ethics

Question 1

you witness a colleague falsifying patient records, what do you do?

Answer 1

Acknowledgement of integrity: First, I would recognize that patient safety and trust are paramount in healthcare, and that falsifying records undermines both. The integrity of medical documentation is essential for ensuring that patients receive the correct care

Immediate Action: “I would approach my colleague privately and express my concerns. I would ask if there was a reason behind their actions, such as pressure or confusion, and offer support.

Escalating the Issue: “If my colleague does not stop or if the situation is not resolved, I would feel ethically obligated to escalate the matter to a supervisor or senior staff member to protect patient welfare and uphold professional standards.”

Reflection on Professionalism: “This approach ensures I remain professional and non-confrontational but still uphold the values of honesty and patient safety. I would also consider discussing the situation with a mentor to reflect on how to better handle such ethical challenges in the future.”

Question 2

4 medical ethics pillars:

Answer 2

Autonomy: respecting the patient’s right to make their own decisions

Beneficence: acting in the best interests of the patient

Non maleficence: not causing harm to the patient

Justice: concept emphasizing equality and distribution of resources amongst individuals

Question 3

Informed consent – what, why, when, without?

Answer 3

Informed consent: consent gained from a patient who is in full possession of all the risks/benefits – makes a balanced decision providing they are of sound mind

Importance: about to decipher whether the treatment is suitable and does it align with their wishes – if we don’t do that, patients may experience negative outcomes from treatments which they weren’t aware of before they gave consent

Consequences of not doing so: Legally, if patients harmed/unhappy, risk of sued practitioners

May not be needed: patient may not be in sound mind – can’t make a balanced decision e.g. those with dementia, learning difficulties, or delirium, consent wouldn’t be informed even though its given

Could have another person giving consent e.g. a child’s would be parent or an adult could have lasting power of attorney – they may wish for the patient to have the procedure – legal format/ document

Emergency procedures: life saving, no time or means to gain consent
Mental Health Act (1983) – practitioners can go ahead with it without informed consent

Question 4

What are the biggest ethical challenges facing the medical field in the next 5 years?

Answer 4

Advancements in AI and Machine Learning:

Ethical Concern: The increasing reliance on AI in diagnostics and treatment raises concerns about the potential for bias, loss of human oversight, and the erosion of doctor-patient relationships.
Balancing Act: While AI can improve efficiency and accuracy, ensuring transparency, accountability, and maintaining a human touch in patient care is critical.

Euthanasia and Assisted Suicide:

Ethical Concern: As more countries and regions consider legalizing euthanasia and assisted suicide, the ethical implications around patient autonomy, the sanctity of life, and vulnerability of certain populations (e.g., the elderly, those with mental illness) will continue to be hotly debated.
Balancing Act: While patient autonomy is vital, safeguarding vulnerable individuals and ensuring proper consent mechanisms remain integral parts of these discussions.

Genetic Testing and Personalised Medicine:

Ethical Concern: The availability of genetic testing and personalised medicine raises concerns about genetic discrimination, privacy, and the potential for creating “designer” babies.
Balancing Act: While personalized medicine offers significant benefits, ethical frameworks need to protect individuals from potential misuse of genetic information and ensure equitable access.

Question 5

Should the UK follow opt-in or opt-out organ donation? Why?

Answer 5

opt in: Respect for Autonomy: An opt-in system places a clear emphasis on personal choice and autonomy, ensuring individuals actively make the decision to donate their organs.
Benefiting Public Health: An opt-out system could increase the availability of life-saving organs and reduce the waiting time for transplants, potentially saving thousands of lives each year.
Opt-out system is the most effective for increasing organ donation rates.
Rationale: The opt-out system (where people are presumed to consent unless they actively choose to opt-out) has been shown to increase donor rates in countries like Spain.
It helps tackle the organ shortage while still respecting individual choice, as people can easily opt-out if they have religious or personal objections.
Ethical Consideration: Presumed consent respects public health goals but safeguards autonomy through an opt-out option.

