Ethical interview question

[Robin Hood]

So what happens if the donor attained the money in a legitimate manner, even one that helped others along the way, and is then putting that money toward a good cause for just one thing in return? Take it to the other extreme, let's say each dollar that the donor raised saved a life, before it was donated. Will you accept their money?

 

Going on another point, will you even take the first donor's money in the first place? How bout the second? Does that make a difference?

 

That could still lead to discrimination based on income, and in most cases, your income is determined by luck.

[Robin Hood]

I'll take a stab at this.

 

I'd take the 300k from the rich guy and move him up enough in the waitlist so as to not directly cause someone's death, but also to benefit him. First I'd have to figure out the average time between movements on the waitlist i.e. how often do you come across a viable liver? I'm sure the time is quite variable, so you'd look at the average (median gets rid of any outliers, if the mode is strong enough you might take that instead). Then look at the people on the waitlist, they should generally be prioritized by the order as well as the urgency of their situation (as far as I know anyways, could be wrong).

 

Take the rich guy and move him up to as high of a spot as you can so that you can give him a better chance of survival, while keeping the more urgent cases near the top that need to stay up there to have a chance of living. If the donor's situation is also urgent, make it clear to him that you can't sacrifice someone's life for his just because he's more wealthy, tell him that you'll still move him up and that it's his call to make on whether or not he still wants to give the money or not. On a side note, you can use this time to let him know what kind of benefit his donation will have on others, so even if the worst does happen and he doesn't make it, he'll still make a huge difference to other patients.

 

Now this makes you wonder, how much money do you have to donate in order to get moved up? Should the amount of money you donate to a hospital correlate with the number of spots you move up a waitlist? I'd set some kind of limit, i.e. you have to donate this much to get moved up in the first place. No kind of correlation. You cannot donate your way to the very top, we place you as stated above. I'd set a limit to the number of these types of "donations" per time frame e.g. only one a month, or maybe set different positions on the list e.g. this guy can get moved up to 10th place, after that the next guy can only get moved up to 15th, something like that. That way you don't have loads of rich people pushing poor people down waitlists.

 

You'd also want to look at the rich guy's health, like if he's expected to die in 2 months you're not going to move him all the way just to get a new liver (then again you could move him up as above, knowing there's a huge possibility he won't be taking a liver away anyways, and your hospital would just get free money, but that would basically be lying to him, so unethical). If the donor turns out to be a raging alcoholic/drug user (which he kept secret from you because you didn't look at why he needed a new liver in the first place, or maybe he decided to take it up recently) and three months later needs a new liver, that's not gonna happen.

 

Then you can take the guy's 300k or whatever he's donating, and put it towards some kind of program that would benefit other patients. In order to minimize the amount that you're essentially screwing over the other people on the waitlist, I'd want to put it towards some program that would benefit them, something that improves their treatment or maybe fund some kind of donor program. Overall you'd want some kind of net benefit, you don't want some guy getting a new liver because he's rich, but because it's going to help more people down the line.

 

I'm sure I missed some points which is where you guys come in.

 

The hospital and other patients could benefit from the donation, and between two people who have an equal urgency for the liver transplant, you may be temped to priviledge the one who will make the donation. But then, that could lead to rich people taking sposts away from poor people and having poor people wait much more (which could also lead to dangers to their lives) (and once you allow some guy to move higher on the waitlist because of the miney he gives, that could lead to a slippery slope). Also, healthcare is supposed to be availible to everyone regardless of their income, and health is not supposed to be a business.

[future_doc]

The hospital and other patients could benefit from the donation, and between two people who have an equal urgency for the liver transplant, you may be temped to priviledge the one who will make the donation. But then, that could lead to rich people taking spots away from poor people and having poor people wait much more (which could also lead to dangers to their lives) (and once you allow some guy to move higher on the waitlist because of the miney he gives, that could lead to a slippery slope). Also, healthcare is supposed to be availible to everyone regardless of their income, and health is not supposed to be a business.

 

Allocation should be to the most worthy recipients in the fairest possible way.

And excess discretion can lead to manipulation and unfairness as in this case. Giving preference to those who have made donations themselves is one thing. But giving preference to the wealthy, connected or privileged is reprehensible and places the entire allocation system into disrepute. If a wealthy person is selected due to medical emergency and other established criteria that is fine, but not otherwise.

[rmorelan]

Allocation should be to the most worthy recipients in the fairest possible way.

And excess discretion can lead to manipulation and unfairness as in this case. Giving preference to those who have made donations themselves is one thing. But giving preference to the wealthy, connected or privileged is reprehensible and places the entire allocation system into disrepute. If a wealthy person is selected due to medical emergency and other established criteria that is fine, but not otherwise.

