Medical Law and Ethics for Medical School Interviews
Introduction:
Preparing for medical school interviews requires a solid understanding of medical ethics and law. Interviewers expect aspiring medical students to be familiar with ethical principles and their application to real-world scenarios, as well as the legal framework governing medical practice – especially in the UK. In this comprehensive guide, we will explore the four pillars of medical ethics, discuss key UK case law examples (with relevant international context), and provide example interview questions on medical law and ethics.
By mastering these concepts and cases, you can confidently discuss dilemmas ranging from patient confidentiality to end-of-life decisions, demonstrating the insight and integrity expected of future doctors. Let’s delve into the core principles and laws that every medical school candidate should know. You will not be expected to know the exact case reference; simply using the name of the individual in the case would be sufficient, e.g. the Bolam test, Gillick competence, etc.
The Four Pillars of Medical Ethics
Four fundamental pillars traditionally guide medical ethics. These pillars provide a framework for analysing ethical dilemmas and ensuring patient-centred care. The four pillars are:
Autonomy – Respecting the patient’s right to make their own decisions. Doctors must ensure that patients can make informed choices about their care and honour those choices whenever the patient has the capacity to do so. For example, a competent adult has the right to refuse a recommended treatment, even if it may result in harm to their health, and this decision should be respected as long as they understand the consequences.
Beneficence – The duty to act in the patient’s best interests by promoting good and providing benefit. This means offering treatments or interventions that will help the patient. For instance, a doctor might go the extra mile to arrange an earlier appointment or stay beyond their shift to ensure continuity of care, out of beneficence towards the patient’s well-being.
Non-Maleficence – “Do no harm.” Healthcare professionals must avoid causing unnecessary harm or suffering to patients. Every intervention carries some risk, so doctors must weigh the potential benefits against the risks and side effects. Prescribing a medication or performing a procedure is only ethical if the potential benefits outweigh the harms. For example, avoiding the prescription of antibiotics for a likely viral infection aligns with the principle of non-maleficence, as unnecessary antibiotics can cause side effects and promote antibiotic resistance.
Justice – Fairness in medical decision-making and resource distribution. This principle suggests that patients in similar situations should receive similar care, and that healthcare resources (such as organs for transplant or ICU beds) are allocated equitably. Justice also means treating patients without discrimination. For example, a doctor should provide the same quality of care to all patients, regardless of background, and public health resources should be distributed in a way that is fair and maximises benefit to society.
These four pillars often need to be balanced against each other. In practice, ethical dilemmas arise when principles conflict. For instance, a patient’s autonomous choice might lead to harm (conflicting with the principles of non-maleficence), or doing the most good for the most people (justice) might not align with one individual’s wishes. In an interview setting, you can use the four pillars as a structured framework to discuss ethical scenarios. In fact, explicitly referencing the relevant pillars in your answer can demonstrate a systematic approach to ethics and impress interviewers. It shows that you recognise the multifaceted nature of ethical problems and are considering each aspect before reaching a balanced conclusion.
Key Medical Law Principles and Case Examples
Medical law in the UK provides the legal framework for many ethical principles, defining the duties of doctors and the rights of patients. While you’re not expected to be a legal expert, awareness of important laws and landmark cases can significantly enhance your answers. Below, we outline key medico-legal concepts, such as consent, capacity, confidentiality, negligence, and end-of-life decisions, along with illustrative cases from UK law. We also note international examples where relevant, underscoring that ethical issues in medicine often have global resonance.
Consent and Capacity
Informed Consent: In UK law and practice, valid consent is fundamental before any medical intervention. Informed consent means that the patient agrees to a proposed plan after being fully informed of its nature, benefits, risks, and alternatives. Historically, the adequacy of risk disclosure was judged by the medical profession’s standard (the Bolam test – see Medical Negligence below).
However, a landmark case, Montgomery v Lanarkshire Health Board (2015), revolutionised this area. In Montgomery, the UK Supreme Court held that doctors have a duty to ensure patients are aware of any material risks involved in a treatment, judged from the perspective of a reasonable patient in that situation. In other words, what would this patient consider essential to know? If a risk might affect a patient’s decision, it must be disclosed. This ruling replaced the old paternalistic standard with a patient-centred standard for consent. For example, Nadine Montgomery, a woman with diabetes of small stature, was not informed of the 9–10% risk of shoulder dystocia during vaginal birth; the doctor felt she might opt for a caesarean if told, and withheld the information. Her baby suffered harm, and the court found that she should have been informed, establishing that patients, not doctors, ultimately decide what risks they are willing to take when properly informed.