Question 6

What do you think about euthanasia?

Answer 6

Euthanisia includes ending a patients life

Euthanasia raises complex ethical dilemmas surrounding autonomy, harm, and the role of the medical profession.

Pros: It respects patient autonomy, providing relief from unbearable suffering in terminally ill patients.

Cons: It may undermine the trust in doctors and lead to pressures on vulnerable people. There is also the risk of slippery slope where vulnerable individuals may feel coerced.

Conclusion: I believe in supporting assisted dying in countries where it is legal but with strict safeguards to prevent abuse of the process.

Question 7

A patient refuses treatment for a life-threatening condition. Discuss the ethical issues involved.

Answer 7

informed consent - check whether all basis are covered - whether they are of sound mind to give informed consent

Autonomy vs. beneficence: The patient’s right to make decisions about their body must be respected (autonomy). However, beneficence requires the doctor to act in the best interest of the patient.
Solution: Explore the patient’s reasons for refusal and provide full information on the risks and benefits. Ensure the patient is competent to make this decision.
If the patient still refuses, it’s important to respect their choice, while ensuring they understand the consequences.

Question 8

A patient with HIV reveals to you that they have not disclosed this to their partner. What should you do?

Answer 8

Confidentiality is paramount, but there is also a duty to protect others from harm.
Legal: In the UK, healthcare professionals are generally not required to disclose a patient’s HIV status unless there is a clear risk to another person.
Solution: Encourage the patient to disclose their status to their partner and provide resources or counseling to help them.
If the patient refuses and is placing their partner at risk, it may be appropriate to inform the partner, but only after carefully weighing the ethical and legal implications. as a medical student, seek advice from a senior advisor or consultant

Question 9

When is it appropriate to breach patient-doctor confidentiality?

Answer 9

Public health threats: When there is a serious risk to others (e.g., infectious diseases), confidentiality may be breached.
Risk to others: If a patient discloses a plan to harm themselves or others, confidentiality may be breached to protect life.
Legal and ethical balance: Always ensure any breach is justifiable, proportional, and in the best interest of public health or safety.

Question 10

Should the NHS fund treatment for smokers?

Answer 10

Yes, but with a focus on prevention and lifestyle change:
Smoking-related illnesses place a significant burden on the NHS, but as healthcare providers, we have an ethical duty to treat all patients, regardless of their lifestyle choices.
Solution: Fund smoking cessation programs and provide treatment, while encouraging preventative measures and awareness to reduce smoking in the long term.

Question 11

Should vaccination of children be mandatory?

Answer 11

Yes, mandatory vaccinations ensure public health by preventing the spread of infectious diseases, especially to those who cannot be vaccinated for medical reasons.
Ethical justification: Protecting vulnerable populations (e.g., immunocompromised individuals) and achieving herd immunity justifies the mandate.
Balance: Allow for exemptions based on valid medical or religious reasons, but these should be carefully regulated.

Question 12

Should patients be allowed to refuse life-sustaining treatment?

Answer 12

Yes, as part of respecting autonomy.
Patients have the right to make informed decisions about their care, even if those decisions may result in their death.
Informed consent must be ensured, and the decision must be respected if the patient is competent. - they need to be aware of all the risks and consequences involved

Question 13

How should medical professionals approach the issue of assisted suicide, what do you know about Dignitas?

Answer 13

Assisted suicide is a complex issue that involves balancing patient autonomy and the sanctity of life.
Dignitas in Switzerland provides assisted dying services, and it raises ethical concerns about ensuring informed consent and avoiding coercion - which is where people may feel they are being persuaded to choose to end their life without being fully certain it is what they want to do.
Approach: Doctors should provide compassionate care, explore all alternatives, and ensure patients are fully informed. In countries where assisted suicide is legal, strict safeguards are necessary.

