hi andre here from the mzag team the four pillars of medical ethics are not only vital to learn before your medical school interview but you will consistently reference them for the entirety of your medical career this video will give you a summary of these pillars and how they can be applied to interviews timestamps in the description below hello and welcome to this video on the four pillars of medical ethics well done if you've already heard of these pillars but don't panic if you haven't as by the end of this video you'll be well up to speed in this video we explain why having a firm understanding of the ethical pillars is important in medical school interviews we will then explain each of the four pillars in more detail to improve your understanding finally we'll go through a mock question with you to show you what a model answer sounds like ethical questions are commonplace at medical school interviews and understanding these four pillars will help you to structure your answers confidently but why do medical schools ask about ethics in the first place well ethical situations crop up regularly in medical practice and it's something junior doctors face from the very beginning of their medical careers medical schools want to examine your ability to approach ethical scenarios which you may face as a medical student or as a doctor ethical questions give you an opportunity to demonstrate a logical approach to a problem and showcase any extra reading which you've done on common ethical dilemmas the four accepted ethical pillars are autonomy beneficence non-maleficence and justice let's start with autonomy what does it even mean well the word autonomy comes from the ancient greek and literally translates to self-rule or self-governance with regards to medicine autonomy means giving a competent adult the right to make decisions about their own medical treatment this concept is relatively modern as medicine used to be a very paternalistic practice in the past a doctor would decide what treatment to give you and you wouldn't have any say in the matter how many of you would expect this type of practice now when we go to the gp we expect to be advised about our treatment options and come to a joint decision with the doctor about which is best for us the concept of autonomy has become very important in our society and often plays a major role in ethical dilemmas let's think about an example if you're admitted to hospital and were diagnosed with appendicitis it's likely that you'd be offered an operation to have your appendix removed your doctor would have to respect your autonomy and would not tell you whether to have the operation or not instead he'd go through all the details about the procedure including the benefits risks and any other information that would impact your decision to go ahead with the operation such as length of hospital stay or recovery therefore the doctor's role is to give you all of the information in a way that you can understand so that you can make an informed decision about whether to go ahead with the operation or not some patients do still want the doctor to make the decision for them and in these instances it's important that the doctor works with the patient to ensure that the right decision is made together one important thing to be clear about with autonomy is that it does not give a patient the right to demand any medical treatment that takes their fancy if doctors don't think that it's indicated however it does allow them to accept or decline any treatments that have been offered to them why don't you spend some time thinking about how this principle of autonomy could be applied to situations like abortion or physician-assisted suicide before moving on to the next part of this video so now we've covered our first ethical principle let's move on and consider the next one beneficence this principle states that our action as doctors should contribute to or improve our patients welfare in other words this is the ethical principle of doing good for our patients and acting in their best interests it's important to note that the doctor's perspective on what he believes is in the patient's best interests may not be the same as what the patients themselves think therefore it's important to ask the patient about their individual beliefs where possible the principle of beneficence may seem fairly straightforward but it's actually more difficult than you may think this is because the principle is closely linked to our next pillar non-molecules to do no harm in fact some ethical systems combine these two pillars into one i like to think of them as two ends of a seesaw if i'm to go ahead with a procedure for my patient despite knowing the potential risks then the seesaw should be overall weighted towards the side of beneficence i and the patient have decided that the potential benefits outweigh the risk to the patient non-maleficence is the concept of doing no harm more formally it's the responsibility of the healthcare worker to never bring harm or suffering to their patient this is often difficult to completely avoid in medicine as most of our investigations and treatments carry some risks of harm and yet we still do these procedures for example if you enter your gp complaining of tiredness they may offer you a blood test to see if there is a more sinister cause for your symptoms other than just the stress of trying to get into medical school now in one respect the blood test is doing you good because it will tell you more information about your tiredness however on the other hand in order to do the test i have to prick you with a needle which may cause pain bleeding or bruising and therefore harm you if we also imagine that you are terrified of needles then i may also be causing you some psychological harm and the balance between doing good for you and harming you becomes more precarious we have heard that an action may have two effects one good and one bad in our taking blood example for most people the harm won't be very severe sometimes however it might be permissible to do something which we know is likely to cause significant harm or even death if that's not the primary intention of the action but a side effect of trying to do something good this is often referred to as the rule of double effect one example of this is the administration of potentially unsafe doses of painkillers to a patient who is dying and in pain the primary intention of the act is to relieve their pain but with the knowledge that these doses might speed up their death as a side effect ethically this is different to administering the same medicine with the primary intention being to end the patient's life so we've made it now to our final