Capacity: A valid consent or refusal also requires that the patient has the mental capacity to make the decision. Under the Mental Capacity Act 2005 (in England and Wales), every adult is presumed to have capacity unless proven otherwise. A patient has capacity if they can understand, retain, weigh up the relevant information, and communicate their decision. Suppose a patient lacks capacity (due to unconsciousness, cognitive impairment, etc.). In that case, doctors must act in that patient’s best interests – which may involve treatment without consent, or overriding prior wishes, depending on circumstances. For instance, in an emergency where a patient is unconscious, life-saving treatment can be given without consent to prevent harm.
Consent in Minors: In the UK, people aged 18 or over are adults with presumed capacity. Those aged 16–17 are generally treated as capable of consenting to treatment on their own behalf. Importantly, individuals under 16 may also consent to medical treatment without parental involvement if they are deemed sufficiently mature and informed – this is known as being “Gillick competent,” stemming from the case Gillick v West Norfolk AHA(1985). A doctor can provide contraceptive advice or other treatment to a minor under 16 if the young person fully understands the implications; in Lord Scarman’s words, parental authority yields to the child’s autonomy once the child has enough understanding and intelligence to understand fully what is proposed. This is called the Gillick test for competence. However, there are nuances – for example, a parent (or the court) might override a young person’s refusal of treatment in certain severe cases. UK case law (e.g. Re W [1992]) has allowed courts to order treatment in a child’s best interests even if an older child refuses, particularly if the treatment is life-saving. In practice, if a 15-year-old refuses a vital blood transfusion, doctors may seek a court order or parental consent to proceed despite the refusal, since the law prioritises the child’s welfare (best interests) in life-threatening situations.
Best Interests and Children: When treating minors or any patient lacking capacity, doctors must act in the patient’s best interests. Usually, parents can consent on behalf of their children. However, conflicts can arise if parents demand treatments that doctors think are futile or refuse treatment that doctors deem essential. In the UK, the child’s welfare is paramount – if agreement can’t be reached, courts can make the decision. Notable cases include Charlie Gard (2017)and Alfie Evans (2018), where doctors and parents disagreed about continuing life support for a terminally ill child. Ultimately, the courts sided with the medical teams to withdraw treatment, emphasising the child’s best interests (relieving suffering with no realistic hope of recovery) over the parents’ wishes. More recently, the Archie Battersbee case (2022) raised similar issues after a 12-year-old boy suffered brainstem death; despite his parents’ objections, the court allowed withdrawal of life support, reaffirming that when a child is determined to have no chance of recovery, doctors should not be compelled to provide treatment deemed burdensome or ineffective. These cases underscore the ethical dilemma of who should make decisions for an incapacitated patient – the family or the healthcare team – and they highlight the role of the courts in mediating such disputes in accordance with best interests principles.
Confidentiality
Maintaining patient confidentiality is both an ethical duty and a legal requirement. Doctors must maintain patient confidentiality and not disclose patient information to others without their consent. Confidentiality is crucial for establishing trust – patients need to feel safe in sharing sensitive information with their doctors. In the UK, the General Medical Council (GMC) and laws like the Data Protection Act 2018 protect patient data. However, confidentiality is not absolute. There are specific circumstances where breaching confidentiality is permitted or even required by law:
With patient consent: If the patient agrees to or requests information sharing (for example, between healthcare providers or with family), it’s allowed.
Public interest or risk of harm: If keeping confidentiality could put the patient or others in danger, doctors may disclose information to the appropriate authorities. For instance, if a patient poses a serious threat to someone or to the public (e.g. a violent plan or a highly contagious serious disease), breaching confidentiality might be justified to prevent harm.
Legal requirements: Doctors must report specific issues by law. Examples include notifying public health officials of certain infectious diseases (e.g. tuberculosis, measles) to protect public health, or informing the Driver and Vehicle Licensing Agency (DVLA) if a patient continues to drive against medical advice when they are unfit (to prevent endangering others on the road). Similarly, gunshot or knife wounds may be reported to the police, and suspected child abuse (safeguarding children) must be reported.
Court orders: If a court subpoenas medical records or testimony, doctors are obligated to comply, even without patient consent.
An example scenario often discussed is a patient confiding that they have a serious communicable disease (like HIV) but refusing to tell their partner. This situation pits confidentiality against non-maleficence/justice (protecting the partner from harm). GMC guidance allows disclosure to a sexual partner or public health authority without consent if a patient with HIV refuses to inform those at risk. Still, the doctor should usually try hard to persuade the patient to do the right thing themselves first. In an interview, when discussing such a scenario, you should acknowledge the importance of confidentiality for patient trust, as well as the doctor’s duty to protect others from serious harm. The key is showing an understanding that breaching confidentiality is exceptional and must be justified by a greater good (imminent risk or legal obligation).