Question 14

What do you know about capacity in medicine?

Answer 14

Capacity refers to a patient’s ability to make informed decisions about their own care.
Mental Capacity Act 2005: In the UK, capacity is assumed unless proven otherwise. Assessing capacity involves determining if the patient can understand, retain, and weigh the information to make a decision.
If a patient lacks capacity, decisions should be made in their best interests.

Question 15

Is it ethical for doctors to accept gifts or incentives from pharmaceutical conglomerates?

Answer 15

No, accepting gifts or incentives can lead to conflicts of interest and undermine trust in the healthcare profession.
Transparency: Doctors should be transparent and maintain professional boundaries to ensure decisions are made in the best interest of patients, not influenced by external factors

Question 16

Should medical research be conducted on animals?

Answer 16

Yes, but with strict ethical guidelines.
Animal testing is necessary for certain areas of medical research, particularly in drug testing and understanding diseases.
Studies for parkinson’s have shown that mouse models have been used to mimic the early symptoms of parkinson’s - they can use the mice to test potential drugs and therapies before human use

Ethical guidelines should be followed to minimize harm and ensure the necessity of the research (e.g., the 3Rs principle: Replace, Reduce, Refine).

Question 17

Should doctors be allowed to prescribe placebos to patients?

Answer 17

randomised clinical trials are the gold standard in clinical research - able to see without bias - placebo has no active ingredient - allows direct comparison whether the treatment actually works

Placebos should only be used in specific circumstances where it is in the patient’s best interest, with full informed consent.

Ethical challenge: Prescribing placebos without patient knowledge undermines trust and can be seen as deceptive. Unfair, why would you not give them the treatment that could have a positive impact.

Use of placebos should be transparent and patients should be made fully aware of the possibility the placebo could be used.

alternative trials could occur instead of placebo vs treatment

overall, the placebo is important to see if the treatment actually works - proven effective - as long as the patients are aware placebo may be adminstered then it can continue as normal

Question 18

Should medical professionals be allowed to refuse treatment to patients based on their sexual orientation or gender identity?

Answer 18

No, medical professionals must provide care to all patients, regardless of sexual orientation or gender identity.
Non-discrimination is central to medical ethics, and refusing care on these grounds would undermine patient trust in healthcare professionals.

Question 19

Is it ethical to provide medical care to prisoners?

Answer 19

Yes, prisoners still have the right to healthcare under human rights law.
Ethical obligation: Medical professionals must provide care impartially, regardless of a patient’s past actions, and ensure all individuals receive fair treatment and access to necessary medical services.

During my time observing on an oncology ward, I encountered a prisoner who had been diagnosed with a terminal illness. Despite his status as a prisoner, the healthcare team treated him with the same level of compassion and professionalism as any other patient. His medical care was a priority, and he received the support he needed, both physically and emotionally. This experience reinforced my belief that, ethically, every individual deserves equal access to healthcare, regardless of their past actions. - maintained professional

Question 20

Should doctors be required to provide medical care in emergency situations, even if they have religious or moral issues with the situation?

Answer 20

Yes, doctors have a professional duty to provide emergency care.
While respecting personal beliefs, emergency care should never be denied. Doctors should refer the patient to another healthcare provider if they cannot ethically provide care.

If patient is unable to provide consent then the next of kin should be contacted

Question 21

How should medical professionals handle the issue of organ donation from prisoners or individuals with mental disabilities?

Answer 21

Consent is key in any organ donation.
Prisoners and individuals with mental disabilities are entitled to make their own informed decisions about organ donation. If they are unable to give consent, donations should not proceed without proper safeguards to protect their rights.

Question 22

Should medical professionals be required to provide medical care to patients in countries with poor human rights records?

Answer 22

Yes, medical professionals should provide care, but with awareness of the ethical implications of working in countries with poor human rights records.
Humanitarian duty: Doctors can offer care while advocating for human rights and ensuring their actions do not inadvertently support oppressive regimes.