 

well under that you still just end up with the wealthy always donating (money is no good to you if you are dead). The wealthy will still end up with all the transplants but the hospitals will have more money (effectively a two tier health care system). You can argue for that either way ethically - remember some places in the world do have paid transplantation

[tom1989]

I will priority for the hard working middle class get a new kidney. Perennial drinking really I find it hard to believe that he will change, I don't want to bear to let him of the danger of wasting a kidney. But the premise is kidney to body matching with them. As well as their current body condition requires a liver transplant.

[Guest mmhs12345]

Just curious to what your responses are, but what would you do if two individuals needed a liver transplant, and one individual is an alcoholic and/or drug abuser and the other a hard working middle class citizen that does not abuse drugs and/or alcohol, but has been diagnosed with cancer. Who would you give the transplant to granted you only have one liver? One of the individuals will die if they don't receive the transplant. The individual that has a history of abusing drugs pleads that he is wanting to change his life around and he can only do that if he recieves the transplant.

 

Can your response just be that you have to follow protocols. I'm sure there is set of rules or situations people who are in charge of the transplant list follow. Since I obviously cannot make up my own rules as to whonshould get it, I should contact higher authority.

[cindylouwho]

Can your response just be that you have to follow protocols. I'm sure there is set of rules or situations people who are in charge of the transplant list follow. Since I obviously cannot make up my own rules as to whonshould get it, I should contact higher authority.

 

That can certainly be a part of your answer, but for a question like this they are absolutely looking for some application of your knowledge of ethical principles and of reasoning -- isn't it the job of physicians to make and challenge rules on transplantation prioritization? Since transplantation can be a common topic in ethics-related interview questions, you should aim to familiarize yourself with how they make the rules in the first place.

 

These may be helpful:

http://www.transplantmanitoba.ca/transplant-program/kidney-allocation

http://www.ualberta.ca/~pflaman/organtr.htm

[Guest mmhs12345]

Yea for sure, going into the interview I believe the interviewee should have some knowledge on this topic

howevrer, I dont know anything of how transplant lists work but my gut feeling tells me it has nothingthem to do with the wealth of an individual, or his familial status or what he or she did to their liver for them to need a trabsplant.

 

It should just be on how healthy the individual is and not the other factors. If you choose one person over thr other, your going to look like bad as your prioritising certain things over others.

 

I feel as though looking for advice from higher authority is a must in most cases

[Guest mmhs12345]

And are the physicians the one who makes the call? Or isnt threre some type of committee thag makes the list. If so, obviously just go to see what they say.

[Guest mmhs12345]

That can certainly be a part of your answer, but for a question like this they are absolutely looking for some application of your knowledge of ethical principles and of reasoning -- isn't it the job of physicians to make and challenge rules on transplantation prioritization? Since transplantation can be a common topic in ethics-related interview questions, you should aim to familiarize yourself with how they make the rules in the first place.

 

These may be helpful:

http://www.transplantmanitoba.ca/transplant-program/kidney-allocation

http://www.ualberta.ca/~pflaman/organtr.htm

 

Ok so looking at the transplantmanitoba link, it seems as though all the factors ( wealth, family, alcohol, etc) has absolutely nothing to do with who gets the in this case lets say liver.

 

Problem solved? Just.prioritise who gets it based on the info from the link - assuming the interviewee has a background on it

[LeBronto2019]

I've heard this question before and one man who has guided 70+ kids getting into med school since 2012 told me that unless there are some specific guidelines/protocols for that situation, you basically pick a name out of a hat (or something of that nature). Based on some logic and your own attitudes about 'where would this liver not go to waste', you'd obviously pick the best suited patient. But shouldn't it be a 50:50 shot based on the fact that everyone should have access to care?

 

I really don't know, I'm probably not very ethical nor do I have knowledge about these situations, and don't remember this man's explanation for why he said that.

[vick001]

Is this an MMI question you are prepping for?

 

If it is you have to keep in mind you have two minutes to collect your thoughts.

 

Don't over think the question.

 

State your goal/objective and highlight your thought process in coming up with a solution. 1-2 min

 

Pick one. Support it with your argument/logic.

 

DEFINITELY state why you didn't pick the other. This is one of those questions where you can certainly rub the interviewer the wrong way lol.

[Guest mmhs12345]

Is this an MMI question you are prepping for?

 

If it is you have to keep in mind you have two minutes to collect your thoughts.

 

Don't over think the question.

 

State your goal/objective and highlight your thought process in coming up with a solution. 1-2 min

 

Pick one. Support it with your argument/logic.