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Medical Negligence and Duty of Care
Doctors have a legal duty of care towards their patients. If they breach that duty by failing to meet the appropriate standard of care, and this causes harm, it can amount to medical negligence. In the UK, the classic standard for judging the doctor’s actions in negligence cases is known as the Bolam test, from Bolam v Friern Hospital Management Committee (1957). The Bolam rule states that “a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.”In simpler terms, if a doctor’s conduct is consistent with what a reasonable group of peer professionals would have done in the same situation, the doctor will not be found negligent. This gives considerable weight to standard medical practice and expert opinion. For decades, Bolam was the dominant legal standard, including in how much information to disclose to patients.
However, the law evolved. Bolitho v City & Hackney HA (1997) refined the Bolam test by asserting that the court need not accept a medical opinion if it is not capable of withstanding logical analysis – introducing a reasonableness filter (the so-called Bolitho addendum). And as discussed in the Consent section, Montgomery (2015) explicitly departed from Bolam in the context of informing patients of risks. The Montgomery ruling recognises patients as decision-makers and expects doctors to provide all information that a reasonable patient would find significant. This is a shift from medical paternalism to patient autonomy in law. It’s a great example of how medical ethics (respect for autonomy) influenced legal standards.
Beyond consent, negligence can arise in various contexts – including misdiagnoses due to failure to meet appropriate standards, surgical mistakes, or incorrect medication administration. Another area to be aware of is the professional and legal responsibility to be honest when things go wrong.
The NHS has a statutory duty of candour, and the GMC’s guidance emphasises that doctors must be open and truthful about errors. In practice, if a doctor makes a serious mistake (for example, administering the wrong drug dose to a patient), they should inform the patient (or their family), apologise, and take steps to rectify the situation. Ethically, this reflects honesty and accountability, and legally, it can mitigate consequences. An interview question might ask how you would handle making a mistake – the expected answer is to prioritise patient care and honesty (tell your senior/supervisor, ensure the patient is safe, disclose the error to the patient, apologise, and learn from it). This shows integrity and an understanding of professional ethics.
End-of-Life Decisions and Euthanasia
Decisions around end-of-life care are emotionally charged and ethically complex. Two key issues often discussed are: (a) withdrawing or withholding life-sustaining treatment when it’s not in a patient’s best interests, and (b) euthanasia or assisted dying.
Withdrawing Treatment: In UK law, there is a clear distinction between active euthanasia and allowing death by withholding/withdrawing treatment. It is legal and ethical to withdraw life-sustaining treatment (like a ventilator or feeding tube) if continuing it is deemed not in the patient’s best interests – for instance, if a patient is in a persistent vegetative state with no hope of recovery.
The seminal case in this context is Airedale NHS Trust v Bland (1993). Tony Bland was a young man left in a permanent vegetative state after the 1989 Hillsborough disaster. The courts allowed doctors to withdraw his feeding tube, recognising that continuing treatment was futile and only prolonging his existence, not offering any prospect of recovery or meaningful life. This was considered an omission (letting nature take its course) rather than an act to cause death intentionally, and thus not unlawful. The doctrine of double effect often comes into play in palliative care: giving pain relief (like high-dose morphine) that may indirectly shorten life is acceptable if the primary intention is to relieve suffering, not to kill. For example, Dr David Moor, who administered high doses of morphine to dying patients, was acquitted in 1999 because it was determined he intended to ease pain, a valid part of reasonable care.
Euthanasia: By contrast, active euthanasia – deliberately administering a drug with the intention to end life – is illegal in the UK. There is no right to die in British law, and assisting suicide is also a criminal offence under the Suicide Act 1961. A famous case illustrating the boundary is that of Dr Nigel Cox (1992): he gave a lethal injection of potassium chloride to a patient suffering from terminal illness and in severe agony (after the patient begged for relief). Dr Cox was convicted of attempted murder because the injection’s sole purpose was to hasten death (potassium chloride has no pain-relieving property). Even the patient’s consent or desperation does not make this legal – the law’s stance is that intentional killing is not allowed in medicine.
