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Ethical Dilemmas in Medicine: 16 Examples and What the Guidance Says
The ethical dilemmas that come up most in medicine are about refusing treatment, informed consent, confidentiality, truth-telling, futile care and end-of-life decisions, patients who lack capacity, minors, scarce resources, medical errors, unsafe colleagues and conscience, with newer ones from telemedicine and AI. For most, the AMA Code of Medical Ethics publishes guidance, and most turn on two of the four principles of medical ethics pulling in different directions.
Below are sixteen, each with an example we wrote, the principles in tension and what the official guidance says, read October 31, 2026. Then a five-step way to work through any dilemma, how medical school interviews turn these into questions and a full example answer. Guidance differs by state and institution, so this is an orientation, not legal advice.
Sixteen ethical dilemmas in medicine, with examples
| Dilemma | Example | In tension | What the guidance says |
|---|---|---|---|
| Refusing treatment | Example: A capable adult refuses dialysis that would keep him alive. | In tension: Autonomy vs beneficence | What the guidance says: A capable patient may decline any intervention, even one expected to lead to death. There is no ethical difference between withholding and withdrawing treatment. Source |
| Informed consent | Example: A patient signs a consent form minutes before surgery without reading it. | In tension: Autonomy vs a rushed process | What the guidance says: Consent is fundamental in ethics and law. Assess whether the patient understands the options and can decide voluntarily. Source |
| Confidentiality and safety | Example: A patient tells you he plans to hurt his former partner. | In tension: Confidentiality vs others' safety | What the guidance says: HHS says providers may disclose what is needed, without permission, to anyone in a position to prevent or lessen a serious and imminent threat. The AMA asks for the minimum necessary. Source More |
| Family asks you not to tell | Example: A daughter asks the team not to tell her father he has cancer. | In tension: Autonomy vs beneficence | What the guidance says: Withholding information without the patient's knowledge or consent is ethically unacceptable outside emergencies, but it can be shared over time at the patient's pace. Source |
| Care that won't help | Example: A family demands full ICU treatment for a patient the team believes cannot recover. | In tension: Autonomy and family wishes vs nonmaleficence | What the guidance says: Physicians are not required to provide interventions that cannot reasonably be expected to help, and autonomy does not mean getting an intervention just because it is requested. There is no single, universal definition of futility. Source |
| Do-not-resuscitate orders | Example: A capable patient asks for a DNR order and her son objects. | In tension: Autonomy vs the family's beneficence | What the guidance says: Physicians must respect decisions to refuse care, even when they will result in death, and should raise resuscitation early, while the patient has capacity. Source |
| Patients who lack capacity | Example: A patient with advanced dementia needs a decision about a feeding tube. | In tension: Autonomy vs beneficence | What the guidance says: Identify the right surrogate, support them, and involve the patient as far as their capacity allows. Source |
| Minors and parents | Example: A 15-year-old disagrees with her parents about a treatment. | In tension: Parental authority vs the minor's developing autonomy | What the guidance says: The more mature the minor, the stronger the obligation to seek their assent to treatment. Source |
| Scarce resources | Example: Two patients need the last ICU bed. | In tension: Justice vs beneficence to the patient in front of you | What the guidance says: Base allocation on medical need: urgency, likelihood and duration of benefit, and change in quality of life. Source |
| Medical errors | Example: A wrong dose was given. The patient is fine and does not know. | In tension: Honesty vs fear of liability | What the guidance says: Disclose the error and the possible harm. The AMA says concern about liability should not affect honesty with the patient. Source |
| An unsafe colleague | Example: A resident smells alcohol on an attending before a procedure. | In tension: Loyalty vs patient safety | What the guidance says: Protect the patient first: speak up so the procedure does not start (our advice). Then report the conduct to the appropriate clinical authorities first, so the colleague can get help. Source |
| Conscientious objection | Example: A physician objects on moral grounds to a legal procedure a patient requests. | In tension: Personal integrity vs duty to the patient | What the guidance says: Physicians have considerable latitude to act on well-considered, deeply held beliefs, but that freedom is not unlimited. Source |
| Gifts from patients | Example: A grateful patient offers an expensive watch. | In tension: Gratitude and culture vs fairness to all patients | What the guidance says: Decline gifts that are disproportionately large, or that you would be uncomfortable having colleagues know about, and never let a gift influence care. Source |
| Telemedicine | Example: A video visit patient wants a diagnosis that really needs an exam. | In tension: Access and convenience vs safe, complete care | What the guidance says: Physicians' fundamental ethical duties do not change online, including privacy, confidentiality and continuity of care. Source |
| AI in care | Example: An AI tool rates a patient low risk, but your exam worries you. | In tension: Efficiency vs clinical judgment and transparency | What the guidance says: The AMA calls it augmented intelligence to stress that AI assists rather than replaces clinicians, and says its use must be transparent to physicians and patients. Source |
| Moral distress | Example: A nurse believes a dying patient's treatment only prolongs suffering, but the decision is not hers. | In tension: Your values vs institutional constraints | What the guidance says: AACN defines moral distress as "the inability to do the right thing due to institutional constraints." Raise it through the team or an ethics consult. Source |
Two of these deserve a closer look because they surprise people. On refusals, the AMA says a capable patient “has the right to decline any medical intervention or ask that an intervention be stopped, even when that decision is expected to lead to their death” (AMA Code). On truth-telling, it says withholding information without the patient's knowledge or consent is ethically unacceptable except in emergencies, while allowing information to be shared over time at the patient's pace (AMA Code). For the elements of consent and its exceptions, see informed consent in healthcare, and for when you can share information, patient confidentiality and duty to warn. For code status, see DNR vs DNI vs full code. How clinicians judge whether a patient can decide is in capacity vs competence.
