Medical Ethics Questions (Plus Real Interview Answers)

Updated on: December 3, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

Medical ethics questions almost always make some sort of an appearance in medical school interviews.

You need to come prepared to discuss a variety of scenarios using the frameworks of modern medical ethics.

This includes the four pillars of medical ethics:

  1. Autonomy
  2. Beneficence
  3. Non-maleficence
  4. Justice

As well as other core ethical concepts such as capacity, consent and confidentiality.

In this article, I’ve taken an example interview question from some of the most common topics and themes that arise when interviewers ask candidates about ethics.

For each question, I look at what key points I’d aim to hit in your interview answer as well as how to avoid some common mistakes for each one.

Euthanasia

Should euthanasia be legalised in the UK?

Euthanasia is the act of artificially ending a patient’s life in order to put them out of their suffering.

It’s generally only practised when a patient is in severe pain, with no available treatment, and they’re suffering from an incurable, fatal disease.

In order to be able to tackle a question like this, asking whether euthanasia should be legalised, you need to be familiar with current legislation as it stands.

At present, both active euthanasia and physician assisted suicide are illegal in the UK.

Assisted suicide is very similar to euthanasia but it’s the patient that takes the final action that ultimately leads to their death.

For example, pushing a syringe with a fatal dose of a sleeping drug into themselves. Physician assisted suicide is legal in places like Switzerland and it’s why a small number of Britons travel there every year.

Arguments For And Against Euthanasia

There are strong arguments on both sides of the debate when it comes to euthanasia and you should aim to describe a few from each viewpoint in an interview answer.

In my opinion, the two most convincing arguments in favour of legalising euthanasia are centred on the pillars of autonomy and beneficence.

In regards to a patient’s autonomy, if we let patients decide how they live, it only makes sense that we should let them decide how they die.

Denying a patient their final wish of being able to die peacefully rather than in pain seems to directly contradict our otherwise utmost respect for patient autonomy.

Secondly, the argument for beneficence says that sometimes allowing a person to die is in fact the best thing we can do for them as healthcare professionals.

It could be considered naive to think that extending a patient’s life is always in their best interests. We have to have the maturity to step back and appreciate when modern medicine can actually be doing more harm than good.

A hospital bed stands empty

However, there are arguably equally convincing arguments on the other side of the fence.

A worrying prediction is that if euthanasia is legalised to some extent it will lead to a ‘slippery slope’ of increasingly radical actions being legalised.

For example, Belgium doctors can now legally euthanise children after a gradual progression from the initial change in law allowing adults to die.

Additionally, it would be incredibly difficult to make euthanasia legal while protecting against vulnerable people being pressured into dying by friends or family.

People may ask to die due to external pressures when that’s not what they truly want- not to mention the very small but devastating risk of rogue doctors taking advantage of their power to euthanise people.

Avoiding Common Mistakes

  • Be familiar with the different definitions and terms used to describe euthanasia. There are active, passive, voluntary, non-voluntary and involuntary forms of euthanasia.
  • Make sure you’re up-to-date with the law in the UK. Active euthanasia and assisted suicide are illegal but passive euthanasia is legal.
  • Address both sides of the argument in your answer and appreciate where the law currently stands. Believing that the law should be changed is not a problem but it would be a mistake to only talk about arguments in favour of your viewpoint.

LEARN MORE: The ethics of euthanasia for medical school interviews.

Jehovah’s Witnesses

What can doctors do if a patient refuses a life-saving blood transfusion?

The most common way that a patient refusing treatment is framed in a medicine interview is that of a Jehovah’s Witness refusing a much-needed blood transfusion.

Jehovah’s Witnesses are a Christian denomination that believe the Bible explicitly forbids humans from consuming the blood of others- whether that be eating, drinking or having an intravenous infusion.

They’re known to refuse blood transfusions even in life-or-death situations, so can put healthcare professionals in some pretty nerve-wracking situations.

While Jehovah’s Witnesses act as an easy way for interviewers to frame the question, the heart of questions like this really comes down to your understanding of medical consent and patient capacity.

