Tackling Ethics

One aspect of studying medicine is acknowledging ethical issues and approaching them in a logical manner. There are several key principles in ethics. In healthcare, the most relevant and important principles to consider are beneficence, autonomy, non-maleficence and justice/fairness.

While the last of these is fairly straight-forward, it would be reasonable for most people to be unfamiliar with the first three. Beneficence in a nutshell is a concept in ethics which places the good of the patient as a high priority. Non-maleficence means no harm should be done. Autonomy is respecting the patient’s right to their own decision, where they are capable of making it. 

When considering beneficence and non-maleficence, it is difficult to deal with these in absolutes. Realistically, most treatments will come with some degree of risk. The cost-benefit of taking such actions must therefore be considered with beneficence and non-maleficence in mind. At the end of the day, you need to be doing more good than harm.

The least obvious of these principles is autonomy. Wherever possible, the patient should be encouraged and supported in making their own decision. This means that in order to facilitate this, as a doctor, acting ethically also involves informing patients of things such as treatment options, disadvantages (side effects) and advantages, without influencing them with any bias.

These four principles are very important to keep in mind during patient interactions. Demonstrating your understanding of these principles during interviews for medicine will be sure to improve your performance. In summary, you should be supportive of the patient through helping them reach an informed decision, ensure that the treatment options you offer have benefits which outweigh the potential harm that can be done and treat the patient fairly without bias.

Aside from the more specific principles of ethics employed in the medical field, there are also a number of ethical dilemmas and philosophies that you might find of interest. 

Take for example, the trolley problem, a widely regarded ethical dilemma with many alternate versions that look at the problem from different angles. The trolley problem involves a runaway trolley hurtling down a track towards 5 immobile people, where your action will determine whether they live or not. You can flip a lever and switch the trolley onto another track with one immobile person. Effectively this means that either 5 people die or 1 person dies, all dependent on the flipping of the lever.

While there are many ways of looking at the problem and deciding moral responsibility, we will look at just a few ethical paradigms which work with this dilemma. 

Firstly, utilitarianism. Utilitarianism is the ethical paradigm whereby the most moral action is the one that results in the most good being done. In the case of the trolley problem, this means that the only morally correct choice to make is to flip the lever, killing the 1 person. Utilitarianism in a sense holds consequence over action. It is not typically regarded as an ethical paradigm that is desirable in a medical practitioner.

In opposition to utilitarianism, deontology considers the moral correctness of individual actions, rather than looking at the results. A strict deontologist may choose not to intervene and flip the switch, as this action causes the death of a person. It is debatable of course, whether actively refusing to flip the switch can be considered an action in itself which leads to the death of the 5 people, but that will not be discussed here. 

The last paradigm that will be discussed is virtue ethics. Virtue ethics regards the character of the person to be key, rather than the actions or consequences. The problem or limitation with virtue ethics is that is does not lend itself in deciding how to act in a situation such as the trolley problem. It gives no clear guidance as to what actions are ethical, only that one should act virtuously.

Remember that the UMAT® Exam and the GAMSAT® Exam are not the only things you should be preparing for if you are attempting to enter a medicine course. Learning about the various paradigms of ethics and ethical principles involved in the medical field will be very important when preparing for interviews.