How to answer medical school interview ethical questions - sample medical ethics questions

Medical School Interview Ethical Questions: How to Answer Them and Practice Questions

How To Prepare For Your Medical School Interview Ethical Questions

Medical schools and residency programs love to ask ethics interview questions to learn more about how you reason and how you might respond in unexpected scenarios. In this blog post, we’ll go through common medical school interview ethical questions and scenarios, and how to answer them well.  If you’re unprepared, stressed out, and coming up close on a medical school interview, we’ve got you covered. 

With each medical ethics principle, we will also discuss sample ethical dilemmas that you might encounter during your interviews or during your clinical experiences. 

4 Pillars of Medical Ethics

It’s important to know medical ethics concepts so you can incorporate them into your upcoming interview. One of the most important aspects for medical school interview ethical questions is understanding the four pillars of medical ethics:

  1. autonomy
  2. beneficience
  3. nonmaleficence
  4. justice
Autonomy

A patient has autonomy when they are primarily responsible for their medical treatment plans.The doctor may educate or advise the patient, but in the end, they must respect the patient’s right to drive the decision, in other words, exercise autonomy.

Another important consideration when considering an individual’s autonomy is to see if they have an advanced directive or will.  Read more about advanced directives and wills the section down below

Consider the following case: 

Jill is deciding between two treatment options: a risky surgery that could cure her life-threatening illness or her current treatment, which will not cure her but will extend her life by a couple years. 

Your ultimate responsibility as a physician is to respect her autonomy by explaining the implications of the two treatment options and ultimately letting her decide which path she wants to take. But autonomy is not always so black and white. 

I’ll reveal more details about this case — Jill is bipolar and manic depressive. She suffers from psychosis during her manic episodes, where she often hears and sees things that aren’t there and believes that she has superhuman powers.

Would you still approach the situation with the same cut and dry application of autonomy? Does a patient have to be rational to be autonomous? Is Jill rational? Does she have a family? What do they think and does it matter? Defend your position. 

 
Beneficence and Nonmaleficence 

These two principles are closely related. A physician exhibits beneficence when they act solely with the patient’s best interest in mind. All treatments benefit the patient, and the benefits outweigh the harms. Nonmaleficence states that a physician should do no harm to patients. Physicians apply this principle when deciding between a medical intervention and doing nothing. 

 

Considering the following case for beneficence:

Jane is rushed to the hospital with a distended abdomen. The physicians can’t tell exactly what’s wrong just by looking at her, so they need to make a series of decisions to 1) pinpoint the problem and 2) treat it.

There are multiple treatment options for this case, and a physician is responsible for minimizing harm and maximizing short and long-term benefits. So with that in mind, how would you approach this scenario? How would you apply the principles of beneficence and nonmaleficence? 

 

Consider the following case specific to nonmaleficence (this is a real case that received a lot of media attention and shifted policy and they way people thought about the right to die):

 

In 1975, 21-year-old Karen Ann Quinlan consumed alcohol and sedatives during a night out with her friends. She stopped breathing and lapsed into a coma. Months later, doctors officially diagnosed her to be in a persistent vegetative state (PVS) — she was unresponsive to environmental stimuli, only kept alive by machines. Her parents asked that she be taken off the machines and the doctors refused. 

What are your thoughts on this case? What would you do differently as a part of Quinlan’s care team? Why would you do these things differently? How can you apply the principle of nonmaleficence to her case?

 

In the same thread, consider the case of Claire Conroy:

 

Conroy is 84, bedridden, and she suffers from severe physical and mental impairment. She has bedsores, gangrene, and her muscles are contracted, which physicians believe indicate pain. Her vegetative state is mostly similar to Quinlan’s except for the fact that she is not completely unresponsive. She does not interact with the environment much, but sometimes she does try to pull out her feeding tube, and she smiles when her hair is combed.

What do you think about this case? What makes it different from Quinlan’s? Would this difference change your approach or application of nonmaleficence? Would you pull out the tube and let her die a potentially painful death, or keep the treatment and sustain her potentially painful life?

 
Justice

There are two major considerations when looking at a medical intervention through the lens of justice for medical ethics questions. 1) Is the intervention good for society? And 2) does it abide by all laws?

 

Consider the following case related to justice:

Remember Martin Shkreli? In September 2015, Shkreli, the CEO of Turing Pharmaceuticals, raised the price of a life-saving drug by about 5,000%. You can read more about the case here:

 

What are your thoughts on Shkreli’s actions? Were they just? Did he abide by federal laws, and even if he did, did he benefit society? Be sure to do some in-depth research before forming an opinion on this case. While there is an obvious ethically-right choice, you could be asked about practical/legal implications.

If you have any questions about medical ethics questions or medical interviews,  Contact Us through the form below!

Other Topics For Medical School Interview Ethical Questions

Other than the 4 pillars of medical ethics, it is important to incorporate your knowledge in other types of ethical scenarios.

Patient Confidentiality

 

As a physician, you may face some grey area with patient confidentiality — your obligation to keep the patient’s medical information private. Your duty may seem clear, but consider the cases below and as you read, think about how you would handle the situation.