Patient Consent And Capacity

Capacity is the ability of a patient to understand a question you’re asking them, weigh up their options, make a balanced decision and then communicate that decision back to you.

A patient needs to have capacity for their consent to mean anything.

For example, you can’t ask a patient if you can proceed with a non-urgent surgery while they’re under the influence of very strong painkillers.

They wouldn’t have capacity as their logical reasoning would be impaired by the drugs. Therefore, even if they gave you the go-ahead to do it, this wouldn’t hold up in court as informed consent.

On the other hand, if a patient has capacity and doesn’t give you consent to continue with a procedure then you can’t just do it anyway- as this could be considered assault.

Jehovah’s Witnesses And Consent

Tying this all back to a patient refusing a blood transfusion then, the simple answer is that if the patient has capacity then there’s nothing you can do as the doctor.

If an adult patient fully understands the risks of not having a blood transfusion and refuses one anyway, you have to respect their autonomy- even if this means they ultimately pass away.

However, where it gets a bit more complicated is if the patient doesn’t have capacity- for example, if they’re drunk, confused after a head injury or unconscious.

In these cases when a patient isn’t able to confirm or deny their consent, a doctor will try and act in the best interests of the patient- doing what they think the patient would have wanted.

So, if a patient needs a blood transfusion in an emergency, but the doctor isn’t able to confirm with the patient what they want, they’ll give the patient the transfusion despite not having explicit consent.

Avoiding Common Mistakes

  • Make sure you’re familiar with some of the common scenarios interviewers use when it comes to Jehovah’s Witnesses. For example, the unconscious Jehovah’s Witness or the child with Jehovah’s Witness parents.
  • Be sure you fully understand the concepts of capacity and consent as well as what doctors do with patients when either is absent to varying degrees.
  • Don’t get sucked into saving the patient even when it’s clear that they wouldn’t have wanted a certain treatment. As a medical professional, you have to respect patient autonomy even when it’s not what you would personally do.

LEARN MORE: The ethics regarding Jehovah’s Witnesses for medical school interviews.

Abortion

What are the ethical arguments for and against abortion?

Abortion is a highly emotive topic that will almost inevitably end up in media headlines whenever there is a proposed change to the current UK legislation.

At present, abortion is legal in England, Wales and Scotland up to the 24-week point and, in certain circumstances, beyond.

Abortion is the ending of a pregnancy either by using special medications or a small surgical procedure and two doctors have to agree that one of the following criteria are met for it to be legally carried out:

  • The pregnancy is less than 24 weeks old and continuing would risk injury to the physical or mental health of the woman or her family; or
  • An abortion is necessary to prevent serious injury to the woman (physical or mental); or
  • Continuing the pregnancy would put the woman’s life at risk; or
  • There is a substantial risk that the child would be born seriously handicapped

After the 24-week point, an abortion can still be conducted but only if there is a serious risk to the woman’s health or there is a high likelihood that the child would be severely disabled if born.

The two main opposing sides of the abortion debate are termed ‘pro-life’ and ‘pro-choice.’

Pro-Life: Against Abortion

Pro-life supporters generally believe in the sanctity of life- they believe that it’s never right to take another human life, no matter what the circumstances.

Additionally, many in the pro-life camp view human life as beginning at conception; that is the moment a sperm meets a human egg.

From this point onwards, the foetus is equivalent to an adult human and so abortion is tantamount to murder.

Abortion also therefore directly contradicts a foetus’ autonomy. A foetus can’t consent to being aborted and it can never be considered to be in the child’s best interests.

There’s also debate about whether or not a foetus can feel pain during an abortion.

If true, this would certainly be the doctor causing harm, not to mention the fact that an abortion is by no means a risk-free procedure.

Women can bleed, have other organs damaged, develop infections and a very small percentage will die as a direct result of having an abortion.

Pro-Choice: For Abortion

It’s probably not fair to paint pro-choice supporters as ‘for’ abortion, but rather they’re determined to defend a woman’s right to have a choice.

For pro-choice supporters safeguarding the adult woman comes before the unborn foetus.

