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Four Pillars of Medical Ethics

Published on
May 13, 2024

Understanding Medical Ethics

Medical ethics plays a pivotal role in the practice of medicine, ensuring that healthcare professionals adhere to a set of guiding principles that prioritise the well-being, rights, and dignity of patients.

In the context of MMI Interviews, understanding these ethical principles is crucial, as they assess potential medical students' ethical decision-making among other attributes. For those looking to deepen their understanding of Medical Interviews and the nuances of MMI, our comprehensive Medical Universities Interview Guide 2024 offers detailed insights into curriculum expectations, interviews, and the ideal candidate profile each med school is looking for in Australia.

This article delves into the essence of Medical Ethics, its importance, the foundational Four Pillars of Medical Ethics, and how these concepts are applied in practice and within the framework of the Medical Interviews.

Why is Medical Ethics so important?

In the complex world of healthcare, medical professionals are often at the crossroads of challenging moral questions and ethical dilemmas. It's here that Medical Ethics becomes their compass, guiding them through these challenges with principles that ensure decisions are both morally defensible and in the best interest of the patients.

Adhering to ethical practices lays the cornerstone of trust between patients and healthcare providers. It guarantees that care delivered not only respects the individual values, rights, and preferences of patients but also upholds the utmost professional integrity.

The Four Pillars of Medical Ethics

1. Autonomy

Autonomy gives patients the freedom to make their own choices about their health. It's about respecting each person's right to decide what happens to their body. Here’s how it works:

  • Adults who can think clearly have the right to make their own medical choices.
  • No doctor or nurse should pressure someone into making a decision.
  • Patients should know all the pros and cons before saying yes or no to a treatment.
  • If a patient doesn't want a treatment for personal reasons, that choice must be respected.

Autonomy case study

A 30 year old male has been involved in a high-speed motor vehicle accident. He experienced blunt force trauma to the head as his head hit the front windscreen. As a consequence, he has a significant head wound that is bleeding profusely. The patient feels ‘fine’ and is refusing to have sutures to close his head wound and would like to leave the ED to go home.

Explanation: Despite the best interests in this patient to undergo a CT scan and have sutures, he is an adult with full mental capacity and as such, we need to respect his decision that he does not want sutures and is choosing to leave the ED.

2. Justice

Justice is all about treating everyone fairly in healthcare. It means making sure everyone gets the care they need, without any bias. Here’s what this involves:

  • Making sure treatments are given out fairly, especially when resources are limited.
  • Considering everyone's needs and figuring out how to meet them.
  • Remembering that patients have rights and there might be laws to think about.
  • Everyone, no matter their background or situation, should have access to treatments.

Justice case study

Patients who are suspected of having cancer are usually given shorter waiting times to be seen and diagnosed. Patients who are then diagnosed with cancer are entitled to a range of treatments. Whilst these treatments are expensive, they treat a small but significant proportion of patients.

Explanation: There are a few ethical dilemmas here that need to be addressed with respect to justice:

  1. Prioritising cancer patients may mean that you then limit the ability of other patients to access healthcare
  2. Referring patients to specialist oncology centres, you’re actually freeing up those services for other patients to then use for their own healthcare
  3. It can be argued that the resources spent on radio and chemotherapy for these small subset of patients is not economically worthwhile as more money may be better spent on health issues that affect a larger percentage of the population - for example, cardiovascular disease.
  4. However, a counter-argument could be that early treatment increases survival rates and may actually reduce the cost of cancer treatments, therefore making it worthwhile to budget.

3. Beneficence

Beneficence means doing what’s best for the patient. It's about making sure that the actions of doctors and nurses are aimed at helping the patient as much as possible. This means:

  • Always looking to do good for the person being cared for.
  • Following moral principles to protect and stand up for the patient's rights.
  • Healthcare professionals must be well-trained and knowledgeable to provide the best care.

Beneficence case study

A fifteen year old child has been admitted to hospital with a significant open fracture to their left arm. The limb is deformed with significant bleeding. It is also deformed and his parents are wanting immediate action.