Question 23

Should medical professionals be required to provide medical care to undocumented immigrants?

Answer 23

Yes, healthcare is a fundamental human right.
Medical professionals should provide care regardless of a patient’s immigration status, with special consideration for vulnerable populations such as pregnant women and children.

Question 24

How should medical professionals approach the issue of providing medical care to minors without parental consent?

Answer 24

Competence and best interest: Minors who are deemed Gillick competent (able to understand the nature and consequences of their decisions) should be able to make their own healthcare decisions.
If the minor is not competent, medical professionals should act in the best interest of the child and seek parental consent. - refers to autonomy of the child / parents

Question 25

Discuss the ethical considerations of telemedicine and virtual consultations in patient care.

Answer 25

Confidentiality: Telemedicine requires robust cybersecurity measures to protect patient privacy.
Quality of care: Virtual consultations can provide access to healthcare in underserved areas, but may not be suitable for complex or urgent cases where physical examination is required.
Informed consent: Patients should be fully informed about the limitations of virtual consultations.

Question 26

How would you approach an ethical dilemma involving cultural sensitivities in patient treatment by medics?

Answer 26

Cultural competence: It’s essential to approach patients with cultural sensitivity, respecting their values and beliefs.
Solution: Engage in open, non-judgmental conversations to understand the patient’s perspective and ensure care is provided respectfully while maintaining medical standards.

Question 27

Discuss the importance of cultural competence in providing effective patient care.

Answer 27

Cultural competence improves patient satisfaction, promotes adherence to treatment plans, and reduces health disparities.
Medical professionals should be aware of cultural differences and work to build trust and understanding, fostering a more inclusive and respectful healthcare environment.

Question 28

How can medical professionals better understand and respect cultural differences in patient treatment?

Answer 28

Through education on cultural competence, active listening, and engagement with patients about their cultural preferences and beliefs.
Training and self-awareness are crucial in overcoming implicit biases and providing effective care for diverse populations.

Question 29

How do you view the ethical responsibilities of healthcare professionals in addressing misinformation about health issues on social media

Answer 29

Healthcare professionals have a duty to combat misinformation by providing accurate, evidence-based information on health matters.
Public trust is vital, and professionals should contribute to educating the public and addressing myths, particularly on social media platforms.

Question 30

What are your thoughts on the ethical implications of genetic testing and personalised medicine?

Answer 30

Personalised medicine offers great potential but raises concerns regarding privacy, discrimination, and access.
Ethical issues include how genetic information is used, ensuring informed consent, and preventing genetic discrimination (e.g., by employers or insurers).

Question 31

Is it ethical for medical professionals to provide medical care to individuals who have committed violent crimes?

Answer 31

Yes, healthcare professionals must provide care impartially, regardless of the patient’s past actions.
Duty of care: Every individual has the right to receive medical treatment, and denying care would undermine the ethical principle of non-maleficence.

Question 32

Should medical professionals be allowed to refuse to provide medical care to individuals who have refused vaccination

Answer 32

No, refusing care based on vaccination status would be discriminatory and detrimental to public health.
Ethical obligation: All patients should receive appropriate care, regardless of their vaccination status. However, medical professionals should educate and advocate for vaccination where appropriate.

Question 33

Should alternative medicine be funded by the NHS, and why?

Answer 33

Evidence-based alternative medicine may be funded if there is scientific evidence supporting its efficacy and safety.
Solution: Treatments should be evaluated based on evidence of benefit. NHS funding should prioritize proven, effective treatments to ensure the best use of resources.

Question 34

You have one dialysis machine to share between three patients with equal medical need. One is a 17-year-old drug addict who has just overdosed, one is a 40-year old woman with terminal breast cancer and only 6 months of life expectancy, the third one is a 70-year old marathon runner. Who gets the machine?