So, the woman’s autonomy and freedom to decide whether or not she wants to be pregnant overrides the foetus’ autonomy of consenting to being aborted.

The beneficence of aborting a foetus in order to reduce the risk of serious physical or mental injury to the woman overrides the maleficence of the abortion procedure to the foetus.

Pro-choice abortion protestors

Pro-choice supporters often have a different opinion from pro-life supporters as to when human life begins.

This can range from when the unborn baby becomes viable outside of the mother’s womb up until the point it’s actually born.

Aside from the arguments laid out above, there are also countless other benefits to women and society with abortion being legal.

One example is the reduction in backstreet abortions- reducing harm to both women and unborn babies.

To tie both sides into an interview answer, I’d recommend you explore each camp’s views and discuss how they can relate to each of the pillars of medical ethics.

If the interviewer asks for it, you can then conclude with your personal opinion on the matter citing some of the reasoning you’ve just discussed.

Avoiding Common Mistakes

  • Everyone has an opinion on abortion and you may very well feel strongly about the matter. Try not to let your personal opinions get in the way of discussing both sides of the argument in an interview answer in order to present a balanced discussion.
  • The law is subtly different between different countries within the United Kingdom. Make sure you’re aware of these differences in case you’re asked to compare and contrast them.
  • Read up on the latest news regarding abortion both from the UK and abroad (especially America). Your interviewer may very well ask for your opinions on it.

LEARN MORE: The ethics of abortion for medical school interviews.

Organ Donation

How does an ‘opt-out’ system for organ donation compare to an ‘opt-in’ system?

Organ donation is a topic that medicine interviewers can take in a few different directions depending on what they want to explore.

For one, there’s the inherent friction caused by a severe shortage of donated organs leading to ethical discussions about how they should be distributed amongst a long waiting list of worthy patients.

There are also ethical arguments that can be used to debate the different systems for how organ donation should work.

This particular medicine interview question focuses more on this aspect of the topic.

The two opposing systems can be summarised as follows:

  • An opt-in system relies on people putting their hand up to volunteer to become donors upon their death
  • An opt-out system assumes everyone is happy to become a donor unless they specifically state otherwise

The UK used to use an opt-in system but since 2015, Wales, England and Scotland have one after another moved to an opt-out system.

Northern Ireland is currently the only UK nation to still have organ donors opt-in.

Benefits Of Opt-In Organ Donation

An opt-in system for organ donation was the status quo for many years.

It doesn’t assume anything about the individual as it requires them to actively volunteer to become a donor.

As a result, it can be seen as a system that respects patient autonomy to a greater degree. Everyone who signs onto the organ donation register will have given their informed consent to becoming a donor.

This is in direct contrast to the opt-out system.

With the opt-in system, it’s far more unlikely that someone could become a donor without meaning to or in direct opposition to their beliefs or desires.

Many people and religions can see removing organs from a person who’s passed away as highly disrespectful- the opt-in system minimises the chances of this happening to someone who wouldn’t have wanted it.

Benefits Of Opt-Out Organ Donation

Arguably the principal benefit of the opt-out system is that it dramatically increased the number of donors becoming available when it was first introduced.

With hundreds of people in the UK dying every year while on an organ transplant waiting list, increasing the number of donors has a real, tangible impact on the care of patients.

With the opt-out system, people who were on the fence, didn’t really mind or just weren’t bothered enough to make a change to the default all automatically become donors- rather than not being one in the opt-in system.

People who feel strongly about not becoming a donor can still easily opt-out, but this middle ground of people who aren’t fussed either way swells the number of donors available and so drastically improves the quality of life for patients on waiting lists.

Having an opt-out system also normalises organ donation in our society- it’s no longer a niche thing that you have to specifically sign up to.

With donating your organs as the norm, over time people will also become less likely to feel the need to opt-out in the first place.

