Justice in Medical Ethics (UK): Four Pillars Explained & Medicine Interview Examples
- Suhaani Sathish
- 23 hours ago
- 11 min read
Justice is one of the Four Pillars of Medical Ethics in the UK - alongside autonomy, beneficence, and non-maleficence. It represents fairness and equality in medical decision-making, ensuring NHS care is based on need rather than wealth or background. Understanding this principle is crucial for medicine interview ethics questions.
In simple terms, Justice means that medical decisions should be made fairly, without discrimination, and with equal access to care based on clinical need, not social status or wealth.
In this guide, you’ll learn what justice in medical ethics really means, why it’s a vital part of the NHS and GMC Good Medical Practice, and how to apply it effectively in medical school interviews such as the MMI.
We’ll also explore real NHS examples, like organ transplants and ICU bed allocation, that demonstrate distributive justice and ethical resource allocation.
Whether you’re preparing for your medicine interview, revising the Four Pillars of Medical Ethics, or practising ethical reasoning questions, mastering the Justice Pillar will help you answer with confidence, empathy, and strong moral judgement.
What Is the Justice Pillar in Medical Ethics (UK)
What Does Justice Mean in Medical Ethics? What is its definition?
Justice in medical ethics means providing fair and equal treatment for all patients, ensuring healthcare decisions are made without bias and that limited NHS resources are distributed ethically and transparently.
As a prospective medical student, understanding the Pillar of Justice is essential for both ethical reasoning and upholding professionalism. Justice will actively shape how you make decisions about patient care, resource allocation, and equality throughout your medical career.
Here is why justice matters and how it integrates into UK Medical Practice:
Justice ensures fair access to care, especially when resources are limited.
This principle becomes essential during scenarios like ICU admissions, organ transplants, and clinical trial selection, where decisions must be made without discrimination.
Justice requires doctors to treat patients without bias or discrimination.
This means care must not be influenced by a patient’s age, background, socioeconomic status, or personal lifestyle choices.
The NHS is founded on the principle of justice and clinical need.
Healthcare in the UK is provided based on clinical urgency, not on a person’s wealth, job, or social standing. This is a direct application of distributive justice.
The GMC’s Good Medical Practice demands fairness and transparency.
Doctors must make decisions fairly and consistently, avoiding personal bias, and ensuring that care is guided by evidence and need.
Justice often overlaps with other ethical pillars.
For example, respecting autonomy may confront justice when a patient’s choice could affect care for others; beneficence may conflict when helping a patient means not acting in the best interests of another patient.
A strong understanding of justice shows interviewers you understand healthcare as a system.
It shows you can think beyond individual patients, and consider equity on a population-wide, NHS-level scale: a mindset that is crucial to becoming a well-rounded future doctor.
Justice in Medical Ethics Explained: Definition, Types, and Real Examples
Definition: Justice in medicine refers to the fair, equitable and appropriate distribution of healthcare resources, in addition to the fair treatment of individuals regardless of personal characteristics.
Distributive Justice = fair distribution of limited healthcare resources
Legal Justice = respect for the law
Rights-Based Justice = the respect for individuals’ rights
Justice aims to ensure that all patients:
Are treated without discrimination.
Receive the care they need, regardless of their socioeconomic status or background.
Have their clinical needs weighed fairly against others when resources are limited.
Why Justice Matters in Medicine and UK Medical School Interviews
The Pillar of Justice in medicine ensures that the NHS and Medical professionals uphold fair, legal and ethical standards for the following reasons:
Upholding Justice is part of your professional responsibility under the GMC’s Good Medical Practice
As a doctor, you will likely face scenarios where Justice is in conflict with other ethical pillars (e.g. balancing saving one life vs helping the majority)
Demonstrating understanding of the Pillar of Justice shows empathy, fairness and awareness of legal guidelines.
NHS Medicine operates under both financial and resource constraints, which mean providing fair, equal healthcare to patients is an ongoing challenge.
