Medical Ethics Foundations for SJT

You do not need to be a medical ethicist to score well on SJT. But understanding the four pillars of medical ethics gives you a robust framework for answering questions consistently and correctly. When you are unsure about a scenario, these principles act as a compass.

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The Four Pillars of Medical Ethics

These four principles, established by Beauchamp and Childress, form the foundation of medical ethics teaching worldwide. Every SJT scenario can be analysed through this lens.

1. Autonomy

Definition: Respect for the patient's right to make their own decisions about their care.

Aspect	What it means in practice
Informed consent	Patients must be given sufficient information to make decisions
Right to refuse	Patients can refuse treatment, even if you believe it would help them
Capacity	Patients with capacity have the right to make decisions you disagree with
Voluntariness	Decisions must be made freely, without coercion
Confidentiality	Protecting patient information respects their autonomy over personal data

SJT application: When a scenario involves a patient making a decision you disagree with, autonomy tells you to respect their choice (assuming they have capacity), while ensuring they have all the relevant information.

Example scenario: A patient with diabetes refuses to change their diet despite medical advice.

• Very appropriate: Ensure the patient fully understands the risks, respect their decision, and document the discussion
• Very inappropriate: Tell the patient they must change their diet, threaten to discharge them, or go behind their back to inform family members without consent

2. Beneficence

Definition: The duty to act in the best interest of the patient — to do good.

Aspect	What it means in practice
Promoting wellbeing	Choosing treatments and actions that benefit the patient
Preventing harm	Taking proactive steps to protect patients
Balancing risks	Ensuring the benefits of an action outweigh the risks
Competence	Maintaining your own skills to provide the best possible care

SJT application: Beneficence often drives the "correct" answer in scenarios about treatment decisions, referrals, and going above-and-beyond for patient welfare.

Example scenario: You notice a patient on the ward seems confused and has not been reviewed by a doctor today.

• Very appropriate: Alert the nursing staff and ensure a review is arranged
• Inappropriate: Assume someone else will notice and take no action

3. Non-Maleficence

Definition: The duty to do no harm — "primum non nocere" (first, do no harm).

Aspect	What it means in practice
Avoiding harm	Not performing procedures or treatments that carry unnecessary risk
Recognising limits	Not attempting procedures beyond your competence
Reporting concerns	Raising concerns when patient safety is at risk
Honest mistakes	Acknowledging errors transparently rather than covering them up

SJT application: Non-maleficence is central to scenarios about patient safety, reporting errors, and recognising the limits of your competence.

Example scenario: You are a medical student and a nurse asks you to prescribe medication for a patient.

• Very appropriate: Explain that you are not qualified to prescribe and help find a qualified doctor
• Very inappropriate: Prescribe the medication to be helpful (violates non-maleficence — you could cause harm)

4. Justice

Definition: Fair distribution of resources and equitable treatment of all patients.

Aspect	What it means in practice
Fair treatment	All patients receive care regardless of background, status, or personal characteristics
Resource allocation	Resources are distributed based on clinical need, not personal preference
Non-discrimination	No patient is disadvantaged based on age, gender, ethnicity, disability, religion, or socioeconomic status
Transparency	Decisions about resource allocation are made openly and fairly

SJT application: Justice appears in scenarios about resource allocation, treating patients fairly, and challenging discriminatory behaviour.

Example scenario: A colleague makes a dismissive comment about a patient's lifestyle choices.

• Very appropriate: Address the comment privately with the colleague and ensure the patient receives unbiased care
• Very inappropriate: Ignore the comment or agree with it

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How the Pillars Interact

In many SJT scenarios, two or more pillars conflict with each other. Understanding these tensions is crucial.

Common Conflicts