Avoiding Common Mistakes

  • Make sure you’ve done your homework before interview day and understand the core concepts of opt-in vs opt-out systems. It can be helpful to have a few examples of countries that use each system.
  • Being able to talk about the legislative changes that occurred as the UK transitioned to an opt-out system will take your interview answer up a level in the eyes of an interviewer.
  • There’s a lot more to organ donation as an interview topic than just the different systems used for donors. Read around the subject and think about some other questions on the topic an interviewer could ask you.

LEARN MORE: The ethics of organ donation for medical school interviews.

Gillick Competence

A fifteen-year-old girl comes to you as a GP asking for condoms. What are your considerations?

This is a classic medical ethics interview question that references both Gillick competence as well as the Fraser guidelines.

If you aren’t familiar with the concepts then it can seem like a near-impossible task of coming up with a convincing answer on the spot.

However, once you’re familiar with the case law you should be confident in tackling any variation of the question an interviewer can throw at you.

What Is Gillick Competence?

Under UK law, anyone under the age of 18 is legally a child. And in medicine, a child’s parents or guardians are who consent on the child’s behalf for any form of medical treatment or procedure.

The term Gillick competence, however, is used in medical law to determine whether a child has the capacity to consent to their own medical treatment, without the requirement for parental permission or knowledge.

Anyone under the age of 18 is legally a child

This doesn’t just have to be in relation to asking for condoms from a doctor- it can be anything from a blood test to a knee operation.

The key concept to understand is that whether or not a child has the capacity to make a decision will depend on the decision being presented: a 9-year-old may have the capacity to consent to a blood test but likely wouldn’t be able to fully weigh up the pros and cons of having a lung transplant- therefore wouldn’t be able to consent to this procedure themselves.

Fraser Guidelines

The Fraser guidelines essentially relate Gillick competence directly to scenarios involving minors asking for contraception.

Gillick competence is the broad concept at play and Fraser guidelines are specific guidance for doctors in the situation posed by the interview question.

It’s lawful for doctors to provide contraceptive advice and treatment without parental consent to minors if the following criteria are met:

  • The young person will understand the advice
  • The young person cannot be persuaded to tell their parents/guardian
  • The young person is likely to begin (or continue) having sex with or without contraceptive treatment
  • Unless they receive contraception their physical or mental health is likely to suffer
  • It’s in the young person’s best interests to receive contraceptive advice and/or treatment

These criteria are known as the Fraser guidelines. They’re what you’d have to determine in a consultation with a 15-year-old if they came to you asking for condoms.

Other Considerations

While determining if the child is Gillick competent and whether she meets the Fraser guidelines is the heart of this interview question, there are still some other considerations that you should talk about in your interview answer.

You’d want to ask about who her partner is and how long they’ve known each other. Is this a schoolmate who she’s known since year 7 or is this a 27-year-old man she met online?

Is she feeling pressured into having sex or is this something that she wants to do? How much do her parents know? Do they even know that she has a boyfriend?

There are plenty of other lines of enquiry but you’d essentially want to build up a picture of whether there’s a chance this girl is at risk of abuse or whether it seems like a healthy young relationship.

Avoiding Common Mistakes

  • Make sure you fully understand the difference between Gillick competence and the Fraser guidelines and how they relate to scenarios such as this. They can be extremely tricky to think through on the spot if you don’t quite understand the principles at play!
  • Be sure to consider the scenario as a whole and don’t just focus in on if the child’s Gillick competent or whether they meet the Fraser guidelines. There may be other factors that you need to consider.
  • Appreciate that Gillick competence applies to any healthcare scenario, not just a child requesting contraception. Be prepared to discuss it when it comes up.

Breaking Confidentiality

An HIV-positive patient is too embarrassed to tell their partner about their diagnosis. What are your options as the treating doctor?

This question is designed to test your understanding of medical confidentiality.

Medical confidentiality describes the duty of a doctor to keep any patient information private, regardless of the form in which it is collected or stored.

For example, anything a patient tells a doctor during a consultation is strictly between that patient and that doctor- the doctor won’t go and gossip to their friends about what the patient told them.

This confidentiality also however applies to any hospital letters, medical records or test results that are identifiable to the patient.

Anything that can be directly matched to the patient is held in private unless express permission is given by the patient.

