‘I’m worried about ethics’ is a common answer I hear when asking students what concerns them most about their upcoming interviews. One of the reasons that people find ethics daunting is that there is often no obviously correct answer; two people could give completely opposite opinions and both get excellent marks. How does that work? The key to a good answer is a clear reasoning process and ability to apply the principles of medical ethics to the given scenario.

In this blog, I will share with you a suggested structure for answering this type of questions at medical school interviews. This is by no means the only way to answer an ethics question, but I hope is one that you will find useful. Having a good structure will allow you to show off your understanding of the ethical principles and by practising over and over you can improve your confidence in answering this common type of interview questions.

TELL ME ABOUT THESE PRINCIPALS OF ETHICS

In order to show off your knowledge of the principles of medical ethics, you need to actually know about them first! You need to be familiar with the four pillars of medical ethics: Autonomy, Beneficence, Non-maleficence, and Justice. I highly recommend you read our previous blog post to understand the four pillars of medical ethics before we continue to make sure that you fully have your head around these terms.

STRUCTURE BASICS

An ethics scenario is a question asking for your opinion. A helpful basic structure for this type of question goes like this: Beginning…Middle…End or Introduction, Body, and Conclusion! Easy peasy, right? We are going to look at each section in detail and consider what we should include in each of them when answering a question on medical ethics. As you go through your answer, try to use ‘signposting’ language. This means using words of phrases to make it clear to the interviewer where you are in your answer and where you are going next, for example: ‘To begin with…’, ‘In conclusion…’. This makes your answer easier to follow and understand which will help you get top marks. I recommend signposting for any interview question.

THE INTRODUCTION

The introduction should briefly set the scene for your answer. There are two key things to include in your introduction:

1. Define any terms used
2. Highlight the key issues raised

Defining terms is useful for two reasons. If you know what you are talking about, simply defining the terms will help show this and make you look good. On the other hand, if you are wildly off with your understanding of a term, it might be in your benefit for this to be clear to the interviewer at the start, before you spend five minutes going down completely the wrong track with the rest of your answer!If you are lucky, perhaps they might even be allowed to help you out with a correct definition. If you aren’t certain, the use of phrases like: ‘My understanding of x is …’ can be helpful.  An example introduction to a scenario about euthanasia could go: ‘This scenario is about euthanasia, which I understand means deliberately ending someone’s life to relieve suffering. The key issue here is that the patient is requesting euthanasia, which is currently illegal in the UK’.

THE BODY

Here is where you will be collecting most of your marks. The most important thing here is that you need to consider both sides of the argument. There are two ways to do this: 

1. Make a list of pros and cons 
2. Go through different people’s perspectives 

In an ethics question, the pros and cons list is usually easiest. You should, however, always consider different opinions after. To make your answer easy to follow, we recommend going through one side of the argument first, then the other. This is clearer than jumping between them. The basis of your arguments for both sides should follow the four pillars of medical ethics and you should consider each of these in turn.

To practice answering questions with a pros and cons list, make a list like this:

Now choose an ethics scenario (e.g. euthanasia) and try to fill in the table. In the ‘pros’ column, consider how you could use each ethical pillar to argue the case for your topic and, in the cons list, try to use each to argue against. Don’t worry if you can’t fill in all of the boxes, you don’t always need to use all four pillars on both sides.

So how do we transfer this table into an interview answer? A nice way to start the middle of your answer is to explain that you understand that there are arguments both for and against the topic. Signpost by explaining that you will talk through one argument first, then the other. Then that’s exactly what you do!For example: ‘I appreciate that there are arguments both for and against euthanasia (assisted suicide). I will talk you through the arguments for euthanasia first. In terms of patient autonomy, one could argue that the patient should be able to choose how and when they die.’ etc. Talk through the pros list and then the cons list. Remember to use the proper terms autonomy, beneficence, non-maleficence and justice as these are buzzwords and will help you get marks. 

After you have talked through both sides of the argument, there are a few more things to consider:

1. The 3 Cs: Are there any issues relating to capacity, consent or confidentiality in your scenario? If so, mention them now! 
   
2. Consider different people’s perspectives: it’s important to show an appreciation that different people in the scenario will have different views and priorities. Mention that we need to respect other people’s religious or cultural beliefs if relevant.
   
3. Do you need any more information? To make these decisions in real life, you will usually need more information about the situation. You should state what else you would like to know (e.g. how many weeks pregnant is the patient who is asking for an abortion?).
   
4. Ask for help! This is so important and often forgotten. In any ethical scenario, I recommend stating that you would discuss with or ask for help from senior doctors and your medical defence union. These are rarely decisions you would be expected to make on your own as a junior doctor!

THE CONCLUSION

We’re finally here, the conclusion. This is the part where you have to pick a side and justify it. The conclusion should be short and sweet, do NOT go through all of your points again and never introduce any new concepts. Start by signposting with something simple like ‘In conclusion’ or ‘In summary’ to make it clear that you are finishing your answer.

DOES IT MATTER WHICH SIDE YOU PICK?

Usually no. In our example so far, some of you will conclude that the argument for euthanasia is the strongest, perhaps because of patient autonomy or being able to reduce suffering. Others will think that the argument against is better, perhaps because causing death could be thought of as the ultimate harm. That’s fine! What’s important is that you have shown an understanding of both sides of the argument and can justify your choice. If you follow the structure above, that’s exactly what you will have done!

SUMMARY

• Introduction: Define and identify key issues. 
• Middle / Body: Pros and cons list considering the four principles of medical ethics. Also, consider the 3Cs, different people’s perspectives, ask for more information and for help from senior doctors or your defense union.
• Conclusion: Pick a side and briefly justify. Don’t introduce any new concepts.
• Throughout: use the buzzwords ‘autonomy, beneficence, non-maleficence, justice’, signpost as you go to make your answer easy to follow.