Ethical Questions

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 lesson covers the core ethical principles you need to know, common topics that arise, and frameworks to help you structure clear responses.

Doctors face ethical dilemmas regularly—balancing patient wishes against clinical recommendations, allocating limited resources, navigating confidentiality, and handling mistakes. Interviewers want to see that you can recognise ethical dimensions, consider multiple perspectives, and reach reasoned conclusions.

They're also testing whether you understand professional standards. Familiarity with GMC guidance and key legal frameworks shows you're preparing seriously for a career where these principles govern daily practice.

Classical ethical dilemmas

• Is it ever acceptable to break patient confidentiality?
• Should doctors be able to refuse to treat patients who are verbally abusive?
• A hospital proposes a blanket visiting restriction. Do you think this is right?

Professionalism scenarios

• A colleague makes belittling remarks to staff during ward rounds. What would you do?
• You notice a fellow student copying answers during an exam. How would you respond?
• A doctor you're shadowing arrives smelling of alcohol. What do you do?

Mistake scenarios

• You realise you've given medication to the wrong patient. What would you do?
• A colleague asks you to sign a form saying you witnessed something you didn't see. How do you respond?
• You notice an error in a patient's notes that wasn't yours. What do you do?

Topic-specific questions

• What do you understand by patient consent?
• When might a doctor break confidentiality?
• What is Gillick competence?
• What are your views on assisted dying?

These four principles underpin ethical reasoning in medicine. When they conflict, explain the trade-off, choose an appropriate course, and state your reasoning clearly.

Autonomy

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Respecting the patient's right to make their own decisions about their care, even if you disagree with those decisions.

Beneficence

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Acting in the patient's best interest—promoting good and providing benefit.

Non-maleficence

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Avoiding harm. Sometimes this conflicts with beneficence when treatments carry risks.

Justice

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Fair and consistent allocation of resources; treating patients equitably regardless of background.

There's no universal template—some questions require specific knowledge and applied thinking. But these frameworks provide useful starting points.

Classical ethical scenarios

Use this structure when the four pillars apply:

1. Identify the issue

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State the core ethical question clearly.

2. Acknowledge both sides

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Aim for at least two or three points on each side of the argument.

3. Apply the four pillars

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Consider how autonomy, beneficence, non-maleficence, and justice apply.

4. Relate to professionalism/GMC guidance

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Reference relevant professional standards.

5. Balanced conclusion with reflection

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State your view, acknowledging the complexity.

Professionalism scenarios (SPIES framework)

S – Seek information

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Gather details before acting. What happened? Why?

P – Patient safety

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If there's risk to patients, this is the priority.

I – Initiative

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What can you reasonably do yourself? Express concern, have a supportive conversation, offer help.

E – Escalate

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If your actions don't resolve the issue or risk persists, involve a senior or appropriate authority.

S – Support

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Support everyone affected—the patient, your colleague, and yourself afterwards.

Mistake scenarios

1. Patient safety first

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Prevent further harm, reassess the patient, call for help if needed.

2. Take responsibility

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Be honest, don't hide the error or shift blame, escalate early.

3. Communicate with the patient

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Under the duty of candour, explain what happened, check understanding, outline next steps.

4. Report appropriately

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Complete incident forms, inform senior staff.

5. Reflect and learn

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Identify root causes, consider how to prevent recurrence, share learning with the team.

You should be familiar with these areas, as they commonly appear in ethical questions.

Consent

Consent matters because it respects autonomy and is a legal requirement—treating without valid consent risks battery or negligence. For consent to be valid, the patient must have capacity, receive adequate information about risks and alternatives, and give consent voluntarily without pressure.

Exceptions exist: in emergencies, necessary treatment can proceed in a patient's best interests if consent cannot be obtained.

Capacity (Mental Capacity Act 2005)

Capacity is the ability to make a specific decision at the time it's required. Always presume capacity unless there's reason to suspect otherwise. An unwise decision alone doesn't mean someone lacks capacity.

To assess capacity, determine whether there's an impairment of mind or brain, and whether because of that impairment the person is unable to: understand relevant information, retain it long enough to decide, weigh up options, or communicate their decision.

If capacity is lacking, make a best-interests decision considering past wishes, values, and beliefs. Consult those close to the person and choose the least restrictive safe option.

Gillick Competence

Under-16s can consent to treatment if they have sufficient maturity to understand, retain, and weigh up information and communicate a decision. Competence is decision-specific. Encourage parental involvement where safe. Importantly, Gillick competence allows children to consent to treatment but does not give them the right to refuse treatment.

Fraser Guidelines

These set conditions for providing contraception and sexual health care to under-16s without parental consent. All five criteria must be met: the young person understands the advice; they cannot be persuaded to involve a parent; they're likely to continue sexual activity regardless; their health would suffer without treatment; and treatment is in their best interests.

Confidentiality

Confidentiality protects identifiable patient information and preserves trust so patients disclose fully. You can disclose without consent when: required by law or court order; in the public interest to prevent serious harm; for safeguarding children or adults at risk; or when a patient poses serious risk to public safety (e.g. refusing to stop driving with a relevant condition).

When breaking confidentiality, disclose the minimum necessary, record your reasoning, and inform the patient where safe and practical.

DNACPR

A DNACPR is a clinical decision that CPR will not be attempted if the patient's heart stops. It applies only to CPR—all other treatment and comfort care continues. Discuss early and honestly with the patient, explain likely outcomes, and document the clinical recommendation and the person's wishes.

Assisted Dying

Assisted dying and euthanasia are illegal in the UK. Encouraging or assisting suicide is a criminal offence under the Suicide Act 1961. If asked about this topic, explore the patient's reasons, treat distress, optimise palliative care, and give lawful information about prognosis and care options.

Abortion

Under the Abortion Act 1967, abortion is lawful in Great Britain when approved by two doctors on statutory grounds, typically up to 24 weeks. Later abortions require limited indications such as serious risk to life or severe foetal anomaly. Northern Ireland operates under separate regulations.

Organ Donation

The UK uses a soft opt-out (deemed consent) system. Adults are assumed to agree to donate unless they've opted out. "Soft" means families are still consulted about the person's known wishes. Organ donation should never reduce the quality of end-of-life care.

Good Medical Practice sets professional standards for UK doctors across communication, teamwork, safety, and leadership. It's organised into four domains: knowledge and skills; patient partnership and communication; colleagues, culture and safety; trust and professionalism.

The guidance distinguishes between "must" duties (which you're expected to meet or justify why you couldn't) and "should" recommendations. It includes explicit expectations on respectful, safe workplaces, including prohibitions on bullying and harassment.

Giving a one-sided answer

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Ethical questions usually have legitimate arguments on both sides. Failing to acknowledge complexity suggests shallow thinking.

Forgetting patient safety

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In professionalism and mistake scenarios, patient safety must come first. Address immediate risks before anything else.

Not knowing key concepts

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If you can't explain consent, capacity, or confidentiality, you'll struggle with ethical questions. Learn the fundamentals.

Being too rigid

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Context matters in ethics. Blanket statements like "confidentiality should never be broken" ignore the nuances that make these questions interesting.

Forgetting to conclude

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After exploring both sides, state your view. Sitting on the fence without reaching a reasoned conclusion is unsatisfying.

Not mentioning GMC guidance

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Referencing professional standards shows you understand the framework doctors work within.

With ethical questions covered, the next lesson focuses on NHS and topical issues. You'll learn about NHS structure, current challenges facing healthcare, and how to discuss health policy questions thoughtfully.