Your beginning should start by stating what you currently know about the provision of fertility treatment through the NHS. Here is a brief outline of the current situation but things do change so try to stay as up to date as you can on ethical topics such as this one. 

At present NICE (National Institute for Clinical Excellence) recommends that women under 40 years old be offered 3 cycles of funded In-Vitro Fertilisation (IVF) if certain criteria are met and that woman between 40-42 years old are offered one cycle. The criteria requiring to be met include having been trying for a baby for a specified amount of time and previous treatments being unsuccessful. 

However, not all Clinical Commissioning Groups (CCGs) follow the NICE guidance for example, some CCGs only offer funding for IVF for under 35-year-old patients. Because CCGs decide which services NHS money is spent on in their local community there is variation in the access to funded IVF across the UK and this is often referred to as the postcode lottery.

Once you have briefly outlined your existing knowledge it is a good idea to highlight what you feel are the most important ethical issues/ethical principle in this scenario. In this case, it would likely be the beneficence and psychological well-being of the woman requesting IVF versus the justice to the rest of the public who require treatment through the NHS, which we all know has a very limited pool of funding available. 

THE MIDDLE

Here is the time to consider each of your ethical pillars and how these may help you to come to a decision. Remember, much of a doctor’s practice is also governed by the 3 C’s (Consent, Confidentiality and Capacity) so don’t forget to consider these too. 

PATIENT AUTONOMY

• Pro-funding: Patients should be able to choose whether or not they want to start a family.

BENEFICENCE/NON-MALEFICENCE

• Pro-funding: Funding the treatment would benefit the patient and give them a chance to have a family. Not allowing fertility treatment could be detrimental to the psychological welling of these patients. It may mean that they are unable to have a family at all.
  
  
• Anti-funding: It is often older women that undergo fertility treatment and they are more likely to suffer complications during pregnancy. In addition, there is a higher probability of foetal complications e.g. Down’s syndrome with increasing maternal age.

JUSTICE

• Pro-funding: Without funding fertility treatment will only be available to those who are able to afford it as the private industry will continue to supply this treatment.

Many women may have been able to have a family at an earlier stage in life but have chosen to focus on their careers during this time. These women have contributed heavily to the economy through tax contributions and services and therefore arguably justice should reward.

• Anti-funding: There is a finite amount of funding within the NHS and this can be classified as an inappropriate use of resources. The probability of a successful outcome is not 100% and therefore money would be better spent on a different aspect of the NHS.

Consent, confidentiality and capacity aren’t particularly applicable in this particular ethical scenario but are still worth mentally ticking off when giving your answer. 


It is always worth considering if having any extra information might help you to answer this question. This scenario is asking for your general opinion on the matter so there’s not a lot more information that you can ask for. 

SUMMARY

Finally, it is time to give your opinion on the matter of funding fertility treatment. It really doesn’t matter which side you are on as long as you can justify your thought process and support your answer with arguments from your ethical pillars. Make sure you do pick a side and don’t just sit on the fence.


We hope this has helped you to feel more prepared for tackling ethical medical school interview questions. The main thing to remember is to stay calm and just work through each of your ethical pillars in turn. Don't hesitate to send us any questions or comments by email at [email protected]. Good luck in your interview!