Ethical Scenarios in NHS Interviews

If you are asked to attend an NHS interview, you should always put plenty of work into preparation, as doing so will help you find success. One way to prepare is by looking at the type of questions which you’ll need to answer. In any NHS interview, you will get asked a range of questions to determine whether you are the best person for the position. One of those questions will more than likely revolve around an ethical scenario.

What is an Ethical Scenario?

An ethical scenario is a clinical situation where hospital staff must make a difficult decision regarding ethics, often concerning a patient.

It isn’t an ethics question such as, “do you think UK citizens should automatically be on the organ donor list?” (although questions like that may come up in your interview). Instead, ethical scenarios focus on specific situations that will likely occur in a hospital setting. It requires you to use your clinical knowledge, experience, and understanding of ethics to form a balanced answer.

Here are some examples of ethical scenario questions:

• “What would you respond to a colleague handling a situation unethically?”
• “How would you respond to patient who requests a particular treatment that you don’t believe is in their best interest?”
• “Tell me when you faced an ethical dilemma?”
• “How would you respond if a patient doesn’t want to see a doctor of a particular race?”
• “How would you deal with a colleague that you felt had mistreated a patient?”
• “You suspect a colleague to be intoxicated at work – what do you do?”
• “A family disagree on the treatment options for their child”

There are a whole host of questions that are likely to come up depending on the speciality that you are interviewing for so if you require specific examples we have an extensive bank collated over years. Feel free to email us with your grade and specialism and we’ll send over what we have.

Why Are Ethical Scenarios Important in NHS Interviews?

Ethical scenarios are crucial in NHS interviews as they show the interviewers:

• Your understanding of ethics in the NHS
• Your communication skills
• Your ability to see situations from other perspectives
• How you work under pressure
• Your ethical standards

Every NHS organisation needs to know that their hires have aligned ethics with their workplace. That way, they can be sure patients receive the best possible care.

The Four Pillars of Medical Ethics

The four pillars of medical ethics are principles that every NHS organisation and NHS staff member must adhere to. It would help if you related your ethical scenario answer to these pillars, ensuring they meet the standards.

Autonomy

Autonomy is about respecting the patient’s choice – your answer should adhere to that.

Beneficence

Beneficence means doing what is best for the patient. Therefore, your solution should always keep the patient’s best interest in mind.

Non-maleficence

This means that no harm should be done.

Justice

Justice means treating all patients equally.

Using these four pillars will help you create a solution to the ethical scenario that will adhere to the NHS organisation’s expectation of ethics.

How to Answer Ethical Scenarios

The ethical scenario part of the NHS interview is understandably challenging. After all, there is rarely a right or wrong answer; instead, you must use your understanding of ethics and clinical situations to come up with the best solution for the patient. So here are some ways to answer in a way that will impress the interview panel.

Keep a Clear Head

Do not rush into your answer. Instead, think carefully about the ethical scenario you’ve been presented with.

Use the Four Pillars

The four pillars of medical ethics help form a solution that keeps ethics in mind. When coming up with your answer, use these to guide you.

Consider All Perspectives

When answering the question, be sure to talk out loud about various perspectives, including the patient, the patient’s family, and your colleagues (if that applies). Doing this will demonstrate your empathy while showing that you consider scenarios from all sides.

Relate Your Actions to NHS Values

Don’t just tell the panel what you plan on doing – reiterate why you do what you do. Who does it benefit? When you take action, it’s important to give a reason.

The STAR Approach

Even if you have an excellent answer to the ethical scenario, that still won’t be enough if you don’t structure your answer clearly and concisely. That’s where the STAR approach comes in handy. Standing for Situation, Task, Action, and Result, the STAR method helps you organise your answer so that the interview panel will fully understand.

Situation

Begin by explaining the situation. Do this in a simple manner, proving that you understand the task at hand.

Task

Next, talk the interview panel through the tasks you plan on following, including the order. You can also explain why each task is necessary.

Action

After that, explain the actions you will take to resolve the ethical dilemma.

Result

Lastly, explain the direct result of your proposed plan to the ethical scenario. At this stage, you can bring in the four pillars of medical ethics, showing how you adhere to each one.

Key Points to Remember

Before going into the interview, it’s a good idea to read the GMC guidelines and NHS constitution, as this will help you understand what ethical guidelines you’ll need to follow. Here are some other key points to remember when forming your answer:

The Duty of Candour

The Duty of Candour states that every professional must be honest with patients if something goes wrong or if something might harm the patient. It might involve telling the patient when something goes wrong, providing an apology, offering a remedy, or explaining the effects of the situation.

The Duty of Confidentiality

The Duty of Confidentiality provides the patient with privacy. It means that whatever is said between the doctor and their patient stays between them. However, there are exceptional circumstances where confidentiality might be overridden. For example, when the patient may prove harmful to themselves or others.

Competence and Capacity

If a patient cannot make a decision concerning their health care, you must figure out where that responsibility lies. It might be the power of attorney or an advanced directive from the patient.

The Law

Every medical professional must adhere to legal regulations. These regulations may surround scenarios like organ donations and abortions.

Keeping all of these points in mind when answering an ethical scenario question is crucial, as you need to adhere to all of them.

Example Ethical Scenarios

Keep in mind that the very nature of Ethical Scenarios mean that there are grey areas and answers rarely never black and white. These are merely hypothetical responses and shouldn’t be taken as specific guidance:

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.

In Summary

Ethical scenarios are notoriously difficult to answer, as they are some of the most challenging situations that medical professionals find themselves in. Doing your research and keeping the four pillars of medical ethics in mind is key to ensuring you provide an answer that proves your ethical standards.

Please email us if you are currently preparing for an NHS Interview as a doctor and would like to receive more of our free speciality specific interview preparation materials.