DR HANNAH PIERCE • Dec. 12, 2018
Dr Hannah Pierce is a O&G Trainee. She studied at Keele Medical School where she was also an interviewer. She taught at Keele medical school as a clinical fellow and she co-wrote theMSAG's Interview Guidebook.
Getting medical ethics questions in your medical school interview is not uncommon. So, let’s imagine you are halfway around your MMI circuit and you get asked to answer the following question: Should the NHS fund fertility treatment? How would you go about answering this question as a future medical student/doctor? Well if you’re not quite sure yet, this blog will cover everything you need to know to help you give an informative and insightful answer.
In this blog, we are not going to focus too much on how to structure your answer to an ethical question as this is covered at our full day interview course and in another blog post on how to answer medical school interview ethical questions. However, just to recap having a beginning, a middle; discussing your four pillars of medical ethics and three C’s, and finally a summary section will help you to stay on track when answering more lengthy questions like this one.
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.
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.
- Pro-funding: Patients should be able to choose whether or not they want to start a family.
- 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.
- 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.
However, if we changed the question to ask if a specific woman should be given IVF on the NHS then there is plenty you would likely want to know. For example, does she already have children? How old is she? Has she tried any fertility treatments before this one? Are there any legal aspects to consider?
The answers to these questions might change your opinion on whether she should have free treatment so always ask yourself: is there something that could change my mind about this ethical conundrum?
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 hello@theMSAG.com. Good luck in your interview!