 

DEFINITELY state why you didn't pick the other. This is one of those questions where you can certainly rub the interviewer the wrong way lol.

 

You can't decide based off of factors of wealth, family, why the person became ill etc.

The asnwer should be purely based off of protocols that have been made already.

 

So isn't the best answer- to follow protocols of how people become prioritized on a transplant list. It's as simple as that isn't it?

[ikillreid]

You can't decide based off of factors of wealth, family, why the person became ill etc.

The asnwer should be purely based off of protocols that have been made already.

 

So isn't the best answer- to follow protocols of how people become prioritized on a transplant list. It's as simple as that isn't it?

 

You're missing the bigger picture of the MMI here. They aren't just assessing whether you can "get the right answer" and move on. They want to assess your thinking process, your communication ability, your empathy, etc.

 

Even if that's your answer (and it's a fine answer), you need to explain how you got there and why. For example, explain WHY you feel that the decision shouldn't be based on x, y, z, but rather based on w. And explain the importance of basing that decision on w, from your perspective. Following up with higher authority is also good, as you mentioned, because that shows the quality of humility and respect for procedures which help to standardize the process. Maybe also acknowledge that it's a difficult situation, and there will be ramifications for everyone involved (those that get the transplant even, but especially those that do not). Etc. I don't want to keep going because then I'll feel obligated to give a real answer, and that's not my purpose.

 

Please though, don't approach these questions like a right/wrong test.

[cindylouwho]

^^100% agreed

[vick001]

You're missing the bigger picture of the MMI here. They aren't just assessing whether you can "get the right answer" and move on. They want to assess your thinking process, your communication ability, your empathy, etc.

 

Even if that's your answer (and it's a fine answer), you need to explain how you got there and why. For example, explain WHY you feel that the decision shouldn't be based on x, y, z, but rather based on w. And explain the importance of basing that decision on w, from your perspective. Following up with higher authority is also good, as you mentioned, because that shows the quality of humility and respect for procedures which help to standardize the process. Maybe also acknowledge that it's a difficult situation, and there will be ramifications for everyone involved (those that get the transplant even, but especially those that do not). Etc. I don't want to keep going because then I'll feel obligated to give a real answer, and that's not my purpose.

 

Please though, don't approach these questions like a right/wrong test.

 

 

This ^ ; but keep in mind that the interviewer is human. The MMI isn't as objective as you think. If you said something by accident or unintentionally that comes off as judgmental you can address that in the end by briefly stating why you didn't pick x.

[Guest mmhs12345]

technically speaking though

- by saying you must follow guidelines/protocols- you are technically correct with your answer.

- and those who justify the womans children or the fact that the man drank his way to his bad liver- must technically be incorrect EVEN if they give justifications and a well thought out answer.

 

Yes or no?

[ikillreid]

technically speaking though

- by saying you must follow guidelines/protocols- you are technically correct with your answer.

- and those who justify the womans children or the fact that the man drank his way to his bad liver- must technically be incorrect EVEN if they give justifications and a well thought out answer.

 

Yes or no?

 

No.

 

This is still what I was getting at.

 

One small part of the MMI is about gauging your decision making abilities, and showing a knowledge of the Canadian Healthcare system is a plus as well.

 

But MORE important, ultimately, is your ability to justify your answers and to show your ability to reason. As well as your communication ability, empathy, etc., as I said above.

 

You're not a doctor yet, and they aren't expecting you to have a physicians' understanding of the healthcare system; understanding the intricacies of the transplant protocol is not crucial.

 

To illustrate my point, consider: it would be better for you to make the "WRONG" choice with excellent justification and/or evidence of thorough consideration of the options than to make the "RIGHT" choice with next to no context, explanation/elaboration, follow-up, etc., as you seem to gravitating toward. In your question above, the person who perhaps makes a suggestion that doesn't align with Canada's current protocol is not necessarily going to have that answer marked "incorrect"... they can still end up with a much better score than the person who recites the actual transplant protocol.

 

Of course, ideally, you make the most appropriate choice you can AND back it up.

 

TL;DR Correct vs. incorrect is subjective, and not how these stations are scored.

[rmorelan]

and just because it is the current Canadian protocol doesn't mean it is ethical. The entire point is that those protocols evolve over time - in theory what is "right" is unchanging (well at least according to main schools of thought - the goal of ethics is to find a universal approach to determining what is right). Policies that change suggest they are potentially flawed in their current form and as well learn and apply more careful thought then those flaws can be corrected.

 

I will say right now there are easily arguably numerous unethical aspects in the current Canadian system. As future doctors the expectation is that we can correct that.

[MD2015]

Such as the recent law on allowing euthanasia in Quebec.