SJT: Core Ethical Principles for Medicine

The Four Pillars of Medical Ethics

Understanding these four principles will guide you through almost every SJT scenario:

1. Autonomy

Patients have the right to make their own informed decisions about their care. This includes the right to refuse treatment, even if the doctor disagrees. Respecting autonomy means:

• Providing clear, honest information so patients can make informed choices
• Not pressuring, coercing, or manipulating patients into decisions
• Respecting a competent patient’s refusal of treatment
• Obtaining informed consent before procedures

2. Beneficence

Act in the patient’s best interest. This means providing treatments that benefit the patient and actively working to promote their wellbeing. Beneficence includes:

• Providing the best available care
• Considering the patient’s overall quality of life
• Preventing harm where possible
• Advocating for the patient’s needs

3. Non-maleficence

“First, do no harm.” Avoid causing unnecessary harm to patients. This includes:

• Not performing unnecessary procedures
• Considering risks vs benefits of treatments
• Not practising beyond your competence level
• Reporting safety concerns and errors

4. Justice

Treat patients fairly and equitably. Distribute healthcare resources justly. This includes:

• Not discriminating based on age, gender, ethnicity, socioeconomic status, or personal beliefs
• Allocating scarce resources fairly
• Advocating for equitable access to healthcare
• Following laws and professional regulations

Professional Values in Healthcare

Beyond the four pillars, SJT scenarios test your understanding of professional values:

• Honesty and integrity: Never lie to patients, colleagues, or in documentation
• Confidentiality: Protect patient information; share only with those who need to know for patient care
• Teamwork: Collaborate effectively, communicate clearly, support colleagues
• Accountability: Take responsibility for your actions and decisions
• Reflective practice: Acknowledge mistakes, learn from them, seek to improve
• Patient safety: Always prioritise patient safety above convenience, hierarchy, or personal comfort

The Priority Hierarchy

When values conflict, use this general priority order:

1. Patient safety — always the top priority
2. Professional standards — follow guidelines and regulations
3. Teamwork and communication — address issues through proper channels
4. Personal comfort — your convenience is the lowest priority