reserved for pregnancies that may pose a risk to either the mother or the baby (e.g. a baby that may be born with severe disability).
Appraisal of ethical principles:
One may try to use the 4 pillars to show how complicated this situation may be.
Here, the patient autonomy (patient being the mother) is being focused on, so her choice of having an abortion should be respected.
What is considered as the best interest for the patient or the baby? It is important to consider all aspects of well-being, i.e. physical, social and mental well-being. The baby’s beneficence can also be assessed by looking at his/her quality of life after birth.
3. Non-maleficence (do no harm)
NB: this stands for both the patient and the baby. Certainly, the first thought would be “It certainly harms the baby!” Again, quite similar to beneficence, consider the quality of life of the baby, the risks that could pose to the mother etc.
This may not be completely useful for this situation, since it deals with whether others can get the same treatment (distributive justice), or whether they are entitled to the treatment (rights based justice). In both cases, the answer would be yes as long as it is before the 24 weeks of pregnancy.
It is also important to bear in mind that some ethics questions would be disguised in a question like “What would you tell the patient who walked into the clinic uncertain of whether to go for an abortion.” In which case, it may be wise to mention things like informed consent and confidentiality.