In both medical school and as a doctor you will be faced with ethical dilemmas. Throughout your medical training you will receive guidance on expectations of medical professionals. You will be taught how to professionally and morally respond to dilemmas applying your critical thinking skills. Doctors have an ethical responsibility. A career in medicine can be extremely uncertain at times and some challenges you face won’t have binary solutions. Ethical theories provide doctors with principles, value and rules to base their conduct upon.
The GMC – General Medical Council provide guidelines for physicians. Within these guidelines it states that doctors should “leave their personal beliefs “ at the door”
During interviews and in clinical practice scenarios arise which require you to consider the ethical problems you may face. Medical ethics using 4 principles of: autonomy, justice, beneficence and non-maleficence to inform decision making. Ethical medical practice would consider and respect these principles. It is important to understand what these pillars mean as how as how each moral principle may affect how you conduct behaviour. When gaining consent physicians need to consider the competency of their patient and provide them with all the information required to make an independent and informed decision.
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Autonomy: The British Medical Association define autonomy as “the right of competent adults to make informed decisions about their medical care.” Patients have a right to self-determination. As a doctor it will be your role to provide patients with information on their conditions and treatment plans so they can engage in shared-decision making with you. An autonomous patient will be able to provide consent for medical procedures and protocols. When gaining consent physicians need to consider the competency of their patient and provide them with all the information required to make an independent and informed decision. This requires providing accessible, understanding information, patients also have the right of access to their medical records. In addition, respecting confidentiality and having a thorough understanding on confidentiality rules and preceding allows healthcare professionals to protect the autonomy of their patient as the patient is controlling the spread of their personal information.
Beneficence : Doctors have an obligation to act morally in a way that would act for the benefit of the patient. Where doctors fail to meet the standard of behaviour to care for their patients and breach their duty of care they can be charged for negligence. It should be argued that legalisation of euthanasia would allow doctors to show beneficence as terminally ill patients avoid suffering and pain,
Non- Maleficence: The medical community appreciate that doctors cannot save everybody however doctors have a moral obligation to not inflict harm on their patients, colleagues or associated parties. This can be applied to ethical dilemmas such as abortion. On the one hand non-maleficence supports that abortion should be allowed as it protects the physical and mental wellbeing of the mother and prevents physical and potential mental harm inflicted on the child. On the other hand, abortion could be argued as a method of “killing” the foetus – in this case harm is done.
Justice: There are four main types of justice: distributive justice which determines who gets what. Within medicine distributive justice is becoming increasingly important. There is an exponential increase in the demand of resources of healthcare which isn’t been met by supply. Procedural justice determines how fairly people are treated, one of the 6 NHS Constitution core values is that “Everyone Counts.” – doctors have an obligation to ensure that nobody is excluded or discriminated against.
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Medical students are expected to have a detailed knowledge of modern medicine. Applicants should be aware of areas of medicine which are currently in the news. In your preparation for interviews try to ensure you have an awareness of current ethical issues. Try to create a bank of examples that you can draw into your examples. In order to do this, consider if any recent laws or legislations have been passed which will pose ethical dilemmas or influence the practice of medicine. For example:
