9 HARD Medical Ethics Questions | Medical School Interview Questions

[Music] it is never okay to lie to a patient under any circumstance outline the arguments for and against the statement

so as doctors I think one of the key things that we have to maintain is trust and integrity with patients so some may

say that lying is never okay because if you were to lie it might break that Doctor P relationship and compromise that so that they don't feel safe they don't feel open as though they can be

honest about um conditions I think as well lying would stop informed consent if a doctor was withholding information or lying about a

diagnosis or about a treatment or something like that that would really stop informed consent and that is not ethical at all a patient should be able

to have full information about the risks and the benefits and what goes on within the treatment and as well kind of

professionally and legally we cannot lie to patients but some people may disagree and say that there are some specific

circumstances where lying is okay and this is um done therapeutically when people may be at risk in a given moment

in time if they were to understand the full truth and then it is okay to withhold TR the truth but overall I personally believe that to maintain

integrity and honesty and a trusting relationship is Paramount in the underlying foundations of a patient doctor relationship and so should be maintained at all

times you are a medical professional working in a rural community one of your patients who is pregnant has been diagnosed with a condition that requires urgent medical attention in a City Hospital

however the patient does not want to leave her family behind and refuses to go to the hospital what ethical considerations should you take into account in deciding how to proceed so the first thing I would want to do in

this situation is really offer compassion to this patient they're pregnant and obviously it's can be an incredibly stressful and emotional time and so I'd want to offer them the best

support I could and so what I'd want to do is try and understand why they don't want to go to the hospital at that time is it because of practical reasons of

they've got a child at home that needs um looking after or if they have a responsibility that they needed or maybe that they didn't necessarily think that they could get to the hospital because

being in a rural location there can obviously be some limited resources with public transport and things like that so the first thing I'd want to do is discuss if there are any practical

reasons that are stopping them from going to the hospital and trying to solve them together to try and offer and say oh I can communicate with your husband I can try and organize the

transport and may maybe say get order a taxi for you if that's something that you would want us to do so I think practical is the first thing to kind of eliminate off and then I'd really want

to make sure that the patient understands and has informed consent about why as a doctor I'm recommending that they attend um hospital so maybe it

be it could be because of gestational d diabetes which I know I think can be is it can be common in pregnant women where they then require treatment that is for

the health and safety of the baby but also for themselves and to try and help educate them on why I think that it's really important but also at the same

time acknowledging that a patient has autonomy and if they have um informed consent on the situation that they can then make that decision themselves so I

think overall that in this ethical situation I would have to understand if a patient decides that they do not want to go because that is their own decision

and patient has autonomy but to be openly communicating to try and solve the problems and have an open and honest conversation to try and prevent any problems further down the line that

could have any risks to both the mother or child is it better to perform 100 hip replacements or 10 brain surgeries provide reasons for your

conclusion so when making these kind of decisions the thing that we really need to take into consideration is patient impact and outcomes and which is going to have the best patient improved

outcomes so a hip replacement for example could be given if there was maybe a fall and then a fracture that needed assistance with or maybe if there is pain and swelling to the area where

other treatments cannot work and a replacement is the best thing so for these people they could go from really having restricted mobility and having to

rely on others to then having a complete cure where they can be independent again they can walk to the shops and everything is fixed but also we need to understand that with these hip surgeries

that there is the risk of infection and complications from surgery that could then affect them and then if we think about what tends to happen with brain surgeries brain surgeries tend to be

associated with a lot more risks there is risk of damaging other areas of the brain so they may have say motor complications or speech and memory

problems further down the line but they also tend to be for the more serious cases for example removing a brain tumor now this is a very complex surgery and

removing the brain tumor can have a significant impact on people's lives they can go from living in pain and from suffering from lots of symptoms and

preventing that but there also becomes the risk of these treatments may not necessarily be curing people just like the hip replacements things like brain

tumors it may be that it inevitably will come back unfortunately so I think that's another thing that we need to take into consideration so I think the main things are cost and resource

allocation I would think about you know the price differences between the surgeries but also the amount of people that are going to be impacted by this 100 people could really have an improved

quality of life versus just the 10 people so if we look on just a pure number scale then 100 hip surgeries would seem more beneficial I think we

also need to take into consideration the individual hospital do they have access to specialist surgeons who are act in

hip replacements or maybe if we are a brain specialist center then maybe that could be something that we need to take into consideration where the resource allocation is and what would be most

beneficial for the patients in that area so I think it's important to note that this is a difficult situation and that all patients deserve care but if we look

in terms of improved outcomes for patients you could maybe say that 100 hip replacements would be more beneficial than the 10 brain surgeries

you are a surgeon a 16-year-old has attended your clinic alone and request a rhinoplasty a rhinoplasty is an operation to alter the appearance of the nose she states that she's getting

bullied at school for her appearance she hates how her nose looks but reports no other symptoms should you perform the surgery what ethical considerations should you take into account so I think

it's important to note that a rhino plasti can be taken for a variety of reasons one can be medically because of issues with breathing so that can help

alleviate their breathing issues but also it can be done for a more cosmetic and aesthetic um scenario where they want to try and change the shape of their nose so I think it would be

important to give this patient um information and education about the surgery and why it why it is often given and make sure that they have informed consent and really understand the risks

of the surgery it's not a minor surgery it can be associated with risks and complications and it's really important that they understand that but I think

the main um thing that I would want to do as a doctor here is really help the patient understand and offer them support emotional support specifically

because they were noting that they were getting bullied maybe they wanted to change the shape of their nose because they think that would stop the bullying and really offer that emotional support

whether that be seeing if we wanted to help them with counseling or CBT therapy or or maybe get in contact with the school and to see if they're aware of

that situation so I think initiating an open and honest conversation with the patient is really important in this situation because as a