Assisted Dying Debate: The ethical debate around euthanasia and assisted dying is very active. Proponents argue from beneficence and autonomy – that allowing terminally ill patients to choose a dignified death can alleviate unnecessary suffering and respect their personal choice. They may point to places like the Netherlands, Belgium, or Canada, where forms of physician-assisted dying are legal under strict criteria. Opponents invoke non-maleficence (“do not kill”) and caution about the slippery slope – worrying that legalising euthanasia could lead to pressure on vulnerable people, devaluation of lives with disability, or abuses if safeguards fail.
The UK, as of 2025, has not legalised assisted dying, despite ongoing public discourse and some proposed bills. An interview question like “Should euthanasia be legalised?” expects you to discuss both sides: e.g. compassion and autonomy versus the sanctity of life, potential for misuse, and the importance of improving palliative care. The current legal position is clear – deliberate life-ending acts are unlawful – but as a candidate, you should focus on the ethical reasoning and perhaps mention that any change in law would be up to society and Parliament to decide. Always conclude with a balanced personal stance if asked directly, showing you appreciate the complexity (“Overall, I would be cautious about legalising euthanasia because of X, though I understand why some patients feel Y…” or a similar nuanced take).
Do Not Resuscitate (DNR) and Advanced Decisions: Related to end-of-life law, patients in the UK can make advance decisions (living wills) to refuse specific treatments in the future, which doctors are legally bound to respect if valid and applicable. There has also been a recent development that allows people to appoint a Health and Welfare Lasting Power of Attorney to make decisions if they lose capacity. While these specifics might be beyond what most interviews cover, it’s helpful to know that respecting patient wishes at the end of life is part of both ethics (autonomy) and law.
Abortion Law and Ethics
UK Law: Abortion in Great Britain is governed by the Abortion Act 1967 (as amended by the Human Fertilisation and Embryology Act 1990). It decriminalized abortion under certain conditions. In England, Scotland, and Wales, abortion is legal up to 24 weeks of pregnancy if two doctors agree that continuing the pregnancy would pose a greater risk to the woman’s physical or mental health than terminating it. In practice, this provision is broad – effectively, most women seeking abortion within 24 weeks can legally obtain one, as pregnancy itself carries health risks. Beyond 24 weeks, abortions are allowed only in more exceptional circumstances, such as a grave risk to the mother’s life, severe fetal abnormalities, or serious permanent injury to the mother’s health. (It’s worth noting that the law in Northern Ireland historically was much stricter – until 2019, abortion was illegal primarily there. As of 2020, following UK Parliament intervention, abortion has been made legal in NI in the early stages of pregnancy, bringing it closer in line with the rest of the UK. However, implementation has been politically contentious.)
Ethical Debate: Abortion remains a topic with strong ethical arguments on both sides. On one side, the pro-choice perspective emphasises autonomy and rights of the woman: a woman should have control over her own body and reproductive choices, including the decision to end a pregnancy, especially in cases of rape, incest, or threats to her health. The mother’s well-being and life prospects are central to this view. On the other side, the pro-life perspective emphasises the value of fetal life, often arguing from non-maleficence (do no harm) – considering the fetus as an unborn child with moral status, making abortion morally akin to taking a life. Some hold a gradualist view in between, accepting early abortions but opposing late-term abortions except in extreme circumstances – noting that the fetus becomes viable around 24 weeks, which is precisely why the law sets that time limit.
An interview question on abortion might be framed as, “Do you agree with abortion?” or “What are the ethical issues surrounding abortion law?”. A good approach is to acknowledge the complexity by discussing women’s rights and welfare, fetal rights, and how the law attempts to balance these (for example, by implementing a 24-week limit and requiring medical approval). You can mention that in UK law, the fetus does not have independent legal rights until birth, whereas the woman’s rights and health are paramount up to that point.
Also, consider the international context: in some countries, abortion is more restricted or has recently been debated. A high-profile example is the United States, where the constitutional right to abortion established by Roe v. Wade (1973) was overturned in June 2022 by the Supreme Court, removing federal protection and allowing individual states to ban abortion. This led to significant variability and controversy, illustrating how ethics and law around abortion differ worldwide. For your interview answer, after presenting both sides, it’s wise to conclude with a sensitive, reasoned personal view and stress that, as a doctor, your duty would be to care non-judgmentally for patients, whatever their decisions within the law.
International Perspectives
While the focus of UK medical school interviews will be on UK ethics and law, it can enrich your answers to show awareness of international examples where relevant. We’ve already touched on a few: legalised euthanasia in some countries versus its prohibition in the UK, and varying abortion laws globally. Another example is organ donation systems – the UK transitioned to an “opt-out” consent system in 2020 for organ donation (except in Northern Ireland), reflecting an ethical stance to increase fairness in organ allocation; other countries, such as Spain, had success with opt-out systems earlier.