There are however certain situations in which medical confidentiality can be broken…

When Can Doctors Break Confidentiality?

A doctor never wants to break confidentiality if they don’t have to.

Breaking a patient’s confidentiality against their will breaks the bond of trust between doctor and patient and can even mean a working relationship ceases to exist entirely.

However, there are certain circumstances in which doctors are forced to break a patient’s confidentiality regardless of their wishes:

  • If the patient is a direct risk to themselves (e.g. threatening to commit suicide)
  • There is an overriding public interest in the disclosure (e.g. the patient has intentions of assaulting their neighbour)
  • If required to do so by law (e.g. notification of transmissible diseases or ordered to do so by a court)

The best option in all of these circumstances is to actually convince the patient to disclose the information publicly themselves.

That way trust isn’t broken and the doctor-patient relationship remains intact.

However, it’s these situations in which someone is likely to come to direct harm if the information isn’t shared that doctors can and will break confidentiality.

The HIV Scenario

In the interview question described above, from the limited information we have there is a direct risk to the public- the patient is unwilling to tell their partner that they’re HIV positive.

HIV is a communicable disease and so the risk is that the patient could infect their partner as a result of not sharing their diagnosis.

Although our duty as a doctor is primarily to our patient, we still need to protect their partner.

The first step would be to explore with the patient why they’re unwilling to tell their partner. Is it out of pure embarrassment? Would having a healthcare professional in the room to explain things be helpful?

Or, perhaps it’s because the diagnosis of HIV would signal to their partner that they’ve been unfaithful- and so potentially ruin a longstanding relationship.

Either way, it’s useful to dig down into a patient’s reasoning so as to explore any avenues you have to help them share the information.

Ultimately, if the patient is adamantly against telling their partner you would be within your right as a doctor to break confidentiality and tell the partner.

However, you should warn the patient of your plans and explain it would likely be much better if it came from them directly.

Avoiding Common Mistakes

  • Even if as a doctor you are in the right to break confidentiality, it’s always best to have the patient share the information themselves. Don’t jump at an opportunity to break their trust.
  • Make sure you fully understand the surrounding circumstances given in the scenario. For example, if a patient is well treated and has an undetectable viral load, HIV isn’t transmissible- so there would be no grounds to tell the partner.
  • It may be appropriate to say that you’d discuss the situation with senior colleagues or seek legal advice. When things aren’t an emergency there’s never any harm in seeking further advice before taking drastic action.

Professional Standards

You see a fellow medical student take medication from a ward as he frequently gets migraines and wants a supply of painkillers at home. What should you do?

This type of ethics question is pretty similar to the type you may have come across in the UCAT Situational Judgement section.

The interview question presents you with a scenario where something clearly isn’t right- but it’s up to you to decide what level of response is appropriate.

To demonstrate to the interviewer you understand the issues at play, and potentially to give yourself a bit of thinking time, I’d start by highlighting some of the concerns you have about the situation.

In this example, the main ones that come to my mind are:

  • By diminishing the ward’s medication stock they may not have any available for when a patient needs some. This could seriously impact a patient’s care if they’re not able to take their prescribed medication.
  • Although taking a few headache medicines may seem relatively minor, it raises questions about what else the medical student is doing. Could this just be the tip of the iceberg when it comes to stealing medications from the hospital?
  • Doctors are trusted with unsupervised access to a vast range of equipment and controlled drugs. A medical student acting this way is not really compatible with him being trusted as a doctor.
  • Self-treating in this way is bad form for any medical student or doctor. If he frequently gets migraines he should see his GP to be prescribed a supply of the appropriate medications rather than stealing them.

Arriving At A Solution

Once you’ve identified the issues, you can then formulate a plan for how to deal with them.

A common theme with a lot of these questions is that approaching the person in question in a discrete manner is normally a good first step.

Talk to your colleague to try and find out why they’re acting this way. Does he appreciate the impact on patient care he could be having? Perhaps he’s never really thought about it.

Does he want to get to his GP for an appointment about his migraines but just hasn’t had time? Or does he think seeing a doctor is a waste of time when he can just take the medications?

