Justice
There are occasions where justice cannot be enforced, and this could be asked as a question to test your knowledge of the four principles. For example, is the NHS postcode lottery fair? This is a problem in which, depending on where you live, certain treatments may not be available to you, while they may be readily available elsewhere in the country. This raises the issue of justice in the NHS, as, based on this principle, surely all people should be offered the same treatment. Another area where issues can arise is when there is the case of an organ transplant. For example, if there are two people who both need a kidney, but there is only one kidney available. You would have to consider many external factors, such as who the kidney would benefit most, if there were children relying on the transplant recipient, as well as a multitude of other factors which may sway your decision. Ultimately, although justice is an ideal, it cannot always be implemented due to limitations of either resources or within the NHS.
Beneficence
The question of long-term vs short term benefit may be addressed in the interview. For example, heart surgery in the short term is definitely not the best thing for the patient. There is a high mortality rate, not only from human error, but also in the aftermath of the operation through sepsis, not to mention the incredible pain caused by the surgery. However, it is deemed as the best thing to do for the patient as, in the long run, this saves the patient’s life and may also increase their quality of life going forward. Although open for interpretation, beneficence is therefore characterised by doing the best thing for the patient in the long-term outcome, rather than focusing on the short term pain/ inconvenience.
Non-Maleficence
You could be given a scenario which tests your ability to identify where there are issues with this principle. For example, breaking bad news to a patient often has a negative effect on their mental outlook, as it can result in more serious conditions such as depression. However, it is still very important to break the bad news to them, as it is their right to know. The same issues with beneficence also apply here with physical harm to the patient.
Autonomy
Once again, problems may arise from different scenarios which interviewers love to test. For example, if a child is technically not of age to make their own decisions, what must be done? By law, they must pass the Gillick competence test before making any decisions, but what if they are too young to pass the test? In these cases autonomy would not be respected as the patient does not have capacity to make decisions. Other situations of confusion may arise when a patient is mentally unwell or in a coma. In these cases, the doctor must use the instructions given by the patient before they became unable to make decisions or use their own discretion to decide the best course of action for the patient. This is made more challenging, if the doctor’s views contradict that of the immediate relatives. Whilst the relatives views will likely be taken into consideration, it is ultimately the professional opinion of the medical team that will be implemented unless there is a valid advanced directive or LPA (Lasting Power of Attorney).