Model Interview Answer: Applying the Justice Principle in a Medical Ethics Question
Organ Donation Allocation
Scenario 1: Two Patients Need the Same Lung for Transplant
You are a resident doctor involved in the transplant team. A single lung has become available. There are two patients on the waiting list: a 30-year-old teacher with cystic fibrosis and a 55-year-old smoker with severe COPD. Both are clinically eligible for the transplant, and both are deteriorating.
Before analysing this dilemma utilising the Pillar of Justice, make sure that you are familiar with our Pillar of Beneficence article to understand how decisions might change when prioritising individual patient outcomes over fairness across a population.
Key points to consider:
Distributive Justice: This is a fairness dilemma: deciding who receives a limited resource (one lung).
Bias Avoidance: Base the decision only on clinical evidence: urgency, likelihood of transplant success, and long-term benefit.
Guideline Alignment: Follow UK National Transplant Guidelines and use standardised scoring systems to ensure fairness.
NICE Framework: Refer to NICE guidance promoting ethical, transparent, and cost-effective allocation of treatments.
MDT Decision-Making: Decisions should be made by a Multidisciplinary Team (MDT) to incorporate varied expertise and ensure balanced, ethical judgement.
Want to read more? 👉🏻 Organ Donation & Organ Transplant Dilemmas
Example Medical School Interview Question: The Pillar of Justice in Action
“A young cancer patient and an elderly patient both need the final available ICU bed in the ward. Which patient should be prioritised and why?”
This particular scenario centres around the ethical principle of Justice, which refers to the fair and equitable distribution of healthcare resources - especially important when they are limited, such as the ICU beds mentioned in the scenario.
Firstly, I would acknowledge that as a doctor this is a challenging decision to make, due to the ethical tension between the Pillars of Justice and Beneficence. I would therefore avoid aking decisions solely based on age, or social standing, as this would be a form of discrimination.
By prioritising the younger patient, presuming that they will live longer, I would be making an unethical and unjust decision based on age. This would also violate GMC guidelines which strongly condemn various types of discrimination.
Instead, I would base my decision on objective, clinically relevant data. This would include each patient’s likelihood of survival with ICU treatment, how likely they are to recover, any comorbidities and prognosis. Combined, these factors would help me assess which patient benefits the most from intensive care - a key principle within the Pillar of Justice.
I would additionally escalate the situation to the MDT responsible for both patients, involving senior doctors and even the ethics team within the hospital, ensuring transparency and carefully considered decision-making.
Finally, I would approach both patients with honesty and empathy, including their respective families. I would strive to explain my decision rationale clearly and calmly, while offering support - both physical and emotional.
This scenario is emotionally and ethically challenging, but by applying justice through structured criteria and professional frameworks, we can help ensure a fair and compassionate outcome.
Justice and Other Ethical Principles: How the Pillars Interconnect
The concept of Justice underpins fair decision-making in medicine. As future doctors, you must be able to understand how the Pillar of Justice interacts with the other PIllars of Medical Ethics: Autonomy, Beneficence and Non-Maleficence.
This is especially relevant, given that the NHS is facing issues of limited resources, greater patient diversity and systemic inequalities.
During your Medical School Interview, the examiner wants to know that you can think critically, fairly while upholding professional GMC standards when faced with ethical dilemmas.
Autonomy vs Justice – Wealth and Access to NHS Treatments
Scenario: A wealthy patient demands access to a costly treatment which is not routinely offered by the NHS.
Why It Matters: While Autonomy supports a patient’s right to choose their treatment, Justice requires that treatment is offered to all patients fairly, and equitably.
Key Points To Understand:
Allowing payment for certain treatments to only a select number of patients undermines NHS Fairness and Equality standards. This can also divert funds from others with greater clinical need.
According to the NICE and NHS Funding guidelines, treatments must meet national thresholds for cost-effectiveness.
Upholding Justice within the NHS, a government healthcare service, means that patients should not receive treatment based on wealth - a form of discrimination.
The Pillar of Autonomy allows patients to choose Private Healthcare - but Justice requires that public systems apply consistent rules to maintain patient trust and equity.
