The interview question bank

Competing duties with no perfect answer: consent, confidentiality, fairness.

• EthicsIntermediate·MMI station · MD, DO, PA, Nursing, Residency

  A Jehovah's Witness patient refuses a blood transfusion they need to survive. What do you do?

  Autonomy and consent · Cultural humility · Communication

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  Sample answer outline

  1. 1A competent adult can refuse even life-saving treatment. Your job is to make sure the refusal is informed, voluntary and consistent with their values.
  2. 2Talk with them privately to check for pressure from family or community.
  3. 3Explore what they will accept: bloodless surgery techniques, cell salvage, iron, medicines that boost blood production.
  4. 4Document the conversation and their decision clearly, and keep caring for them fully.
  5. 5Note how it differs for a child or for an unconscious patient without an advance directive.

  What makes it work

  • It respects autonomy while doing everything else possible.
  • Showing the contrast with a child proves you understand the limits.

  Avoid

  • Trying to persuade them out of their faith.
  • Treating the refusal as a reason to step back from their care.

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• EthicsIntermediate·MMI station · MD, DO, PA

  A family begs you not to tell their grandmother she has cancer because "it'll kill her faster." What do you do?

  Autonomy and consent · Cultural humility · Communication

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  1. 1Listen to the family first: their fear and any cultural norms around sharing bad news.
  2. 2Explain that the information belongs to the patient, and that you won't lie to her.
  3. 3Ask the grandmother how much she wants to know and who she wants involved. Some people choose to let family decide.
  4. 4Share news at her pace, with the family present if she wishes, and plan support together.

  What makes it work

  • Asking the patient what she wants resolves the dilemma respectfully.
  • It honors culture without giving up honesty.

  Avoid

  • Telling her bluntly against the family's wishes without asking her first.

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• EthicsIntermediate·MMI station · Dental

  A patient insists on a cosmetic procedure you believe is unnecessary and could damage healthy teeth. They've already paid in full. What do you do?

  Autonomy and consent · Integrity · Communication

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  Sample answer outline

  1. 1Understand their goal: what do they want to change about their smile, and why now?
  2. 2Explain the risks honestly: removing healthy tooth structure is irreversible.
  3. 3Offer conservative alternatives that meet the goal, such as whitening, bonding or orthodontics.
  4. 4If you still believe it causes harm, decline and refund. Payment doesn't change your duty.
  5. 5Document the discussion.

  What makes it work

  • It separates the patient's goal from the procedure they asked for.
  • Being clear about the payment shows integrity.

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• EthicsIntermediate·MMI station · Nursing, PA, MD, DO

  A patient confides they stopped taking prescribed medications due to religious beliefs, but asks you not to tell the physician. Their condition is worsening. How do you respond?

  Confidentiality · Autonomy and consent · Patient safety

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  How to approach ethical dilemma questions

  1. 1Clarify the facts and what you would want to know before acting.
  2. 2Name who is affected and the principles in tension: autonomy, doing good, avoiding harm, fairness, confidentiality.
  3. 3Walk through realistic options, starting with the least drastic.
  4. 4Choose a course of action, explain why, and say who you would involve.

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