Your ability to navigate ethical dilemmas is heavily tested in medical school interviews, particularly in Multiple Mini Interviews (MMIs).
Today, we’re diving into a common yet complex MMI scenario that forces you to balance empathy, legal obligations, and ethical considerations.
Our goal is to give you a framework you can use for ANY prompt, and to illustrate that framework through an example:
You’re presented with a man responsible for the care of his wife, who has been in a vegetative state for six years following a car accident. She can breathe independently but has no other abilities. The man, who appears to be her legal proxy, requests that her feeding tube be removed, which would ultimately end her life. Your task is to respond to the following:
This scenario, often categorized as a "hypothetical ethical dilemma," tests your situational judgment and critical thinking. But how should you approach it? Here's a step-by-step guide to help you navigate such complex scenarios.
Begin by summarizing the scenario in your own words. This isn’t just about repeating the prompt—it's about demonstrating your comprehension and ensuring there are no misunderstandings. For example, you might say:
"As I understand from the prompt, I’m the physician for a patient who has been in a vegetative state for six years. The husband, presumably the legal decision-maker, requests that I remove her feeding tube, effectively ending her life. My task is to evaluate this request and decide on the appropriate course of action."
By restating the scenario, you confirm your understanding and open the door for any necessary clarifications.
The heart of any ethical dilemma is the conflict between competing values or obligations. In this scenario, the central conflict is likely between the husband’s ethical or moral preference—potentially reflecting his perception of his wife’s wishes—and your professional duty to sustain life.
You could frame it as:
"The primary ethical conflict here is between the husband’s desire, which might reflect what he believes his wife would want, and my professional obligation to sustain life. Additionally, there’s the question of whether the patient herself had previously expressed any wishes regarding her care in such a situation."
This step requires you to dig deeper into the moral, ethical, and legal implications of the situation.
Often, MMI scenarios don’t provide all the details you need, and this is intentional. It’s crucial to identify what’s missing and articulate the questions you need answers to before making a decision.
Consider the following points:
By addressing these points, you showcase your understanding that real-world decisions in medicine are rarely black and white.
Now that you’ve laid out the conflict and identified the necessary information, it’s time to take a stance. Your decision should reflect the nuances you’ve identified in the earlier steps. A balanced approach might look something like this:
"If the law allows for the removal of life-sustaining treatment, if the husband’s status as the legal decision-maker is confirmed, and if no prior directive from the patient exists, I would consider honoring the husband’s request—provided I am confident that he is making this decision in a sound state of mind. However, this decision would not be made lightly or quickly. I would ensure that all legal and ethical standards are fully upheld before proceeding."
This response demonstrates a thoughtful, measured approach that balances empathy with ethical and legal responsibilities.
Finally, it’s important to reflect on the decision-making process itself. This step might feel repetitive, but it solidifies your reasoning and showcases your ability to consider the broader implications of your decision.
You might conclude with:
"In making this decision, I would remain acutely aware of the ethical and legal boundaries that govern medical practice. This process highlights the importance of a thorough, empathetic approach to patient care, particularly in situations involving end-of-life decisions."
By following these steps, you can approach ethical dilemmas with confidence and demonstrate the maturity and judgment that medical schools are looking for.
Good luck, and remember: every ethical dilemma is an opportunity to showcase your values, critical thinking skills, and commitment to patient care.
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