Medical Ethics

The four pillars of medical ethics

Medical ethics provides a framework for making decisions in situations where clinical and moral considerations interact. The most widely used framework in UK medicine is the four-principles approach, sometimes called the Beauchamp and Childress framework after the philosophers who developed it.

The four principles are: autonomy (respecting a patient's right to make decisions about their own care), beneficence (acting in the patient's best interest), non-maleficence (avoiding harm) and justice (treating patients fairly and distributing healthcare resources equitably).

In practice, these principles often come into tension with each other. A patient who refuses a recommended treatment is exercising autonomy, but the doctor's duty of beneficence might suggest a different course of action. Understanding how to identify and reason through these tensions is what medical school interviews are testing when they present ethical scenarios.

Consent and capacity

Valid consent requires three things: the patient must have the capacity to make the decision, the consent must be voluntary (not given under pressure) and the patient must have been given enough information to make an informed choice. Consent can be verbal, written or implied, depending on the procedure.

Capacity is specific to a particular decision at a particular time. A patient may have capacity to decide about one aspect of their care but not another. Under the Mental Capacity Act 2005, adults are assumed to have capacity unless there is evidence to the contrary, and any assessment of capacity must relate to the specific decision being made.

Children and young people have particular considerations. Those aged 16 or over are presumed to have capacity under the Mental Capacity Act. Those under 16 may be Gillick competent if they have sufficient understanding to consent to a specific treatment, as established in the Gillick v West Norfolk case.

Confidentiality

Doctors have a legal and professional duty to keep patient information confidential. This duty is established in GMC guidance and is fundamental to the trust that patients place in the medical profession. Patients are more likely to share clinically important information if they are confident it will not be disclosed without their consent.

There are circumstances in which confidentiality can be breached without patient consent, but these are narrowly defined. They include situations where there is a serious risk to the patient or others that cannot be managed in any other way, where a court orders disclosure, or where disclosure is required by law. The threshold for breaching confidentiality is high and the decision must be proportionate.

Approaching scenarios in interviews

When an ethical scenario is presented in an interview, the assessor is looking for a structured, thoughtful response rather than an immediate conclusion. Identify the stakeholders, name the principles in tension and reason through how you would weigh them. Acknowledging that there is no easy answer is not a weakness; it demonstrates maturity.

Common scenario themes include: a patient refusing treatment they need, a request for confidential information from a relative, resource allocation under constraint, and a colleague behaving unprofessionally. Preparing for these themes by reading examples and practising your responses aloud will help you handle novel variations under pressure.