Being asked what you would do when a 13-year-old asks for contraception and doesn't want her parents told is one of the classic ethics stations at medical school interviews, and most schools ask something close to it. It brings together confidentiality, consent in under-16s and safeguarding in a single scenario, so it tests more than it first appears to. This article goes through why schools ask it, the framework for ethical scenarios, the law you need to know, a worked answer, and the related questions on confidentiality and consent.
Why medical schools ask it
Ethical questions present a clinical or professional dilemma and test your ability to reason through it in a balanced, structured way. They assess judgement, patient-centred decision making, professionalism, and fairness. These questions are not recall tasks. Multiple correct answers exist, provided risks are managed and your justification is lawful, balanced, and context-specific. What matters is how you think through the problem, not arriving at a single "right" answer.
This scenario in particular tests whether you can hold two duties at once: respecting a young patient's confidentiality and autonomy, and protecting a child who may be at risk. Interviewers are also checking that you know the relevant professional standards. Familiarity with GMC guidance and the key legal frameworks, here Gillick competence and the Fraser guidelines, shows you're preparing seriously for a career where these principles govern daily practice.
What interviewers are looking for
There is no fixed list of content points for this station, but across ethics stations interviewers mark for the same things:
- Both sides weighed before you reach a view. Aim for at least two or three points on each side of the argument.
- The four pillars and GMC guidance used where they fit. Autonomy, beneficence, non-maleficence and justice, plus the professional standards that apply.
- Patient safety first. In any scenario involving a child, safeguarding has to be addressed before anything else.
- A clear, justified decision at the end. Sitting on the fence without reaching a reasoned conclusion is unsatisfying.
How to structure your answer
For classical ethical scenarios, use a five-step structure: identify the issue, acknowledge both sides, apply the four pillars, relate to GMC guidance, and give a balanced conclusion with reflection. The model answer below works through this scenario in exactly that order, and ends with the two legal concepts you need to be able to explain.
1. Identify the issue
The ethical issue here is whether a 13-year-old should be prescribed contraception without parental knowledge or consent, balancing the patient’s autonomy and confidentiality against safeguarding concerns, parental involvement, and the doctor’s duty of care.
2. Acknowledge both sides of the ethical debate
Arguments for respecting confidentiality and providing contraception:
Arguments against providing contraception without parental knowledge:
3. Apply the four ethical pillars
4. Relate to GMC guidance
The GMC states doctors must respect confidentiality, but this is not absolute - it can be breached if there are safeguarding risks or if it is in the child’s best interests. The Fraser guidelines specifically apply to contraception in under-16s, requiring the doctor to ensure the young person understands the advice, cannot be persuaded to involve their parents, is likely to continue sexual activity regardless, and that treatment is in her best interests. Safeguarding concerns must always be explored and, if necessary, acted upon.
5. Balanced conclusion with reflection
In this situation, the doctor should sensitively assess the girl’s maturity and understanding using the Gillick/Fraser criteria. Confidentiality should be respected if she demonstrates competence and there are no safeguarding concerns, as this encourages trust and protects her health. However, if there are concerns of abuse or risk of harm, the doctor has a duty to involve safeguarding teams, even if this breaches confidentiality. Reflecting on this, it highlights the importance of balancing autonomy with protection, and the responsibility of doctors to act in the best interests of vulnerable patients.
Key legal concepts to reference
Gillick competence lets a child consent, not refuse
Under-16s can consent to treatment if they have sufficient maturity to understand, retain and weigh up the information and communicate a decision. Competence is decision-specific, and it allows children to consent to treatment but does not give them the right to refuse it. For contraception specifically, all five Fraser criteria must be met.
Example answer
An answer of about two minutes, following the five steps. In a real station you would be asked follow-ups, so you do not need to cover everything at once.
- The issue
- The issue here is whether I can provide contraception to a 13-year-old confidentially, balancing her autonomy and the trust she has placed in me against the fact that she is a child who may be at risk.
- Both sides
- On one side, if she understands the advice she has a right to make decisions about her own health, providing contraception protects her from an unwanted pregnancy, and if young people learn that doctors tell their parents, they stop coming. On the other, at 13 I would question whether she fully understands the consequences, sexual activity at that age raises a real possibility of exploitation, and her parents would normally be the people supporting her.
