By: Ryan Kelly
F. Scott Fitzgerald once said: “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still function.”
Virginia Commonwealth University (VCU) secondaries test pre-meds for Fitzgerald’s version of intelligence by presenting an ethical dilemma, which involves competing ethical priorities at odds with one another.
The details of VCU’s prompt change each year, but we’ve provided last year’s scenario to give you a good idea of what to expect. Because of the frequent changes, we do not suggest pre-writing this essay. Instead, by studying and following the four-step process we suggest, you should be able to tackle any ethical dilemma that a medical school presents.
Acknowledge Competing Ethical Interests
Weigh the Ethical Interest Against Each Other and Prioritize
Propose a Specific Course of Action
Anticipate and Account for Multiple Variables
These four steps can be used to apply to any ethical questions, including those posed during your interviews. Read our latest on how to prepare for the ethical discussion scenarios of the MMI.
For now, though, let’s see how we can apply these steps to VCU’s essay prompt:
VCU Ethical Secondary Essay Topic (2015 - 2016)
Imagine that you are a family physician and are seeing a 15-year-old girl for menstrual cramps. Her mother has accompanied her for this visit. When you examine the patient without her mother present, she tells you that she is sexually active. She begs you not to tell her mother because of her family’s strong values against teen sex. Discuss your next steps. (2000 characters)
Step 1 - Acknowledge Competing Ethical Interests
In this case, the competing interests lie with the mother and daughter. As the hypothetical doctor, you have an obligation to the daughter as the patient, but on the other hand, we as a society deem 15-year-olds minors who lack the maturity needed for important decisions.
You should take time to recognize the mother’s investment in her daughter’s future health and well-being, but also acknowledge the daughter’s request for patient confidentiality.
Step 2 - Weigh the Interest Against Each Other and Prioritize
States might have different laws about healthcare policy with minors, especially when involving parental consent or disclosure. You could mention this as a disclaimer, indicating your willingness to comply with the law.
But if operating outside these restrictions, your first priority always lies with the patient. After accommodating the mother’s perspective, explain how a patient’s request for confidentiality outweighs any parental concerns, especially since the issue does not appear life-threatening.
Step 3 - Propose a Specific Course of Action
It’s not enough to talk about the hypothetical interests; now, you must take action. Here are questions to consider in your response:
1.) With the daughter alone in the exam room...
When she begs you to keep her secret, what will you say? How will you frame your discussion of sex? What interpersonal strategies could you use to create honest and open dialogue? What are the best ways to educate and positively influence her future decisions? How much, if at all, would you push her towards communication with the mother?
2.) In later private discussions with the mother…
How do you breach the conversation of teenage sex in an unsuggestive way? How do you respond to her insistence that her daughter is a virgin? How do you adjust your rhetoric or tone when moving from daughter to mother? How might you encourage the mother to discuss sex openly with her daughter? How would you make her understand its importance?
When formulating your specific course of action, use creative problem-solving in order to accommodate both ethical concerns. But also make sure to stay within the professional parameters of the situation.
Step 4 - Anticipate and Account for Multiple Variables
The prompt exists in a vacuum, but healthcare doesn’t. Since medicine is practiced in context, you should anticipate possible variables that might introduce themselves into the scenario. You can account for them with “if/then” sentences that explain how your actions would change based on these new factors.
For example, if you discovered that the daughter had an STD or another serious health issue, you might be justified (or even required) to inform the mother. At the very least, this information would affect the way you engage and educate the daughter on the topic.
Another hypothetical twist would be if the mother took strong offense to your breaching of the subject. If she misinterpreted your counsel as accusatory, you would need to take extra measures to placate her and reestablish your trust and rapport.
Final Thoughts on VCU Secondaries
With 2000 characters, you should break your essay into 5-6 short paragraphs (4-6 lines each) which cover each of our suggested steps above.
The ethical essay demands a formal, thoughtful tone. Make sure to explain your reasoning and motivations. Use these explanations as transitions between your different steps toward resolution.
If at the end of the day, you’re struggling with the ethical essay, well, you’re probably taking the right approach. These prompts are supposed to test your reasoning skills and your writing skills, so try to live up to Fitzgerald’s challenge and write the best essay you can.
Want to see a sample answer to VCU’s ethical scenario prompt? Enter your email to download a free VCU example secondary essay.