16-year-old who is maybe going through emotional times and you know school can be a very difficult place and it's important to offer support for that person and show that there are

alternative measures that we can go to before quite an invasive procedure has to occur why do you think the General Medical Council encourages doctors to not accept

gifts from patients I think a really important one is maintaining professional boundaries whilst we always want to develop a patient doctor relationship to ensure an

open environment for the best of everyone's Healthcare I think it's important that professional boundary is maintained and so that there is no risk of a conflict of interest maybe some

people may feel as though if they've given a significant gift that they are then entitled to maybe better care or a shorter waiting time but that is not how

the NHS discriminates the NHS discriminates only on patient needs not on gifts and kind of blurring of professional boundaries so I think

that's a really important reason why people would never accept gifts I think as well another important one is for those who are vulnerable for those who

are really in need of care and things like that they do not feel as though they have to give a gift to get this doctor's um advice and so that's really

important that particularly in the vulnerable populations that we are not accepting money that could be very very significant to them everyone should be

entitled to healthc care and for all I think the important thing though would to be do if you were in this scenario is to offer an alternative and say we do

not need any gifts I'm here to look after you and offer any advice as much as I can do maybe if you feel like we are deserving of something maybe offer a

donation to the local hospital charity or the charity that we support so that it can go back out into the community and help people if people are very insistent on giving gifts or maybe even

just say a box of chocolates that can be shared in the staff room so I think to conclude that gifts should never be accepted if they are of high monetary

value from a patient because it can put at risk conflicts of interest blurred patient boundaries um and offer those Alternatives so that you can still

maintain this patient doctor relationship an advanced directive is a statement of instruction about what medical and healthc Care treatment you want to refuse in the future in case you

lose the capacity to make these decisions a patient has an advanced directive in place stating that they do not wish to be resuscitated in the event

of a cardiac arrest however the patient family members are not aware of the directive and insist that all measures to be taken to resuscitate the patient and are concerned he isn't in the right

State of Mind to make decisions about his health what should the healthcare do in this situation the first thing that I would do is go and check the validity of the advance directive and make sure that is

applicable to this situation of cardiac arrest and if it was to be valid I would then facilitate a meeting with the family in a private area because I need

to acknowledge this is an incredibly emotional situation and we want to have an open and honest conversation so what I would do is I would explain to the

family what an advanced directive is and explain that this has been signed by the patient and it is their decision a patient has their own autonomy about

decisions that can be made about their Healthcare and it's really important to emphasize that this patient themsel had capacity and was fully aware of the

situation and consented to this Advanced Directive to be put in place and I would also maybe start by saying why an advanced directive has been put in place

in this case now for some people who have lots of underlying health conditions or are quite elderly and frail by conducting CPR they are going

to maybe have a damage that they would not be able to recover from such as broken ribs from having the CPR done to them and that actually they are going to be

in more pain as a result of having the CPR and that is something that the patient is aware of in that condition so I would kind of explain this to the family and I'd also ask them if they

have any questions that they wanted to know about the patient's condition how they can best support them with that decision and come as like a collective

together so it's a happy and positive environment for that patient and if they were still to push on this idea and say that they don't agree and that they're

still really pushing for CPR at that point that's when I would ask for a second opinion and ask for some support and maybe try and facilitate some family counseling with you know someone who

specializes in medical ethics and law and these scenarios to really um help the patient family come to terms with this Advanced

Directive were the 2023 Junior doctor strikes ethical if so under what conditions so the junior doctor strikes that were recently carried out were in

support of better working conditions and better pay for the junior doctors who are overworked working in incredibly stressful environments and um basically

asking for pay restoration from in 2008 they're not asking asking for a wage increase they're just asking for a restoration of where it was initially so if we think about in the short term what

are some of the consequences of these strikes that could have ethical implications so there were I think around 200,000 appointments that were cancelled across the three or four days

that the strikes took place and so that is going to have an impact on patients immediately patients that were coming in for checkups and for minor procedures are having them cancelled so that is

going to have an impact on that it's then going to mean that the staff that are working at that time are going to face even more increased pressures that's going to put stress on other

members of the healthcare team and maybe even on the Consultants particularly in areas they've maybe not worked in in a very long time the jobs that traditionally Junior doctors do so I

think that can also cause a bit of a risk and if we think about it in the long term there's also the backlog of the appointments from all of the ones that have to be cancelled they're then

