How to Approach Ethical Scenarios in an MMI Interview.
MMI ethics stations are always the hardest to tackle in my opinion. It’s always tough to approach a difficult situation because there are not strictly right or wrong answers to it.
Here’s the thing: MMI ethics stations aren’t about being a moral superhero – they’re about showing you can think like a doctor. But how can you access these stations for the MMI stations?
By teaching yourself on the four ethical pillars.
The Four Pillars
(Autonomy, Beneficence, Non-Maleficence, Justice)
Autonomy: The Right to Make a Choice
“For the Ethical Frameworks & Models what if your 16-year-old patient refuses life-saving chemo? What do do?”
Your Play: I’d explore their reasoning first – maybe they’re scared of hair loss, not rejecting treatment. Then explain outcomes using simple terms: ‘Without chemo, your chance drops to 20%’. Ultimately, patients have the autonomy to make an informed decision.
Pro Tip: Autonomy isn’t absolute. If they lack capacity (e.g., severe depression), you escalate – but be respectful.
Beneficence vs. Non-Maleficence: Doing Good and Not Causing Harm
“A dementia patient keeps wandering – do you restrain them?”
Your Play: Restraints prevent falls (beneficence) but cause distress (maleficence). I’d trial alternatives first – GPS trackers, night lights.
Pro Tip: Use the phrase “weighing risks vs benefits” to show nuanced thinking and follow the Ethical Frameworks & Models.
Justice: Fairness of Patient Treatment
“Two patients need a liver transplant—a recovering alcoholic vs. a single parent.”
Your Play: I’d follow the hospital’s objective criteria for organ transplant allocation. Personal factors shouldn’t sway medical need, which aligns with the pillar of justice.
Landmine Alert: Never imply someone “deserves” care more. Focus on fairness for MMI Common Ethical Dilemmas.
The 3Cs
Confidentiality
The Rule: What happens in the room stays in the room. Get to know the STARR Method (Situation, Task, Action, Reflection, Result) used for MMIs
- There’s a risk of serious harm to the patient or others.
- It’s required by law. (Notifiable disease should be reported)
- The patient consents to disclosure.
Scenario: “A 15-year-old tells you they’re sexually active. Do you tell their parents?”
Your Play: I’d explain confidentiality upfront but encourage involving a trusted adult. If no risk of harm and they’re Gillick competent, I’d keep it confidential. Can use the MMI ethics SPIES Framework (seek information, patient safety, initiative, escalate, support).
Capacity: Can they make the decision?
- Assume capacity unless proven otherwise
- It’s decision-specific (might have the capacity for some choices, not others)
- Fluctuates (today’s “no” might be tomorrow’s “yes”)
Scenario: “Elderly patient with mild dementia refuses flu shot. What do you do?”
Your Approach: “First, I’d assess capacity using the two-stage test from the Mental Capacity Act. Can they understand and retain info about the flu shot? Legal vs. Ethical Considerations are to weigh pros and cons. Communicate their decision? If yes to all, respect their choice even if I disagree.”
Consent
- Must be voluntary (no coercion)
- Informed (risks, benefits, alternatives explained)
- Given by someone with capacity
Scenario: “Patient needs emergency surgery but is unconscious. The family’s not around. What now?”
Your Strategy: In emergencies, we might act in the patient’s best interests without explicit consent. I’d document why waiting for consent isn’t possible and proceed if delaying would cause significant harm.
Final Word
MMIs test whether you can navigate medicine’s gray areas. It’s never about the correct answer, because often it does not exist. Always attempt to make a nuanced analysis by referring to the 4 medical pillars and 3Cs.
I aced my MMI interview by framing every answer with “As a future doctor, I would balance X pillar with Y principle…”
By now, you should be able to ace your next MMI sections with Med School Entry Interview Pathway!
Adam Ho, UCL Medical Student.