How to work through an ethical dilemma
Our five steps, which work at the bedside and in an interview room:
- Get the facts. What is known, what is not, and does the patient have capacity for this decision?
- Name what is in tension. Usually two of the four principles, or a duty against a law or a policy.
- Check the guidance. The law, your institution's policy and professional codes like the AMA's often narrow the options.
- Talk to the people involved. Most dilemmas ease once you find out why someone wants what they want.
- Decide, document and follow up. Make the choice you can defend, involve seniors or an ethics consult when needed, and revisit it.
Step 4 is where most dilemmas soften. A family asking you to hide a diagnosis, a patient refusing a transfusion or a colleague in trouble usually has a reason you can only find by asking. When the news itself is the hard part, the SPIKES protocol gives you a structure for the conversation.
End-of-life requests
What the AMA Code says about physician-assisted suicide
Laws differ by state, and the AMA Code takes a clear position: physician-assisted suicide is “fundamentally incompatible with the physician's role as healer.” It also says physicians should not abandon a patient once it is determined that cure is impossible, and must respect autonomy, communicate well and provide comfort care and adequate pain control (AMA Code).
Where medical aid in dying is legal, and the rules, are in medical aid in dying. In an interview you do not need to share a personal position. Show that you understand why patients ask, what the guidance says and what you would do for the patient in front of you.
How medical school interviews use these dilemmas
MMI ethics stations, panel interviews and Casper all give you a short version of a dilemma like the ones above. They are testing what the AAMC calls ethical responsibility, which includes considering “multiple and/or conflicting principles and values to inform decisions” (AAMC premed competencies). You are not expected to know the AMA Code. You are expected to see both sides, ask for the facts you need and reach a decision.
For 40 prompts in interview form, see MMI ethics questions, and for the written version, Casper ethics questions.
Practice question: the family who asks you not to tell
“A daughter asks you not to tell her father that his biopsy shows cancer. She says the news would destroy him. What do you do?”
A truth-telling dilemma that comes up in MMIs and panel interviews. A strong answer takes the daughter seriously, finds out what the father wants and does not lie to him.
Example answer written by Confetto (the applicant is invented)
I would start with the daughter, because her request comes from love and she knows her father. I would ask what she is worried will happen, and whether something in his past or his culture shapes how the family handles bad news.
Then I would explain that I cannot hide his diagnosis from him. He is the patient, and decisions about his treatment are his to make. But I would also tell her that how and when he hears it can be shaped around him.
With her there if he wants, I would ask her father how much he wants to know about his results and whether he would like family involved. Some patients want every detail, and some want their family to handle it. If he says he wants to know, I tell him honestly, in plain words and at his pace. If he clearly asks for his daughter to take the lead, I respect that and document it.
Either way, I would make sure the daughter has support, because she is about to go through this too.
Sources: the AMA Code of Medical Ethics opinions and AI policy page, HHS, AACN and the AAMC, linked throughout and checked October 31, 2026.
Frequently asked questions
What are the most common ethical dilemmas in healthcare?
Refusal of treatment, informed consent, confidentiality, truth-telling, futile care and DNR orders, patients who lack capacity, minors, scarce resources, medical errors, unsafe colleagues, conscience, gifts, telemedicine, AI and moral distress. The table on this page gives an example and the guidance for each.
Can a doctor break confidentiality to protect someone?
Yes, in limited cases. HHS says providers may disclose the information needed to someone in a position to prevent or lessen a serious and imminent threat, without the patient's permission. The AMA asks physicians to share only the minimum necessary. See the HHS guidance.
Do doctors have to tell patients about medical errors?
The AMA Code says physicians involved in an error should disclose it, explain the possible harm and give the patient what they need to make decisions, and that concern about liability should not affect their honesty. Read the AMA opinion on patient safety.
Is withdrawing life support different from never starting it?
Not ethically, according to the AMA Code. It says there is no ethical difference between withholding and withdrawing treatment, though the two can feel very different to families. Read the AMA opinion.
How do medical school interviews use ethical dilemmas?
MMI ethics stations, panel questions and Casper give you a short dilemma and watch how you reason. They want you to see more than one side, use the facts and reach a decision you can explain. Practice with 40 MMI ethics questions.