 

Consider the following cases:

Case 1

Prosenjit Proddar revealed to his therapist, Dr. Lawrence Moore, his intent to kill Tatiana Tarasoff, his unrequited love interest. Moore was alarmed by the confession and consulted with his superiors at UC Berkeley. Proddar did not have a past record of aggressive behavior, so the psychiatry team respected his confidentiality and did not report Proddar’s confession to the authorities. Proddar later killed Tarasoff. 

For more information on the aftermath of this case, click the following link: https://www.apa.org/monitor/julaug05/jn

Questions to think about: Could Tarasoff’s murder have been prevented and Prosenjit’s confidentiality preserved simultaneously? What conditions warrant breaking doctor-patient confidentiality? If you had the final say in this team of psychiatrists, what would you have done? 

Case 2

Jane is 17. She is severely depressed and lonely, and she doesn’t allow her parents into her illness because she doesn’t trust that they will receive it well. She is seeing a psychiatrist, Dr. Doe, for her chronic depression and she is gradually building trust with Dr. Doe. In one session, Jane reveals that she’s had a particularly challenging month, she’s not sure if she wants to live anymore, and she has developed a plan to end her life if things get worse. Dr. Doe shares Jane’s suicidal ideation with her parents. In future sessions with Dr. Doe, Jane is withdrawn and monosyllabic in her responses. 

Questions to consider: What if Dr. Doe didn’t tell Jane’s parents about her suicidal ideation? Would she be assuming responsibility for Jane’s life? Is that wrong? What would you do if you were Dr. Doe?

 

Advanced Directives and Wills

An advance directive is a legal document in which a person outlines how their health should be handled if they are in a position where they cannot make a rational decision while they are alive and of sound mind. Most states have a legal statute where medical institutions make arrangements for living wills or advance directives. The controversy around advance directives is that they rely on peoples’ ability to predict their future preferences accurately. 

Let’s say your patient is religiously prohibited from getting a blood transfusion, despite its life-saving potential, and she writes this in her advance directive. Later, she becomes senile and develops a painful condition that requires a transfusion. At this time, your patient feels no obligation to her religion and wants to have a blood transfusion, which goes against her advance directive. As a physician, what would you do? What do you think is morally correct and why?

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Common Medical Ethics Interview Questions

Here are other ethical scenarios you can practice.

General Ethical Questions

Sometimes, you may get asked general-types of ethical scenarios that don’t necessarily relate to medicine.Make sure to discuss all these points:

  • values
  • believe systems
  • decision-making process
  • actions

Interview Tip: Have one specific anecdote related to an ethical dilemma you’ve witnessed in a clinical setting that you can talk about in response to any of these questions.

 

Ethical Scenarios and Questions

  • What’s a tricky ethical situation you’ve had to navigate? How did you navigate it?
  • What’s an ethical dilemma you’ve witnessed while shadowing or volunteering in a clinical space?
  • What’s the biggest ethical problem in healthcare?
Medical Ethics Questions

Other ethics questions during your interview will be medicine-related. Make sure to know the 4 pillars of medical ethics and other medical ethics issues.

Interview Tip: Bring in the 4 pillars of medical ethics, when applicable. 

Ethical Scenarios and Questions:

  • How do you determine who gets a ventilator, or other scarce resource?
  • Should physician-assisted suicide be legal? Would you participate, as a physician?
  • Should physicians offer life-sustaining therapy that they view as futile?
  • Should buying and selling organs be legal?

 

Scenario-based questions

Other ethics questions during your interview will be medicine-related. Make sure to know the 4 pillars of medical ethics and other medical ethics issues.

Interview Tip: Use the framework we outline below. 

Ethical Scenarios and Questions:

  • You are a primary care provider, and are seeing a new patient, Ms. A. She is elderly and does not speak English, so her daughter, Ms. B, is translating for her. When Ms. A steps out for lab work, the daughter pulls you aside tells you that Ms. A has terminal cancer, but is unaware of the diagnosis, and the daughter wishes to keep it that way. She says in her culture, children are supposed to carry the burden of their parents’ medical conditions, and her mother would not want to know the diagnosis. Are you obligated to tell your patient about her diagnosis?
  • You are a pediatrician with a busy pediatrics practice. You see a new mom with her infant, and she is refusing all routine vaccinations for her child, despite your best efforts to convince her of the safety and efficacy of vaccines. Should you continue providing primary care to the child, with the risks the child might pose to other not-yet-vaccinated children, or children medically unable to be vaccinated? Should you ask the family to seek care elsewhere?

Framework for Answering Ethical Questions

You can use this general framework to think through ethical questions and then answering them during your medical interviews. 

Framework for answering medical ethics interview questions

  1. Name the ethical dilemma(s) – what is in tension?
  2. Identify the different stakeholders, and what they might each think is in their best interest.
  3. Identify different paths of action, and the pros and cons for each stakeholder.
    1. Ground your answer in the four principles of biomedical ethics – autonomy, justice, beneficence, and non-maleficence. We have a great blog post on these four pillars of medical ethics here.
  4. What additional info might you want to gather, or additional resources might you utilize, if you were to have to actually solve this problem?
    1. Remember that if you were actually in this position as a medical student or resident, you would be able to, and encouraged to, seek help from others.
  5. After laying out all of the above information, choose and justify an answer.

Written by: Neha D, Ruhee S, and Dr. Rizal

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