having to be rearranged that's putting even more of a backlock on such waiting this that are already really huge and again there is always going to be a compromise of patients care but I think

it's really important to know of the reasons of why they need to be done ethically the strikes some people would say that if the strikes did not occur

then even worse ethical implications Could Happen further down the line because Junior doctors are leaving and going to work in other countries or just completely stepping out of the healthc Care profession and then that means

we're going to lose doctors and there's going to be less doctors per patients and then that's going to compromise safety and also as well particularly with the um age category that are

striking that's then going to mean that consultant positions aren't going to be filled and kind of the Specialists for the people that are having to deal with the most complicated diseases and

multiple diseases together are not necessarily going to to be there in the future so I think it's a really interesting discussion when we talk about the ethical implications if we think about long-term versus short term

but I think ultimately we're not going to completely understand the ethical repercussions until the future whether that is there going to be a a change

within the healthcare institution that brings about these changes and therefore the cancellations of appointments or may be seen as minimal versus the huge impacts on patient care that could

happen or alternatively there could be no changes and it could be continuing so I think it's a really open but interesting discussion that we'll just have to wait for the future to see you

are treating a patient who has a chronic illness that is causing them significant pain and suffering the patient is considering physician assisted suicide but this is not legal in the UK what are

the ethical Arguments for and against assisted suicide in patients with chronic pain so I understand assisted suicide to be when a physician helps or

Aids an individual end their own life whether that be because they are experiencing a terminal illness or really intense pain I think in in response to this question that

specifically asks about chronic illnesses I think the first thing that I'd want to emphasize is the impacts of holistic care and alternative measures

that could be given from a physician whether that be cognitive behavioral therapy whe we can explore if there are different pain medications or alternative dosing that could be offered

to them to help them alleviate from this pain or maybe physiotherapy whether that could help because I think it's really important to acknowledge that chronic pain can really have an impact on

people's lives and when they can't see a change in that it can be very difficult and so I think it's important to that we as Healthcare teams try and help these individual patients as much as possible

but if we're going back to the question of the arguments for and against patient assisted suicide physician assisted suicide sorry some people may argue that

it could be a good thing because patients we always say in medicine patients should have autonomy they should be able to make their own health care decisions so they should be able to

choose when to end their life some people may also um say yes because to alleviate suffering like we said these people can be living in such incredible

amounts of pain and that death might be peaceful for them if they are given the choice and control over death for them

it can maybe you know be more peaceful be more private and that it would be a less painful death but other people

would argue and say that as Physicians and as doctors we should we should always abide to non-maleficence we should never be causing harm to patients

sanctity of life and our whole job as doctors is to help patients as much as we can to live the best life that they can and as we know assisted suicide is

illegal in the UK and that is not allowed so I think to conclude um it is illegal in the UK and that I think that the arguments against are more powerful

and that maybe in these circumstances alternative holistic measures should be encouraged and definitely explored to help this patient come to terms with

their chronic illness is it ethical to use Placebo treatments in medical research studies even if it means withholding potentially life-saving treatments from some

participants So currently randomized clinical trials are the gold standard in research it is where say we have a given population half or given the treatment

that they are looking to investigate and half are given a placebo which is a drug or an injection or something that looks like the real treatment but just doesn't have the active ingredient in and

they're really important in understanding the true effectiveness of the treatment it allows the best statistical um results and the direct comparison to really ensure that this

treatment if we're going to approve it and say use it in that NHS that it really is having a good impact on patients some people may argue that it

is not fair to give people Placebo treatments because why would you give it to them when you know that this treatment has the potential to have a positive impact on people's lives and I

think it's important to note that when people consent to randomize clinical trials they have informed consent and they understand that there is the possibility of being given the placebo

they're not being misled or anything but I think it is important to acknowledge that alternative trials could take place instead of it maybe being Placebo versus

treatment it could be the current treatment that's given on the NHS versus this new treatment that we're looking at to see if there is a significant difference between the two so I think it

is important to acknowledge that we can have the Alternatives but I think ultimately having the um Placebo is

really important to generate the most effective medicines and to eventually have the best impact on patients that we can a consultant gynecologist is about

to see his next patient who is a pregnant woman the reason for the appointment is to terminate her pregnancy the consultant himself doesn't want to perform abortions due to his religious beliefs but we'll see the

patient through the initial consultation and then refer it to another colleague to conduct the abortion should doctors be able to refuse treatment based on their personal beliefs and religious

convictions so I think some people may believe that in this situation that a patient's autonomy could be at risk maybe if they're passing judgment it

could make them feel stigmatized and then be more likely to then go and seek out other means that are more dangerous to the person's both physical health and

mental health if they are trying to find alternative abortions if they don't feel like they can have an open and honest conversation with the doctor I think

some people may also think that if there is this transition between one doctor and another not having this continuity of care can really become a bit of an issue and it's not fair on a patient for

them to have to wait time and things like that but I think if a doctor is not passing their judgment if that they are giving them all of the correct and

informed advice and that there is no delay between the doctors passing over between the appointment versus the procedure itself a doctor is entitled to

help hold their own beliefs and if it is not impacting the patient directly then I think that this is ethically

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