Two ethical scenarios appear in most intensive care selection interviews: the full unit with two patients needing one bed, and the treatment plan you believe is futile and causing suffering. Both test whether you reason structurally, whether you know the criteria and the processes units use, and whether you involve the right people rather than deciding alone. This guide covers each.
The full unit
The unit is full and two patients need a bed: a 30 year old with severe sepsis and an 80 year old post operative patient. How do you decide, and who do you involve?
The trap is to answer with age. The panel is scoring whether you would assess both patients properly and apply the criteria units actually use.
Assess both. Go and see each patient, or have them seen, and assess severity, trajectory, reversibility, baseline function and the patient's own wishes if known. Age is one factor in baseline function, not a criterion in itself. A frail 80 year old with a poor prognosis and a fit 80 year old after elective surgery are different patients.
Apply the criteria. Units admit patients who need intensive care and are likely to benefit from it. Say that you would ask of each: does this patient need the unit now, is the condition reversible, and would the patient want it. The patient with the greater need and the greater likelihood of benefit has the stronger claim.
Find more capacity. A full unit is not always full: a patient may be ready for the ward, a bed may be available in another unit or hospital, a patient may be managed with high flow oxygen or close observation on the ward with outreach support while a bed is found. Say that you would look for every option before choosing.
Involve the right people. The consultant, who makes the admission decision; the bed manager and the after hours executive, who find capacity; the retrieval service if transfer is the answer; the treating teams of both patients; and the families, who deserve honesty about what is happening.
Document the decision and the reasoning, and review it. Say what you would do if the patient who did not get the bed deteriorated.
Futility
A colleague's treatment plan is, in your view, futile and causing suffering. What do you do?
Check your own judgement first: look at the patient, the evidence and the goals of care, and consider whether you might be wrong. Then talk to the colleague directly and respectfully, asking about their reasoning and the goals. Many disagreements dissolve when the goals are made explicit.
If the disagreement persists, involve the consultant, because decisions about limits of treatment are the consultant's. Suggest a family meeting to clarify what the patient would have wanted. Involve the palliative care team. If the dispute is serious, the hospital's clinical ethics committee exists for exactly this and you would propose it.
Throughout, the patient's suffering is addressed: analgesia, sedation, comfort, whatever the treatment plan. And the family are kept informed and not caught between disagreeing clinicians.
Say what you would do if the colleague were your own consultant. The answer is the same conversation, with the director of the unit or another senior intensivist involved if needed, because patient welfare comes before hierarchy.
The coroner
What are your obligations if you believe a death should be reported to the coroner? Know the categories of reportable death in your state: unexpected deaths, deaths after procedures, deaths in custody, deaths where the cause is unknown, and others. Say that you would discuss it with the consultant, that the reporting is a legal obligation and not a judgement on anyone, and that you would explain it to the family so that it does not come as a shock.
What the panel scores
Structured reasoning, assessment before decision, knowledge of the criteria and the processes, the search for alternatives, the right people involved, the patient's suffering addressed throughout, and the willingness to question a senior through the proper route. The common failures are deciding by age, deciding alone, and keeping quiet about futile treatment because the consultant ordered it.
Preparing
Talk each scenario through aloud with the probes: the second patient deteriorates; the colleague refuses to discuss it; the family of the patient who did not get the bed want to know why. Learn your unit's admission criteria, your state's reportable death categories, and whether the hospital has an ethics committee. The scenarios are predictable and the structure is learnable.