ethical pillar justice i like to think of this one as a bit of an outsider because instead of focusing on one individual we're looking more at populations and in particular the concept of fairness between different people within the population this pillar is often attributed to aristotle who is believed to have said equals must be treated equally and unequals must be treated unequally this can take a little bit of time to get your head around but what we're saying here is that not everybody in a population has to be treated exactly the same but that two people with exactly the same demographics and with the same health problems should be in reality this can sometimes be impossible to achieve for example let's imagine two men of exactly the same age and health have heart attacks on the same day now in the case of heart attacks time is critical and the sooner you arrive to hospital for treatment the better your outcome is likely to be however one of the men has had his heart attack on an island off of the coast of scotland and the other has had his outside the front door of a city hospital that specializes in cardiology procedures which one is going to have their care fastest and therefore the better outcome of course it's the man who had his heart attack outside the city hospital but is this fair well it's not but you can see how it would be near impossible for everybody to be so close to a specialist unit at their time of need the principle of justice also covers the concept of distributive justice which is particularly important when we come to think about how we distribute the very finite resources of the nhs you may have heard about the postcode lottery in the media but let's take a bit of time to explore this concept further one arm of the nhs is called clinical commissioning groups or ccgs they are given money by the government to allocate medical services to their population based on local demand and needs this is done to try and make sure that if certain areas have a higher percentage of people with a specific health condition then the ccg has the flexibility to use more of its funding in that area now can you see why this might cause a problem imagine you are the captain of your school football team and you've been training hard and have a chance at winning the local league you take part in a friendly match but a tackle goes wrong and you feel a searing pain will rip up through your kneecap resulting in a trip by hospital the doctor sees you and tells you that you'll need an operation to fix the ligament you've torn but the waiting list at the moment is three months long meaning you won't recover in time for the final match on the sideline of the match you get chatting to a player from the opposite team who tells you that exactly the same thing happened to him but where he lives the waiting list was much shorter so he'd recovered in time to play is this fair clearly not but waiting lists aren't the only example of postcode lotteries funding for medications fertility treatment and social care for our growing elderly population also vary depending on where you live therefore when applying the pillar of justice to the allocation of resources it's important to realize that there isn't enough money to pay for every treatment for every condition for everyone this means that every time we decide to fund treatment we need to also consider what else we are not making available as a result are you starting to feel a little bit sorry for the people who have to make these decisions every day i know i do right let's see you tackle an ethical scenario your question is do you think patients should be entitled to all treatments available shall i tell you what my answer to this question would be here is a summary of it for you i can see a couple of ways in which offering patients access to all treatments could cause some ethical concerns particularly when considering the pillars of autonomy versus justice on the one hand the ethical pillar of autonomy states that patients should be able to choose what happens to their own bodies and would therefore support the argument that they should be able to choose to have any treatment they would like however i do understand that in the uk autonomy does not currently extend to patients being able to demand any treatment though it does allow them to accept or decline any treatments offered to them an argument against offering all treatments would be consistent with the pillar of justice and in particular distributive justice the nhs has a finite amount of resources and if we were to offer all patients any treatment including some drugs that can cost thousands of pounds then that money would soon run out and we would find ourselves in a position where we're unable to fund life-saving treatments for patients in need if we were to adopt this approach then big changes would need to be made to the way we fund our nhs and would potentially require an increase in taxes or an increase in prescription charges it could be argued that funding all treatments would support the pillar of beneficence and that we would be able to do more good for patients however i'm aware that many procedures and medications have side effects and that the more treatments we give the more chance of these side effects occurring this may cause harm to patients and would therefore go against the pillar of non-maleficence overall in my opinion i would therefore say that i do not agree with funding all treatments for patients because within the present-day nhs this is not a sustainable approach to delivering efficient medical care this tactic could therefore cause harm to future patients both through lack of funding for necessary care and a higher risk of side effects from multiple treatments so was this answer similar to the one you practiced don't worry if it wasn't you can go back and try again until you feel confident with ethic style questions we have now completed our whistle stop tour of the four ethical pillars in this video we have explained why having a firm understanding of the ethical pillars is important in medical school interviews we have explored each of the four pillars in detail and gone through a mock question to show you what an answer might sound like thanks for watching we hope that after this video you have a firm grasp on the basics of the four pillars of medical ethics for more information on how to approach ethical questions or scenarios check out our brand new online interview resource link in the description if you found this video helpful please leave a like and if you want to see more medical school admissions content then subscribe to our channel we put out new videos every week best of luck on your admissions you