Answer 34

Ethical principles: Focus on maximising benefit and fairness.
The decision would consider life expectancy, the potential for recovery, and the greater good. The young drug addict may have the potential for longer-term recovery, while the terminal cancer patient may not benefit from continued treatment.

Question 35

What are the arguments for and against the decriminalisation of drugs such as cocaine?

Answer 35

For: Decriminalisation can reduce the criminal justice burden, redirect resources to healthcare and rehabilitation, and reduce the stigma associated with drug use.
Against: There are concerns that it may lead to increased use and normalisation of harmful drugs, potentially exacerbating public health issues.

Question 36

What do you understand about QALYs in medicine?

Answer 36

QALYs (Quality-Adjusted Life Years) are a measure used to assess the value of medical interventions by considering both the quantity and quality of life gained.
They are often used in healthcare resource allocation decisions to determine which treatments offer the greatest benefit relative to cost.

Question 37

How does the Hippocratic Oath influence modern medical ethics?

Answer 37

The Hippocratic Oath provides the foundation for modern medical ethics, emphasizing do no harm, beneficence, and patient autonomy.
It serves as a guiding principle in making difficult ethical decisions and maintaining integrity in medical practice.

Question 38

Can you give an example of how the principles of the Hippocratic Oath might guide a doctor’s decision in a difficult clinical situation?

Answer 38

A doctor faced with a difficult decision about end-of-life care could refer to the principle of do no harm—weighing the potential benefits of life-sustaining treatment versus the harm of prolonged suffering.

Question 39

In what ways do you think the Hippocratic Oath is relevant to contemporary medical practice?

Answer 39

The core values of the Hippocratic Oath, such as non-maleficence, beneficence, and respect for patient autonomy, remain central to modern practice, helping doctors navigate ethical challenges.

Question 40

How would you apply the principles of the Hippocratic Oath in a scenario where patient confidentiality conflicts with public health concerns?

Answer 40

The Hippocratic Oath stresses the importance of patient trust and confidentiality. However, in cases where public health is at risk (e.g., contagious diseases), breaching confidentiality to protect others may be justified, balancing the need for public safety.

Question 41

Discuss a situation where the Hippocratic Oath might be challenging to uphold in modern medicine.

Answer 41

In cases of assisted suicide, the Hippocratic Oath’s principle of do no harm may conflict with respecting patient autonomy in jurisdictions where assisted dying is legal.

Question 42

How do you interpret the phrase “do no harm” from the Hippocratic Oath in the context of end-of-life care?

Answer 42

“Do no harm” in end-of-life care involves balancing the continuation of treatment with the patient’s wishes, avoiding unnecessary suffering, and providing dignity in death. Prolonging life at the expense of comfort and quality may cause harm, whereas palliative care focuses on minimizing suffering.

Question 43

What are the limitations of the Hippocratic Oath in addressing ethical dilemmas in medicine today?

Answer 43

The Hippocratic Oath, though foundational, can sometimes conflict with modern ethical dilemmas, such as those surrounding technological advances (e.g., genetic testing) or the use of experimental treatments in terminally ill patients.

Question 44

is it better to performe 100 hip replacements or 10 brain surgeries?

Answer 44

• take account patient impact and outcomes and which one will provide the best
• hip replacement given for fall/fracture or if there is pain and swelling - go from restricted mobility to being independant - there are some risks of infection that may affect the patient - can cure people
• brain surgeries - associated with a lot more risks which can be a lot more severe - small complication has a huge impact e.g. speech function/ memory problems
• brain surgeries are more for serious cases - can have a significant impact on peoples life - treatments may not be curing people

cost and resource allocation - price difference between surgeries + amount of people impacted - hip surgeries would win - links to justice distrubution of resources

type of hospital - specialists that do the surgery with a high success rate

difficult sitch but all patients deserve care - 100 hip replacements is more beneficial than 10 brain

Question 45

You are a surgeon, a 16 year old wants a rhinoplasty because she is being bullied at school - no other symptoms. should you perform the surgery what are the ethical considerations?