The GMC’s Good Medical Practice emphasises the importance of treating patients fairly regardless of their socioeconomic status, background or other personal factors.
2) Should Lifestyle Choices Affect Fair Access to NHS Treatment?
Scenario: A patient who smokes heavily requires elective surgery (e.g. hip replacement) before a non-smoking peer.
Key Points To Understand:
Justice does not permit doctors to withhold treatment based on ‘moral judgements’ or lifestyle - priority should be given to patients based on clinical need and urgency.
Denying a patient surgery due to their smoking habit would directly oppose GMC Guidance, which encourages objective clinical decision-making.
It is vital that patients are well informed about harmful habits, such as chronic smoking. However, doctors are not permitted to let their actions be guided by personal bias - a form of discrimination that if acted on, can be detrimental to safe, patient-centred care.
How to Structure Medical Ethics Interview Answers Using the Four Pillars
When tackling ethical interview questions involving Justice, it’s essential to provide a well-reasoned, structured response that integrates the Four Pillars of Medical Ethics, GMC guidance, and UK legal guidelines.
Here’s how to structure a high-scoring answer:
Identify the Core Ethical Issue :
Start by clearly defining the justice-related issue. Is this a question about the fair distribution of a limited resource (e.g. ICU beds)? Or, is there a risk of discrimination, based on age, wealth, lifestyle or background?
Apply the Four Pillars of Medical Ethics
Use the four pillars to guide your analysis:
Autonomy - respecting the patient’s right to decide
Beneficence - acting in the patient’s best interests
Non-maleficence - doing no harm
Justice - ensuring fairness and legality
Consider Legal Frameworks
Support your answer with relevant UK healthcare laws and ethical standards:
NHS Constitution: Providing the right to non-discriminatory, evidence-based care.
GMC Good Medical Practice: Emphasises treating patients fairly and without bias.
Human Rights Act 1998: Provides right to life and protection from discrimination.
Empathy and Clear Communication
Being empathetic is essential for demonstrating emotional intelligence in your interview. Highlight how you would speak with the patient and their family, as ethical decisions can often be distressing for those involved. Always provide:
Clarity, and honesty about the rationale behind your decisions.
Empathy to emotional distress, especially when resources are denied.
Recognition that this is a challenging situation, both for the patient, their family and the medical team.
Involve Senior Colleagues
Teamwork and escalation are integral to resolving any ethical issue. As a medical student, and even as a doctor, you are never expected to solve everything alone. Demonstrating that you would involve senior colleagues and a variety of opinions shows that you value making safe, carefully considered decisions that are truly in the best interests of the patient.
Conclude with a Balanced Judgement
Weigh the options and summarise a reasonable, ethical course of action based on the scenario.
Practice MMI and Panel Interview Questions on the Justice Pillar
A smoker and a non-smoker both need lung transplants. Should their lifestyle affect access?
A wealthy patient offers to privately fund an expensive cancer drug not available on the NHS. Should this influence your care decisions?
A 95-year-old and a 25-year-old both require urgent dialysis - how do you decide who goes first?
Pillar of Justice – FAQs for Medical School Interviews
What does the Justice pillar mean in medical ethics?
Justice in medicine refers to fairness in the distribution of healthcare resources and ensuring all patients are treated without discrimination. It is one of the Four Pillars of Medical Ethics, along with autonomy, beneficence, and non-maleficence.
Why is the Pillar of Justice important in NHS healthcare?
The NHS is founded on the principle of justice, aiming to provide equal access to healthcare based on clinical need, not personal wealth or background. Justice ensures transparent and ethical treatment allocation.
How to demonstrate understanding of justice in medical school interviews?
Use a structured ethical framework in your answers. Identify fairness-related dilemmas, apply the Four Pillars, reference GMC Good Medical Practice, and explain how you would act without bias while involving senior colleagues.
What are some real-life examples of justice in medicine?
Examples include:
Organ donation allocation between patients.
ICU bed prioritisation during emergencies.
Ensuring equal treatment for vulnerable groups like prisoners or the elderly. These highlight distributive justice and non-discrimination.