Explanation: We need to consider quite a few treatment options here and medicine works in a stepwise manner where the least invasive treatment options are considered first. However, let’s consider one of the more extreme options - arm amputation. On one hand, if the bleeding is life-threatening and the limb is non-viable with compromise to blood supply and nerve damage, it may be a good option as it would resolve any possibilities for the injury to lead to infection or bleeding out. However, there are many negatives to amputation. It is a life-changing treatment option whereby the patient would need to adjust the way they fundamentally live their life in a physical sense. It would also result in mental health issues attached to the loss of a limb. There are other, more sensible options such as an orthopaedic referral for fracture surgery and care. As for the bleeding, transfusing the patient with blood products may be sufficient enough to manage their risk. Ultimately, to think about beneficence in relation to this patient, it allows us to promote a course of action that is genuinely beneficial to the patient for their condition, but also helps us rule out other courses of actions if there are better options out there.

3. Non-maleficence

Non-maleficence is a fancy way of saying ‘do no harm’. Healthcare providers have a duty to avoid hurting the patient. This includes:

  • Not doing anything that could cause death.
  • Avoiding actions that might cause pain or suffering.
  • Making sure not to weaken or disable the patient.
  • Being careful not to insult or upset the patient.
  • Ensuring that the patient does not lose any of their basic human needs.

Non-maleficence case study

A 20 year old man collapses on the street complaining of severe acute abdominal pain. A surgeon, who is walking by, is passing the man and examines him only to determine that he is at risk of rupturing his appendix. He decides to remove the appendix using his pocket-knife. (Yes, this is a Simpsons episode example)

Explanation: If we think of the beneficence in this example, successful removal of the appendix would improve the patient’s life and quality. However, there are many issues of non-maleficence that we need to consider here:

  1. The environment in which the surgery would be taking place is non-sterile and the risk of infection is very high
  2. The surgeon has no assistance around him, making the chance of a successful operation much lower than normal
  3. The surgeon would have never performed a roadside appendectomy before, and it would not be ethically sound to do so now
  4. If there is a hospital nearby, then this is a very unreasonable course of action for the doctor to take

Expanding the Ethical Framework

Exploring beyond the foundational Four Pillars of Medical Ethics reveals additional dimensions that critically inform ethical decision-making in healthcare. Understanding these dimensions—Biomedical Ethics, Clinical Ethics, Professionalism, and Systems-Based Practice—is essential for navigating various MMI scenarios effectively.

Biomedical Ethics

Biomedical Ethics addresses the ethical questions that arise in biological and medical research. This domain ensures that research practices honor the respect and dignity of all participants, focusing on the moral implications of conducting research.

Example: Imagine a scenario where your patient is battling a particularly aggressive cancer, and conventional treatments have proven ineffective. A new experimental treatment emerges, offering a glimmer of hope. Before enrolling your patient in the clinical trial, it's essential to ensuring the patient's informed consent is genuinely informed, balancing the potential benefits against the risks, and considering the broader implications of the treatment's success or failure. The ethical framework here emphasizes the patient's autonomy, the potential for beneficence, and the imperative to minimize harm.

Clinical Ethics

Clinical Ethics zeroes in on the ethical challenges that healthcare providers face in the course of patient care. It's about making the right decisions when the path isn't clear, ensuring those decisions respect the patient's values, dignity, and rights.

Example: You encounter a patient with a hereditary condition that poses significant risks not just to them but potentially to their immediate family members. The ethical conundrum surfaces when pondering whether to breach the patient's confidentiality to inform their family members, who are oblivious to their risk. This situation demands a delicate balance between respecting the patient's privacy and potentially preventing harm to others. It involves engaging in a transparent dialogue with the patient about the benefits of sharing this information, seeking their consent to disclose, and carefully considering the family's right to know against the patient's right to privacy.


Professionalism in healthcare goes beyond mere competency in medical skills; it encapsulates the ethical obligation to uphold the standards of conduct and moral judgment that society expects from healthcare professionals. This includes maintaining patient confidentiality, obtaining informed consent, and navigating conflicts of interest with honesty and integrity.

Example: Consider a physician who discovers an innovative yet controversial method of treatment that could significantly benefit patients but is also lucrative for the physician's practice. The ethical challenge here lies in navigating this potential conflict of interest, ensuring that patient care remains the paramount concern. Professionalism demands transparency about the physician's financial interests, allowing patients to make informed decisions about their care.

Systems-Based Practice

Systems-Based Practice acknowledges the complexity of healthcare systems and the necessity for healthcare professionals to effectively navigate these systems to provide optimal patient care. This includes understanding how patient care intersects with other parts of the healthcare system, such as insurance, hospital policies, and public health initiatives.