Answer 45

important to know the rhinoplasty can be taken for medically - alleviate breathing issues or cosmetic and aesthetic

important to give informed consent so they understand the risks of the surgery - risks of complication

psychological evaluation - help and offer emotional support for the bullying - counselling or CBT therapy or contact with school - initiating an open and honest conversation

Question 46

why do you think the GMC encourages doctors not to accept gifts from patients

Answer 46

integrity - creates a sense of obligation and may influence medical decisions

maintaing professional boundaries - although trust and bulding rapport with a patient is important to do, a boundary should be maintained

if given significant gift they are then entitled to better care/ shorter wait times hwoever NHS only does this on the basis of patient needs - not on gifts

patients who are vulnerable - in need of care they do not need to feel they have to give a gift to get the best care - everyone is entitled to healthcare

important is to offer an alternative - maybe offer a donation to the hospital charity if they are insistent

Question 47

patient has a DNR in cardiac arrest event - family is not aware and insist all measures should be taken to resuscitate - they are also concerned the patient is not in the right state of mind to make the decision

what should MDT do ?

Answer 47

review the validity of the directive - if it even is applicable to a cardiac arrest

respect their wishes - assess the mental capacity of the patient - if he seems to be in sound mind and he understands the risks (has informed consent) of what may happen in the event of the cardiac arrest with no treatment

if he is well aware and can understand clearly then to respect patient autonomy

non-maleficence - we have a duty of doing no harm to the patient and beneficence - acting in the best interest so it is good to bear those in mind - but ultimately autonomy is favourable in this sitch

explain to the family this has been assigned to the patient - he had the capacity and he had full informed consent - say why an AD has been put in place - damage they may not be able to recover from - more pain

any more question?

Question 48

were the junior doctor strikes in 2023 ethical?

Answer 48

why were the strikes carried out - due to their working conditions not being up to standard - they are overworked/overstressed and felt they were being under paid

in terms of ethical reasons, they have a legal right to strike as a working professional in the uk, if strikes werent a thing they may even step out of the profession - less doctors per patients

however, due to the nature of the profession it may cause some side effects to other people in the job - immediate patient impact - compromised patient care

all doctors have a duty to consider non maleficience and beneficience - doing no harm and acting in the best interest of the patient - this may not be adhering to those ethics.

due to the strikes, senior specialists will have to pick up the work load and that can cause stress and put back log on work - increase pressure - trying to do the serious conditions and the minor ones that the jr doctors usually pick up

overall, they should be allowed to strike, however in proportions that do not have adverse affects on patients

Question 49

what are the ethical arguments for and against for physician assisted suicide for a patient with chronic pain

Answer 49

where a physician helps a patient end their own life

chronic illnesses - emphasise the impact of holistic care or alternative measures - therapy or pain medications or alternative doses to alleviate pain - explore all different options

chronic can be very difficult to live with - its a life long thing and it can be hard to see the light at the end of the tunnel

for: may argue it can be a good thing - patient has autonomy and should be able to choose when to end their own life - alleviate suffering and death may be peaceful for them

against: as physicians we have a duty to abide by non maleficience - doing no harm by the patient but assisting them in ending their life could be seen as a form of harm
help patients as much as we can

illegal in the UK - arguments against are more powerful - alternative, holistic measures should be explored

Question 50

should doctors be able to refuse treatment based on their own beliefs

Answer 50

patient autonomy should be respected at all times - if the doctor refuses the treatment it may cause the patient to feel judged or stigmatised - and may seek out other more dangerous means of abortions

no continuity of care may become an issue

doctors also have their own beliefs and if another colleague is capable and feels more comfortable in performing that procedure the patient is okay with it, then there should be no reason for that not to take place - informed advice and there will be no delay between doctor Passovers -

as long as it doesn’t impact the patient directly then it should be ethically okay