[Interview Question] Medical Ethics Overview | Pillars, capacity, consent

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There is always at least one question about Medical ethics in medical school interviews. Always.

It can be a tricky one to approach. The question can be a general one or a very specific one. In this video, Olivia explains everything you need to know about medical ethics so you are ready to answer any medical ethics-related question!

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[CrAsh-and-burn]

In regards to the ethics question:
I would first assess the organ to see if either of the candidates are a match as a recipient, especially in terms of size of the organ. If one was a match and the other wasn't, I would give it to the match and take the appropriate steps to provide alternative treatment to the other, whilst waiting for a match for them. I would weigh up the pro Vs cons of the procedure and also look at alternative interventions to make sure that we are doing the least harm to the patient, whilst also acting in their best interest. It may be that either of these patients have comorbid health conditions that would mean surgery would be a higher risk for them than the benefit of receiving the lung. In which case, I would consider give the lung to the other patient.

If it turned out that both the recipients were a match, I would assess the capacity of the patients. As the 12 year old is likely not to be deemed Gillick competent, I would have a discussion with her and her parents. I would ask both the patients whether they actually wanted a lung transplant. Although a new lung is best case scenario, it may be that the patient wants to try a different intervention first. It may be that one of the patients does not want one, at which point I would explain the risks and benefits of recieving/not recieving the transplant. If it is the older male and he has capacity, I would respect his autonomy and not go ahead with the transplant. If it is the young girl, I would default to her parents to act in her best interest. If her parents did not consent, I would ask to take it to court, to act in her best interest.

If both had capacity, I would explain the risks and benefits of recieving the transplant, and make sure both patients were fully informed regarding the procedure.

When considering justice, we have to look at the wider picture. One opinion could be that the smoker needed a new lung due to self-inflicted behaviours, but this is not clear in this picture whether the smoking in the reason that he needs a new lung. Regardless, justice means that everyone is treated fairly and should not be judged on their actions. He is a long-term smoker, but that does not mean that he is currently smoking, or that he won't cease to smoke with the new lung. He may also have external factors such as high stress levels or low income that contribute to his smoking, and providing holistic care and help with these factors may cease his smoking. It is also unfair to judge someone on this, as we have no way of knowing whether the 12 year old will also start smoking with the new lung, when they are older or even now. He also has a wife and 2 children, and the impact of not raising his children may do more harm to wider society. However, he has already lived a lot of his life, which is why it could be seen as more beneficial to give it to the younger patient.

If we give the lung to the 12 year old, it is likely to extend her life by 10 years. We are not sure what may happen at this point, whether she will need another transplant or not. If she does, this may cost the NHS more in terms of surgery and organs, which may harm the wider community as there is fewer resources to be used elsewhere. However, it may be that new interventions are discovered by then, so the cost would be minimal. She also has the potential to impact the wider community, she may grow up to become a doctor herself.

These situations are extremely nuanced and need to be approach as a multi-disciplinary team. However, if I was in a situation where everything aligned and I had to make a snapshot decision, I would give it to the 50 year old man.

[sim_aware]

Great approach to the ethics questions. Camera looks great. Thanks for posting! #SimTribe

[R]

Hi, Thank you for the helpful video
For the question about the lung transplant
1. Find out who is a match to the lungs considering the age of the donor and the size of the lungs
2. If both are a match. Then I will run more tests to see who is in a worse condition and give them the lungs.

[Daniel-dlrm]

It’s helpful video plus you make it lovely:)

[ellemetcalfe]

I've found your videos so helpful, thank you. Could you cover what questions to expect about our personal statements and how to go about them?

[bowenwangs]

Hi, I'm so glad I subscribed to you. Your videos have been so useful and have made me so much less anxious for my interviews. Sending all my love and appreciation 💕

[muhammadpatel]

Hi!
Great Video It was nice to find out about Gillick Competence and Frasers Guidelines.
In regards to the Ethical Question... It would be a difficult one to answer. To begin with we would weigh out all the pros and cons.
Some questions we would look into:
1) Based of Justice, a pillar of ethics Who would benefit more from the organ donation.
2) If another organ was to be available who would be more likely to have a second chance at attaining it.
3) As smoking is a self inflicted illness and CF is genetic would that give the 12 Yr Old more credibility.
4) Who’s higher in the organ donation list?

🤷🏽‍♂️🤷🏽‍♂️

[adnanmossa]

That's really helpful and informative ❤️
Thank you very much for this useful video 👍🏻
You're always beautiful without and with new cameras Olivia 😊

[sandrasajosh]

1)I would look at both recipients first and see if they both are a biological match to the donor and if the size of the lung is suitable for both .
2)then i would look at who who need the organ more and who is most likely to take care of it . The smoker may damage it through excessive smoking which may be a waste of a precious organ and it’s self inflicted . Whilst the 12 year old condition is genetic .
3) The man has a wife and a child so him not receiving the liver may have a toll on the mental health .
4) the child is younger and has many years ahead of her/him .
If I was really pressed on time I would talk to my colleagues and I would gravitate towards the 12 year old patient because they are younger. But I would make to sure to make sure that the man is on the waiting list and he is aware of the necessary support services available to him .

Is there anything else I could add and also could I favour the younger patient because they many years ahead of them or would that go against the justice principle ?