Example: Imagine a situation where a doctor must advocate for a patient's access to a potentially life-saving but expensive medication. The healthcare provider must navigate the intricacies of insurance coverage, hospital policies, and possibly appeal to public health advocacy groups to secure the treatment for the patient. This scenario underscores the importance of Systems-Based Practice in ensuring equitable patient care within the broader healthcare ecosystem.

How To Answer Ethics And Value Questions In Medical Interviews

MMI ethics stations generally present a candidate with a set of circumstances, ending in a complicated dilemma. Generally speaking - the scenarios are open-ended and have no clear answer that will satisfy all parties involved. The most serious mistake to avoid when it comes to medical interview questions is launching straight into an unstructured action plan. Instead, take a deep breath, and consider the following points:

1. Who Are The Affected Parties In This Ethics Issue?

The first step in analyzing any medical ethics topics is to discard emotion or prejudice and view the scenarios from everyone involved. In the real world, there are very few people with explicitly malicious intentions. If you are consistently encountering scenarios where one party is clearly morally correct - this most likely means that you are engaging with your own bias and not properly evaluating underlying motivations. Consider and validate the concerns of the characters presented to you and how their conflicting interests can be reconciled. 

2. Open By Acknowledging The Complexity Of The Situation

A powerful medical interview skill is awareness of the logical assumptions and conclusions that you make. In simpler terms - a medical MMI examiner cannot read your mind. If you assume the scenario, make sure to clarify this in your response. A key phrase such as “from the perspective of ….” or “assuming that…” makes clear the starting point of your reasoning to your MMI examiner and reduces possible confusion. 

In stating your assumed understanding of the situation, however, you should strike a balance between clarity and reductionism. The worst possible error in a medical interview is simplifying the question to the point where the medical ethics issues disappear almost entirely. For example, if the ethics question requires a student to discuss the eligibility of an elderly person for a driving permit, a broad sweeping assumption such as “elderly people are cognitively impaired” or “elderly people have poor eyesight” is a weak approach to discussing the nuance of the situation. In these circumstances, it is valuable to state the reality of the case - “the situation is complicated because….”

3. Clearly State Your Ethical Limitations

Both in medical practice and the multiple mini interviews, a valuable candidate knows their capacity limitations. The examiners want to see confidence within their own domain. When presented with a medical school interview ethical dilemma, do not respond with decisions that are well beyond your training level. For example - any form of medical decision-making is out of the question. Ethics scenarios often place the interviewee in the shoes of a medical student to test their capacity to understand the scope of their own practice. The same goes for cultural competence.

It is highly inadvisable to bring amateur knowledge of cultures of religions into a medical ethics scenario unless you happen to be a theology professional. The best advice to stick to when encountering a circumstance that strains your qualifications is to a) state your ethical limitations b) state that you will ask for help. 

Other limitations that an interview candidate must respect are those of the ‘four medical ethics’ - we will further discuss in this article.

4. Propose a Plan of Action

A discussion of a morally ambiguous situation is only half complete without a plan of action. It is good medical interview practice to create a 3-5 points plan of action that summarizes your approach to a given situation. After all, it is simply not enough to diagnose a patient in the hospital setting - one must act on the diagnosis! An action plan for a medical MMI should also include ‘failsafe’ steps. This means that you need to acknowledge that your initial approach to the problem may fall short of the resolution required by all parties involved. Therefore, you should try to include concessions or even a method for escalating the scenario to a higher authority. Be careful, when escalating, you should never undermine the first of the four medical ethics - ‘Respect for Autonomy’! 

Example: Answering a Medical Ethics Scenarios

Now it’s time for you to try and unpack an MMI values scenario by yourself. Be sure to discuss this case with your Fraser’s GAMSAT private interview tutor, and present your answer at the first opportunity. 

Scenario: You are a GP. A young, 14-year-old girl has booked an appointment at your clinic and is requesting birth control medication. She explicitly requests that you not discuss this with her family. How do you respond?

  • Who are the Affected Parties in this Ethics Issue?
  • Open by Acknowledging the Complexity of the Situation
  • Clearly State your Ethical Limitations
  • Propose a Plan of Action

What Should You Read Next?

Now that you have been presented with an overall idea around the basics of medical ethics, you should try our approach to Public Health stations or Teamwork stations.