Multiple Mini Interview (MMI) Ethics and Professionalism Syllabus

Ethics and Professionalism syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Ethics and Professionalism in Multiple Mini Interview (MMI), not a summary of it.

1. 1

   The Four Pillars of Medical Ethics

   4 topics

   • Autonomy
     • Respecting patient choice and informed decision-making
     • Refusal of treatment by competent adults
   • Beneficence and non-maleficence
     • Balancing benefit against harm
     • Risk-benefit reasoning
   • Justice
     • Fair allocation of finite NHS resources
     • Equity vs equality of access
   • Applying the four pillars to a dilemma
     • Weighing competing principles
     • Structured ethical reasoning out loud
2. 2

   Consent, Capacity and Confidentiality

   4 topics

   • Valid consent
     • Voluntary, informed and capacitous consent
     • Montgomery and material risk disclosure
   • Mental capacity
     • Mental Capacity Act two-stage test
     • Best interests for those lacking capacity
   • Gillick competence and young people
     • Gillick competence and Fraser guidelines
     • Parental responsibility limits
   • Confidentiality and its limits
     • When breaching confidentiality is justified
     • Duty to protect third parties and public interest
3. 3

   Common Ethical Dilemmas

   4 topics

   • End-of-life issues
     • DNACPR and withdrawal of treatment
     • Assisted dying debate in the UK
   • Reproductive ethics
     • Abortion law in the UK
     • Contraception and conscientious objection
   • Resource allocation dilemmas
     • Rationing and NICE/QALY decisions
     • Triage and prioritisation
   • Vaccination and public health ethics
     • Mandatory vs voluntary vaccination
     • Individual liberty vs collective benefit
4. 4

   Professional Behaviour and Integrity

   3 topics

   • Probity and honesty
     • Admitting mistakes and duty of candour
     • Academic and clinical honesty
   • Raising concerns and whistleblowing
     • Escalating an underperforming colleague
     • Patient safety over loyalty
   • Boundaries and conflicts of interest
     • Gifts, social media and professional distance
     • Treating friends and family

Ethics and Professionalism flashcards for Multiple Mini Interview (MMI)

20 of 51 cards from the Ethics and Professionalism deck — real questions with worked answers.

1. What are the four pillars (principles) of medical ethics?

   Autonomy, Beneficence, Non-maleficence, and Justice (the Beauchamp and Childress framework).

2. Define autonomy as a pillar of medical ethics.

   Respecting the patient's right to make their own informed decisions about their care, free from coercion, even if the doctor disagrees with the choice.

3. Define beneficence in medical ethics.

   The duty to act in the patient's best interests and to do good — promoting their wellbeing and providing benefit.

4. Define non-maleficence in medical ethics.

   The duty to 'first, do no harm' (primum non nocere) — avoiding causing injury or suffering to the patient.

5. How do beneficence and non-maleficence relate to one another in practice?

   They are weighed together as a risk-benefit balance: every intervention carries potential harm, so the doctor ensures the expected benefit outweighs the risk of harm.

6. Define justice as a pillar of medical ethics.

   Treating patients fairly and equitably, distributing resources justly, and not discriminating — equals should be treated equally.

7. Name the three sub-types of justice often distinguished in medical ethics.

   Distributive justice (fair allocation of resources), legal/rights-based justice (respecting law and rights), and respect for people's equality.

8. What is a structured approach to applying the four pillars to an ethical dilemma?

   Identify the issue, consider each pillar (autonomy, beneficence, non-maleficence, justice) in turn, weigh competing principles against each other, consider the law/GMC guidance, and reach a balanced, justifiable decision.

9. When two ethical pillars conflict (e.g. autonomy vs beneficence), how should they be handled?

   No pillar is automatically supreme; they are weighed against each other in the specific context, and the decision is justified by which principle carries most weight in that case.

10. What are the three core components of valid consent?

    The patient must be (1) informed (given adequate information), (2) have capacity, and (3) give consent voluntarily (free from coercion).

11. Which legal case redefined the standard of information disclosure for consent in the UK?

    Montgomery v Lanarkshire Health Board (2015) — patients must be told of any material risks a reasonable person in their position would want to know, plus any risks significant to that particular patient.

12. Does consent always have to be written to be valid?

    No. Consent can be verbal, written, or implied (non-verbal); written consent is documentation of the process, not a legal requirement for validity except in specific circumstances.

13. Which Act governs decision-making for adults who lack capacity in England and Wales?

    The Mental Capacity Act 2005.

14. State the two-stage test for assessing mental capacity under the Mental Capacity Act 2005.

    Stage 1 (diagnostic): is there an impairment of, or disturbance in, the functioning of the mind or brain? Stage 2 (functional): does that impairment mean the person is unable to make this particular decision?

15. What are the four functional abilities a person must have to demonstrate capacity?

    Ability to (1) understand the information, (2) retain it (long enough to decide), (3) weigh/use it in the decision, and (4) communicate the decision.

16. List the five statutory principles of the Mental Capacity Act 2005.

    (1) Presumption of capacity; (2) support to make own decision; (3) unwise decisions do not mean lack of capacity; (4) acts for those lacking capacity must be in their best interests; (5) choose the least restrictive option.

17. Is mental capacity decision-specific or global?

    Decision-specific and time-specific — a person may have capacity for some decisions but not others, and capacity can fluctuate over time.

18. What is Gillick competence?

    A test allowing an under-16 to consent to their own medical treatment if they have sufficient maturity and understanding to fully appreciate what is involved, without needing parental consent.

19. From which legal case does Gillick competence originate?

    Gillick v West Norfolk and Wisbech Area Health Authority (1985).

20. What are the Fraser guidelines, and what do they specifically apply to?

    Criteria for providing contraceptive (and sexual health) advice/treatment to under-16s without parental consent: the young person understands the advice, cannot be persuaded to tell parents, is likely to have sex regardless, their health would suffer without treatment, and it is in their best interests.

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