Medical Ethics Questions: 4 Pillars of Medical Ethics

By December 12, 2019 Interviews

4 Pillars of Medical Ethics To Prepare You For Your Medical Ethics Questions Interviews

If you’re unprepared, stressed out, and coming up close on a medical school interview, we’ve got you covered. This blog post covers a significant player in healthcare and the medical interview: medical ethics questions. The following post will also catch you up on some key healthcare-related events.

We’ll delve into the four pillars of medical ethics: autonomy, beneficence, nonmaleficence, and justice.

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

Written by: Neha Dronamraju

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. 

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.

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Dr. Rachel Rizal

Author Dr. Rachel Rizal

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