Multiple Mini Interview (MMI) Ethics and Professionalism Syllabus

Can a competent 16–17 year old in the UK refuse life-saving treatment?

They can consent to treatment, but their refusal of life-saving treatment can in some circumstances be overridden by a person with parental responsibility or the court — unlike a competent adult's refusal.

What is the general duty of confidentiality owed to patients?

Doctors must not disclose identifiable patient information without consent, as confidentiality is essential to maintaining trust in the doctor-patient relationship.

List the main situations in which confidentiality can lawfully be breached.

With patient consent; when required by law (e.g. court order, notifiable diseases); and when disclosure is in the public interest (e.g. preventing serious harm to others).

Give two examples where confidentiality must be breached because the law requires it.

Reporting notifiable infectious diseases, and informing the DVLA-relevant authority/notifying under statutory duties such as the Road Traffic Act when a driver is unfit to drive (after attempts to persuade them).

What is the public interest test for breaching confidentiality?

Disclosure may be justified when it is necessary to prevent a risk of serious harm or death to the patient or others, and the benefit of disclosing outweighs the harm to trust and the individual.

Does the duty of confidentiality continue after a patient dies?

Yes — the ethical and legal duty of confidentiality persists after death.

What is the legal and ethical status of euthanasia in the UK?

Euthanasia (a doctor actively ending a patient's life) is illegal and is treated as murder or manslaughter under UK law.

Distinguish euthanasia from withdrawal of treatment.

Euthanasia is an active act intended to cause death (illegal); withdrawing or withholding futile/unwanted treatment, allowing the natural disease to take its course, is lawful and ethically accepted.

What is the doctrine of double effect in end-of-life care?

Giving treatment (e.g. opioids) with the intention of relieving suffering is permissible even if it may foreseeably hasten death, provided the primary intention is symptom relief and not to kill.

What is an Advance Decision to Refuse Treatment (ADRT / living will)?

A legally binding decision made by a capacitous adult to refuse specified treatment in the future should they lose capacity; it must be valid and applicable to the situation, and refusal of life-sustaining treatment must be in writing, signed and witnessed.

What is the legal status of assisted dying / assisted suicide in the UK (as of the framework taught)?

Assisting a suicide is a criminal offence under the Suicide Act 1961; helping someone end their life can lead to prosecution.

What does the ethical principle of the 'sanctity of life' contribute to end-of-life debates?

It holds that human life has intrinsic value and should be preserved, which can conflict with patient autonomy and quality-of-life arguments at the end of life.

What is the legal time limit for most abortions in Great Britain under the Abortion Act 1967 (as amended)?

Up to 24 weeks' gestation, provided two registered doctors agree continuing the pregnancy poses a greater risk to the woman's (or existing children's) physical or mental health.

Under what circumstances can an abortion be performed after 24 weeks in Great Britain?

With no time limit if there is grave permanent injury risk to the woman, risk to her life, or substantial risk the child would be seriously handicapped.

What key ethical tension underlies reproductive ethics such as abortion?

The conflict between the woman's autonomy over her own body and the moral status/right to life of the fetus.

Whose consent is legally required for an abortion in the UK?

Only the pregnant woman's (if she has capacity); the father/partner has no legal right to consent to or veto the procedure.

What ethical framework is most associated with 'the greatest good for the greatest number' in resource allocation?

Utilitarianism (consequentialism) — maximising overall benefit/welfare across the population.

What is a QALY and how is it used in resource allocation?

A Quality-Adjusted Life Year combines length and quality of life into a single measure; one QALY equals one year of perfect health. NICE uses cost-per-QALY to judge whether treatments are cost-effective.

What body in England assesses cost-effectiveness of treatments for NHS funding?

NICE (the National Institute for Health and Care Excellence).

Name common criteria used when allocating scarce medical resources (e.g. organs or ICU beds).

Clinical need, likelihood of benefit, urgency, capacity to benefit, and fairness/equity — explicitly excluding ability to pay or social worth judgements.

What is the core ethical dilemma in resource allocation?

Balancing distributive justice (fairness to the whole population) against the duty of beneficence to the individual patient in front of you, given finite resources.

What is herd immunity?

When a sufficiently high proportion of a population is immune (through vaccination or prior infection) that transmission of a disease is interrupted, indirectly protecting the non-immune.

Why is mandatory vaccination ethically contentious?

It pits public health benefit (beneficence/justice for the community and herd immunity) against individual autonomy and bodily integrity.

Is childhood vaccination compulsory in the UK?

No — childhood vaccination in the UK is recommended and voluntary, relying on informed parental consent rather than legal compulsion.

What public health ethics principle justifies some restrictions on individual liberty?

The harm principle — individual freedom may be limited to prevent harm to others, underpinning measures like isolation of infectious patients.

Define probity in the context of medical professionalism.

Probity means being honest, trustworthy, and acting with integrity in all professional dealings, including with patients, colleagues, employers, and regulators.

Give examples of probity breaches a doctor must avoid.

Falsifying research data, fraudulent claims/CV padding, accepting inappropriate gifts/bribes, dishonest financial dealings, and lying or misleading patients or colleagues.

What is the duty of candour?

The professional (and statutory) duty to be open and honest with patients when something goes wrong with their care, including apologising and explaining what happened and its consequences.

What is whistleblowing in healthcare, and what should a doctor do first when they have a concern?

Raising a concern about patient safety, malpractice, or wrongdoing. A doctor should first raise it through local/internal channels (e.g. a manager or clinical lead), escalating externally (e.g. to the regulator) if the concern is not addressed.

Which UK law protects employees who raise concerns (whistleblowers)?

The Public Interest Disclosure Act 1998 (PIDA), which protects workers from detriment for making protected disclosures.

What is a conflict of interest, and how should a doctor manage one?

A situation where personal, financial, or other interests could improperly influence professional judgement; it should be declared/disclosed transparently and managed or avoided so patient interests remain paramount. Examples include treating family members, accepting gifts from drug companies, or financial interests in services to which patients are referred.