You might also consider public health ethics: for instance, during the COVID-19 pandemic, different countries adopted varying policies (lockdowns, mask mandates, vaccine mandates), sparking debates about individual freedom versus community health. If asked something like “Should vaccination be mandatory for certain diseases?”, you could mention how some nations require childhood vaccinations for school entry – an approach that prioritises community health (justice and beneficence) but at the cost of some individual autonomy. Always tie it back to ethical principles and, if possible, any relevant legal frameworks (e.g., public health laws) to demonstrate your appreciation for the interplay between law, ethics, and cultural values.
Having explored the core principles and legal cases, let's now apply this knowledge to some practice questions.
Example Medical School Interview Questions on Medical Law and Ethics
Medical school interviewers often pose hypothetical scenarios or direct questions to assess your understanding of ethics and law, as well as your ability to reason clearly and empathetically. Here are 15 example questions that cover a range of medical law and ethics topics. Try practising how you would approach each one, using the four pillars and relevant legal context to structure your answers:
What are the four pillars of medical ethics, and why are they important in clinical decision-making?
Describe a situation where a patient’s autonomy might conflict with beneficence. How should a doctor handle it? (For example, a patient refusing a life-saving treatment – what ethical and legal considerations come into play?)
How do doctors decide if a patient has the capacity to consent to or refuse treatment? (What criteria are used, and what happens if the patient is found to lack capacity?)
A 15-year-old patient asks for contraception and does not want her parents to know. What issues does this raise, and what would you do?
What does informed consent mean, and how did the case of Montgomery (2015) change the standard for obtaining consent?
Under what circumstances, if any, is it acceptable for a doctor to breach patient confidentiality?
If a patient diagnosed with a serious communicable disease (e.g. HIV) refuses to tell their partner, what would you do as their doctor?
Should a doctor ever withhold information from a patient “for their own good”? (Consider the ethics of truth-telling vs. paternalism in medicine.)
Discuss the ethical and legal considerations in end-of-life care decisions. (For instance, deciding to withdraw life support in a critically ill patient – who should decide and on what basis?)
What are your thoughts on the legalisation of euthanasia or physician-assisted suicide? (Give arguments on both sides and explain your position.)
Outline the current abortion law in the UK and discuss the ethical debates surrounding abortion.
How should doctors approach allocating a scarce resource, like one ICU bed or a donor organ, when multiple patients need it? (What principles of justice or criteria could be used to make a fair decision?)
What is “medical negligence”? Give an example of a scenario that could constitute negligence by a doctor.
If you made a serious mistake that harmed a patient, what would you do afterwards? (What are the ethical and professional steps a doctor should take in such a situation?)
Imagine you suspect that a senior colleague is practising in a way that endangers patients (for example, coming to work intoxicated or ignoring safety protocols). What would you do? (Discuss the balance between professional duty, patient safety, and the difficulties of whistleblowing.)
Each question above tests your ability to apply ethical principles and knowledge of medical law in a reasoned manner. When responding, remember to remain calm, think systematically (often using the four pillars framework), and show empathy and respect for all parties involved. It’s fine to acknowledge when issues are complex – interviewers aren’t looking for a “perfect” answer but instead insight into your thought process and moral reasoning. They want to see that you can appreciate multiple perspectives and justify your decisions based on ethical principles and, where relevant, legal guidance.
Conclusion
Mastering medical law and ethics is a crucial aspect of preparing for medical school interviews. A strong candidate can articulate the core ethical principles – autonomy, beneficence, non-maleficence, and justice – and apply them to challenging scenarios, while also being mindful of the legal duties and precedents that govern medical practice in the UK. Whether discussing a patient’s right to refuse treatment, the confidentiality dilemmas that doctors face, or debates on issues like abortion and euthanasia, your goal should be to demonstrate balanced reasoning. Demonstrate an understanding of the patient’s perspective, the doctor’s responsibilities, and the broader societal values. Referencing key cases (such as Montgomery for consent, or Gillick for young patients) or guidelines can add depth to your answers, indicating that you’ve gone beyond surface-level knowledge.
Finally, practice is crucial. Use the sample questions to rehearse structuring your thoughts. When speaking, maintain a formal yet compassionate tone – much like a real doctor would. By preparing thoroughly in medical law and ethics, you will not only be ready to excel in those interview stations but also be building a foundation for your future professional life. After all, being a great doctor is not just about scientific knowledge, but also about moral integrity, legal accountability, and doing what is right for patients. Good luck with your interviews!