How does justice conflict with other medical ethics principles?
Justice can conflict with:
Autonomy (e.g., denying costly treatments not NHS-funded).
Beneficence (e.g., prioritising population health over an individual). Ethical dilemmas arise when fairness and individual needs do not align.
Are lifestyle choices considered in ‘Just’ healthcare decisions?
No they are not - according to GMC guidance, patients must not be denied treatment based on lifestyle choices (e.g., smoking or obesity). Decisions should be based on clinical need and evidence, not moral judgments.
How should I answer justice-based questions in an MMI interview?
Utilising this structure:
Identify the ethical issue (e.g., limited resources).
Apply the Four Pillars of Medical Ethics.
Include relevant UK legal frameworks.
Show empathy, transparency, and escalation to senior colleagues.
Conclude with a balanced, ethical judgement.
Can wealth or social status influence treatment access in the NHS?
No it should not - NHS treatment is provided based on clinical urgency, not financial means. Justice ensures that all patients, regardless of income or background, receive fair access to care.
What is distributive justice in healthcare?
Distributive justice refers to the fair allocation of limited healthcare resources such as ICU beds, organs, or medication. It aims to ensure ethical decisions are made without bias and with transparency.
What is the principle of fairness in medical ethics?
The principle of fairness in medical ethics means that all patients should be treated consistently and without discrimination, regardless of their personal circumstances. It focuses on ensuring equal access to care based on clinical need rather than wealth, background, or lifestyle. Fairness is the foundation of the Justice Pillar in UK medical ethics and underpins every decision made within the NHS.
What are examples of distributive justice in UK healthcare?
Distributive justice describes how limited NHS resources are shared fairly among patients. Common examples include prioritising transplant recipients according to urgency, allocating ICU beds during crises, and using NICE cost-effectiveness guidelines when approving new treatments. Each of these ensures transparent and evidence-based decision-making.
How does justice relate to healthcare inequality in the NHS?
Justice seeks to reduce healthcare inequalities by promoting equal access to treatment for all patient groups. This includes addressing systemic barriers faced by disadvantaged populations, such as those related to income, race, or disability. Upholding justice helps doctors align with NHS equality and diversity principles while supporting fair outcomes for all patients.
How can I answer ethical questions about fairness in a medical interview?
When asked about fairness or justice in a medical interview, begin by defining justice as one of the Four Pillars of Medical Ethics. Apply it logically to the scenario by identifying the ethical issue, balancing it with the other pillars, referencing GMC Good Medical Practice and NHS guidance, and concluding with a fair, transparent decision. This structure demonstrates strong ethical reasoning.
What is the difference between fairness and equality in healthcare ethics?
Equality means providing everyone with the same resources, while fairness (justice) involves tailoring care based on individual need and potential benefit. In NHS practice, this ensures patients who need treatment most urgently are prioritised, maintaining both compassion and ethical integrity. Understanding this distinction is key when discussing justice in medical interviews.
Why is justice important in medicine?
Justice ensures that all patients receive care based on clinical need rather than wealth or background. It helps maintain trust in the NHS and ensures decisions are fair, transparent, and ethically sound.
What are examples of justice in healthcare and the NHS?
Examples include organ transplant allocation, ICU bed prioritisation, and equal treatment for vulnerable groups. These show distributive justice and non-discrimination in real NHS settings.
✍️ About the Author
Written by: Suhaani Sathish - Medical Student at Barts and The London, Queen Mary University of London. Suhaani received offers from all four of her medical school choices and has a strong interest in medical ethics, NHS healthcare policy, and clinical communication. She now helps students prepare for MMI and Panel Interviews with TheUKCATPeople.
Reviewed by: Dr Akash Gandhi MBBS MA (Cantab) DGM DRCOG MRCGP - GP in London and Co-Founder of TheUKCATPeople. Dr Gandhi is a medical school admissions and interview expert, having supported thousands of students with their UCAT tutoring, personal statements, and interviews for over a decade. His guidance ensures all ethical and clinical content on our site aligns with GMC and NHS standards.
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