- Four pillars
- So autonomy depends on whether she is Gillick competent. Beneficence and non-maleficence pull in both directions: withholding contraception could harm her, but providing it without looking at safeguarding could leave ongoing harm unaddressed. Justice says she has the same right to care as any other patient, within the limits safeguarding sets.
- GMC guidance
- The GMC says confidentiality is not absolute and can be breached where there is a safeguarding risk or it is in the child's best interests. The Fraser guidelines specifically cover contraception for under-16s: she must understand the advice, I must have tried to persuade her to involve a parent, she is likely to continue regardless, her health would suffer without treatment, and it must be in her best interests.
- Conclusion
- In practice, I would talk to her sensitively, assess her understanding and ask about the relationship and who else knows. If she is competent, there are no safeguarding concerns and the Fraser criteria are met, I would provide contraception and keep it confidential, while encouraging her to involve a parent. If anything suggested abuse or coercion, I would have to involve the safeguarding team even though that breaks confidentiality, and I would tell her that I was doing so.
Practise this question out loud
Try answering it with the AI interviewer: it asks the question, follows up on what you say, and marks you against the points above.
Common follow-up questions
Interviewers usually follow up on whichever side you came down on. If you said you would keep it confidential, expect to be asked what would change your mind. If you led with safeguarding, expect to be asked what a 13-year-old is entitled to. These are the related confidentiality and consent questions reported in the bank:
When should you breach patient confidentiality?
Asked at Sheffield and Aberdeen. Four grounds: required by law, public interest to prevent serious harm, safeguarding, and serious risk to public safety.
What does it mean for a child to be Gillick competent?
A straight knowledge question. Give the definition, say it is decision-specific, and add that it covers consent but not refusal.
A 14-year-old girl you have looked after for five years says she needs to tell you something, but only if you promise not to tell anyone. What do you do?
Never promise unconditional secrecy. Explain that you will keep what she says private unless she or someone else is at risk, then listen.
A patient tells you they are HIV-positive and asks you not to tell their partner. What do you do?
Asked at King's and Barts. Encourage disclosure first; a breach is justified only to prevent serious harm to an identifiable person.
A six-year-old attends with a parent and you notice bruises. What do you do?
Asked at King's and St George's. The same safeguarding duty, without the competence question.
Common pitfalls
Things to avoid when answering the question:
- Giving a one-sided answer :
- Ethical questions usually have legitimate arguments on both sides. Failing to acknowledge complexity suggests shallow thinking.
- Forgetting patient safety :
- In any scenario involving a child, safeguarding must come first. Address the possibility of exploitation before anything else.
- Not knowing key concepts :
- If you can't explain Gillick competence, the Fraser guidelines or when confidentiality can be broken, you'll struggle with this question.
- Being too rigid :
- Context matters in ethics. Blanket statements like "confidentiality should never be broken" or "I would always tell the parents" ignore the nuances that make the question interesting.
- Forgetting to conclude :
- After exploring both sides, state what you would actually do.
- Not mentioning GMC guidance :
- Referencing professional standards shows you understand the framework doctors work within.
Which schools ask it
Applicants have reported this scenario at the schools below. Confidentiality and consent questions in some form come up at most schools; Sheffield, for example, asks directly whether it is ever appropriate to breach a patient's confidentiality. Each link opens the school's interview page.
Reported at Keele, Nottingham, Cardiff and Manchester.
Frequently asked questions
Do I need to know the law in detail?
You need to be able to explain Gillick competence and the Fraser guidelines in a sentence or two each, and to know that confidentiality can be broken for safeguarding. You do not need case names or statute numbers, although the Gillick case (1985) is easy to remember.
What is the difference between Gillick competence and the Fraser guidelines?
Gillick competence is the general test of whether an under-16 can consent to treatment. The Fraser guidelines are a specific set of five conditions for giving contraceptive or sexual health advice and treatment to an under-16 without parental consent.
Should I say what I would actually do?
Yes. The framework ends with a conclusion for a reason. The strongest answers describe the conversation they would have with the patient, say what would make them keep it confidential and what would make them escalate, and are clear that they would tell the patient before involving anyone else.