Practice Set 8: Ethical Dilemma Scenarios

Ethical dilemmas are scenarios where two or more ethical principles conflict and there is no option that satisfies all of them perfectly. The SJT is built on the four pillars of medical ethics — autonomy, beneficence, non-maleficence, and justice — and dilemma questions test whether you can navigate the tension between them.

Common ethical tensions in the SJT include: a patient's autonomy versus their safety, confidentiality versus public protection, doing what a patient wants versus what is medically best for them, and fair resource allocation when demand exceeds supply. There is rarely a "perfect" answer in these scenarios — the best answer is the one that manages the tension most professionally.

When ethical principles conflict, the SJT generally applies a hierarchy: patient safety (non-maleficence) is the overriding priority, followed by patient autonomy, beneficence, and justice. However, this hierarchy is not absolute — the specific circumstances of each scenario determine which principle takes precedence.

Partial credit scoring is especially important in ethical dilemma questions. Because these scenarios are genuinely complex, the difference between Band 1 and Band 2 may come down to very fine distinctions. Focus on eliminating clearly inappropriate responses first, then rank the remaining options by how well they balance the competing ethical principles.

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Quick-Reference Decision Framework

Ethical Tension	General SJT Approach	Key Consideration
Autonomy vs Safety	Safety usually wins if the patient lacks capacity or others are at risk	Respect autonomy when the patient has capacity and only affects themselves
Confidentiality vs Public Protection	Breach confidentiality only as a last resort and only for serious risk	Explore all alternatives before disclosure
Patient wishes vs Medical advice	Respect wishes if the patient has capacity and has been fully informed	Ensure genuine informed consent, not just compliance
Individual need vs Resource fairness	Consider clinical need objectively, not personal characteristics	Justice means treating like cases alike
Beneficence vs Non-maleficence	Weigh the potential benefit against the potential harm	A treatment that does more harm than good is not beneficent

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Focus for This Practice Set