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Ethical Scenarios asked within NHS Interviews

• January 28, 2020

Ethical Scenarios and the NHS

Towards the end of your NHS interview, you will be asked a clinical scenario and you may be asked an ethical scenario so the hospital can see your ethical and legal approach to modern medicine. You will be presented with an ethical dilemma that the hospital may have experienced. When a dilemma seems especially challenging, the General Medical Council offers a clear direction in the decision-making process. In this blog post, we explain the four pillars of medical ethics and provide some ethical scenarios you may encounter with answers.

What are the four pillars of medical ethics?

1. Autonomy – The respect for the patient’s right to self-determination
2. Beneficence – The duty ‘do good’
3. Non-Maleficence – The duty ‘not to do bad’
4. Justice – To treat all people equally and equitably

The law reflects these principles as follows:

1. Autonomy

• Consent
• Confidentiality / Privacy
• Access to Records
   

2. Beneficence

• Negligence Law
   

3. Non-Maleficence

• Criminal Law
• Negligence law Regulation
   

4. Justice

• Anti-discrimination Law

How to apply the four pillars of medical ethics to clinical scenarios?

It is always essential to first discuss arguments both for against the dilemma before coming up with a balanced conclusion that appreciates the nuances of ethical scenarios. This should always be done within the framework of the four pillars of medical ethics:

• Autonomy – Does it show respect for the patient and their right to make decisions?
• Non-maleficence – Does it harm the patient?
• Justice – Are there consequences in the wider community?
• Beneficence – Does it benefit the patient?

Example Ethical Scenarios

Scenario 1: As a Specialist Registrar you hear that your Consultant is involved in a clinical drug trial. You believe he is fabricating data and submitting it for the trial. What do you do?

The GMC states that you must always conduct research with honesty and integrity. You therefore have a responsibility to act on concerns brought to your attention about the quality and integrity of research including allegations of fraud or misconduct. You must take action promptly, including:

• Taking account of participants’ safety
• Establishing the facts as far as you are able, separating genuine concerns from those made mischievously or maliciously
• Have systems in place to deal fairly and promptly with complaints and allegations of fraud or misconduct

As you only have suspicions at this stage, you should try and confirm the facts. The first step will be to discuss your concerns with the Consultant in question and what you may believe may have a simple explanation. If you are not satisfied with the response, you should inform the appropriate authority with your concerns. This may be the director of research, medical director, clinical director etc.

Scenario 2: You are due to a cardiac catheter list tomorrow and your father has been rushed into hospital in another city. He is going to have emergency surgery and your mother would like you to be with her during this upsetting time. What do you do?

This is a frequent scenario for doctors, where they have committed to patient responsibilities and their personal life becomes a conflict between the two. Patients must be able to trust that NHS doctors will save their lives and their wellbeing is always a priority. The GMC states that “you must make the care of the patient your first concern”.

It would therefore not be fair to abandon your cardiac catheter list as you would break the GMC code. You could then ask an experienced colleague to substitute for you. If you are unable to get a doctor to cover for you, your HR department might be able to organise locum cover to ensure patient care is not jeopardising patient care.

The GMC also states that as a doctor you “must always act quickly to protect patients from risk if you have good reason to believe that you may not be fit to practice”. Therefore, if you are very stressed and upset about your father being taken into hospital, you should declare you are unfit to practice.

Scenario 3: A patient’s wife’s solicitor has telephoned you to inquire about the diagnosis and prognosis of your patient. What do you do?

The GMC states the following: “Information about patients is requested for a wide variety of purposes including education, research, monitoring and epidemiology, public health surveillance, clinical audit, administration and planning. You will have a duty to protect all patients’ privacy and respect their autonomy.” When asked to provide information you should:

• Seek patients’ consent to disclose any information wherever possible, whether or not you judge that patients can be identified from the disclosure
• Anonymise data where unidentifiable data will serve purpose
• Keep disclosures to the minimum necessary

There may be certain circumstances where you have no choice but to disclose confidential information about your patient, for example if you are instructed to do so by a judge or to comply with a specific statutory requirement such as notification of a known or suspected communicable disease.

In this specific case, you do not have to tell the solicitor anything about your patient without the specific consent of the patient. When you are dealing with telephone queries, it is difficult to ascertain with whom you are talking to. It is therefore better to refuse to discuss issues on the telephone but to answer questions in writing after obtaining consent from your patient. After you have obtained the consent, you should only disclose factual information which you can substantiate and present it in an unbiased manner. Post the Access to Medical Reports Act of 1988, your patient has the right to see written reports about them before they are disclosed. You should ask your patient if this is required.

Ethical Scenarios to practice for your interview with

• A patient won’t see a non-white GP
• What to do if a patient forges a sick note?
• Can I allow access to a deceased patient’s medical notes?
• How do I encourage a patient to see our pharmacist?
• Do I have to record drug taking in a patient’s notes?
• How should we respond to negative comments on social media?

References

Downes T, Channer KS, Ethical problems in clinical practice, Postgraduate Medical Journal 2003;79:151-153.
 

Pulse Practice Jobs. (2020). Ten ethical dilemmas of 2016 – what would you do? | Pulse Practice Jobs. [online] Available at: https://www.pulsepracticejobs.com/article/ten-ethical-dilemmas-of-2016-what-would-you-do-/ [Accessed 27 Jan. 2020].