Taking medications from a ward

Depending on his responses, you can then decide whether or not to escalate things further.

A natural next step could be a private word with the student’s academic tutor or indeed clinical supervisor if you’re medical students on a clinical placement.

The correct answer is almost never going to be to sweep what you saw under the carpet because after all “he was only taking a few easy-access drugs off the ward.”

Avoiding Common Mistakes

  • Be sure to highlight the failings in professional standards in your answer so the interviewer doesn’t think you haven’t just not spotted them- even if your solution doesn’t directly address them.
  • Start with a stepwise approach to dealing with the issues from the bottom up: don’t immediately rush to someone in high authority when the problem could have been dealt with at a lower level.
  • If you’re being posed the question it’s almost certain that some sort of intervention is needed. Don’t take a laissez-faire approach!

Alternative Medicine

Should the NHS fund alternative medicine? Even if there’s no substantial evidence for it?

The NHS currently spends millions of pounds each year on complementary and alternative medicines.

These are treatments outside the normal realm of scientifically backed medicines or interventions.

Examples include:

  • Homeopathy
  • Acupuncture
  • Chiropractic
  • Herbal medicines

The evidence base for these sorts of treatments is generally extremely weak. There are individual studies that may show a tangible benefit to one treatment or another over a placebo but these studies are often flawed and the same trends aren’t apparent in larger meta-analyses.

However, real patients do report significant benefits to using such treatments and often find real relief from both chronic and acute medical conditions.

Arguments Against Funding Alternative Medicine

The main argument against funding alternative medicine is the complete lack of solid scientific evidence backing up many of the claims made.

There is a huge scientific improbability that the mechanism of action behind homeopathy, as an example, is possible.

Homeopathy works on the principle that the more dilute a solution is the more powerful a treatment it is. So something diluted down to a 1:1 solution with water is far weaker than something diluted down to 1 part per million.

There have therefore been mass homeopathy overdoses staged with no tangible effects (adverse or otherwise) on the protestors.

The harm of accepting these therapies goes above and beyond someone wasting a few pounds on a pot of sugar pills, however.

Patients will turn to alternative medicines and therapies in place of conventional ones, sometimes with disastrous consequences for their care.

For example, a cancer patient self-treating with acupuncture in place of chemotherapy will almost certainly have a far worse outcome in the long term.

Arguments For Funding Alternative Medicine

On the other hand, many would argue that you can’t just brush over the fact that thousands of people experience real benefits from using complementary and alternative medicine every day.

Cynically, even if these therapies are just a streamlined way to harness the placebo effect, I don’t think that this should be ignored.

The placebo effect can be an incredibly powerful treatment, especially in situations where conventional medicines are often unsuccessful.

Alternative therapies can offer a more holistic experience to patients- which is often exactly what they want instead of an overworked GP prescribing them an evidence-based medicine in the 5 minutes before they’re kicked out of the consulting room.

I believe one of the reasons alternative therapies are so popular is because patients are able to sit down, explain their problems and actually feel listened to; something that unfortunately all too often falls by the wayside under the immense pressures of service provision in the NHS.

Avoiding Common Mistakes

  • Only addressing one side of the argument. Although you may feel like there’s an obvious answer one way or the other you should discuss viewpoints for and against the question.
  • Being too condescending of complementary and alternative medicines. The reality is the NHS does currently fund them. Perhaps you disagree with this but you should explain your viewpoint logically, not disrespectfully.
  • Having a few examples of alternative therapies and their proposed mechanisms can really help illustrate your answer and show the interviewer you know what you’re talking about.

Final Thoughts

The secret to giving an excellent answer to any medical ethics question is to always make sure you give a balanced view on the topic.

Even if you’re convinced one side is completely right and the other so wrong you don’t even want to think about it, an interviewer wants to hear your thoughts on each side.

The four pillars of medical ethics and the 3Cs will also always be able to provide a structure to your answer if you’re floundering, allowing you to succinctly describe your thoughts in an organised manner on any ethics question an interviewer can throw at you.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.