Ethics and Governance for Your O&G ST1 Interview

The ethics and governance station remains a mystery for the upcoming 2026 interviews, given the last-minute introduction of this station and the limited information available. Nonetheless, it is likely to involve a clinical scenario that raises an ethical, legal, or professional dilemma and you will be asked to discuss how you would approach it. Examples include a teenager requesting a termination without parental knowledge, a woman with capacity refusing a life-saving caesarean, a colleague you suspect is working whilst impaired, or a situation where patient confidentiality conflicts with safeguarding duties.

The station is not testing whether you can recite legislation word for word. It is assessing your ability to recognise the ethical issues at stake, apply a framework to reason through them, balance competing principles when they conflict, and demonstrate that you would practise safely, compassionately, and within the law.

To help you prepare, this post covers the essential ethical and legal frameworks you should be comfortable with before your interview.

GMC Good Medical Practice 2024

Good Medical Practice (GMP) is the GMC's core guidance document setting out the professional standards expected of every doctor registered in the UK. It was significantly updated in January 2024. This 2024 update is shorter and more concise, with a stronger emphasis on workplace culture, kindness, tackling discrimination, and patient-centred care.

The four domains are:

Domain 1 -- Knowledge, Skills and Development. Doctors must maintain their competence, keep their knowledge and skills up to date, and recognise the limits of their practice. The 2024 update adds emphasis on competency in leadership roles, sustainability in healthcare, and safe practice in both face-to-face and remote consultations.

Domain 2 -- Patients, Partnerships and Communication. This domain centres on treating patients as individuals, not making assumptions about their preferences, and working in genuine partnership with them. There is a strong focus on kindness, courtesy, respect, and supporting patients to make informed decisions about their care.

Domain 3 -- Colleagues, Culture and Safety. The addition of "culture" to this domain title is deliberate. The 2024 update places significant emphasis on creating workplaces that are respectful, fair, supportive, and compassionate. For the first time, GMP explicitly addresses sexual harassment and discrimination towards colleagues, and reinforces that doctors must feel safe to raise concerns.

Domain 4 -- Trust and Professionalism. Covers honesty, integrity, maintaining patient confidentiality, and acting within the limits of your knowledge. The 2024 version includes new guidance on social media and instant messaging, reminding doctors that messages sent in private groups may not stay private.

Interview tip: You do not need to quote paragraph numbers, but you should be able to name the four domains and explain how they apply to a given scenario. If asked about raising concerns about sexual harassment in the workplace, for instance, you could frame your answer around Domain 3.

The Four Pillars of Medical Ethics

Before thinking about specific legislation, it is also worth grounding reminding yourself of Beauchamp and Childress's four pillars of medical ethics. These come up constantly in interview scenarios and provide a useful framework for structuring your answers.

• Autonomy: Respecting the patient's right to make their own informed decisions about their care, even if you disagree with their choice.

• Beneficence: Acting in the patient's best interest and doing good.

• Non-maleficence: Avoiding harm. This does not mean avoiding all risk, but ensuring that the benefits of an intervention outweigh the risks.

• Justice: Treating patients fairly and equitably, and distributing resources in a just manner.

In O&G, these pillars frequently come into tension with one another. A woman declining a recommended caesarean section, for example, creates a conflict between autonomy (her right to refuse) and beneficence (the clinical team's desire to act in the best interest of both mother and baby). Being able to articulate these tensions and explain how you would navigate them is important for scoring well on this station.

Consent: Montgomery v Lanarkshire (2015)

This Supreme Court case fundamentally changed the legal standard for informed consent in the UK and is absolutely essential knowledge for anyone entering O&G. The case involved a woman with diabetes whose baby suffered a brachial plexus injury during a vaginal delivery complicated by shoulder dystocia. The obstetrician had not discussed the option of caesarean section or the specific risks of vaginal delivery for a large baby in a diabetic pregnancy.

The key takeaway: the old "Bolam test" (what a reasonable body of doctors would do or explain to a patient) was replaced with a patient-centred standard. Doctors must now ensure that patients are aware of any material risks involved in a proposed treatment, and of any reasonable alternative treatments. A risk is "material" if a reasonable person in the patient's position would be likely to attach significance to it, or if the doctor is (or should reasonably be) aware that the particular patient would attach significance to it.

In practical terms, Montgomery means that consent in O&G must be individualised. A blanket discussion of "risks of caesarean section" is not enough: you need to consider what matters to this particular patient and ensure they have the information they need to make an informed choice.

Mental Capacity Act 2005

The Mental Capacity Act (MCA) applies in England and Wales and provides the legal framework for making decisions on behalf of adults who lack the capacity to do so themselves. In O&G, this comes up in scenarios such as a woman in labour who is confused, a patient with a learning disability, or a woman with severe mental illness refusing treatment.

The five statutory principles you must know:

1. A person must be assumed to have capacity unless it is established that they lack capacity.

2. A person is not to be treated as unable to make a decision unless all practicable steps to help them do so have been taken without success.

3. A person is not to be treated as unable to make a decision merely because they make an unwise decision.

4. Any act done or decision made on behalf of a person who lacks capacity must be done in their best interests.

5. Before the act is done or decision made, regard must be had to whether the purpose can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

Critical point for O&G: a woman with capacity has the absolute right to refuse any treatment, including a caesarean section, even if that refusal puts her own life or the life of her unborn baby at risk. The unborn baby has no separate legal personhood in UK law.

Duty of Candour

The statutory duty of candour (introduced in the Health and Social Care Act 2008, Regulation 20) applies to healthcare organisations and requires them to inform patients when a "notifiable safety incident" has occurred, offer an apology, and provide a written account of what happened.

In practice, this means that if a patient comes to harm as a result of their care, whether through error or not, they must be told openly, promptly, and honestly. An apology is not an admission of legal liability.

Gillick Competence and Fraser Guidelines

These are frequently confused, so make sure you understand the distinction. Both relate to treating young people under 16, which is highly relevant to O&G practice in areas like contraception, sexual health, and pregnancy.

Gillick competence is the broader legal principle, established in the 1985 House of Lords case Gillick v West Norfolk and Wisbech Area Health Authority. It states that a child under 16 can consent to medical treatment without parental consent if they have sufficient understanding and maturity to fully comprehend what is proposed. This applies to all medical treatment, not just contraception.

Fraser guidelines are specifically about contraceptive advice and treatment for under-16s. They come from Lord Fraser's judgment in the same case and set out the conditions under which a doctor can provide contraception to a young person without parental consent. The young person must understand the advice, be likely to begin or continue having sexual intercourse with or without contraceptive treatment, their physical or mental health would likely suffer without it, and it must be in their best interests to receive it.

Abortion Act 1967

The Abortion Act 1967 (as amended by the Human Fertilisation and Embryology Act 1990) sets out the legal framework for termination of pregnancy in England, Wales, and Scotland. It does not apply in Northern Ireland, which has its own separate legislation.

Key points to know:

• Two registered medical practitioners must agree in good faith that at least one of the legal grounds is met.

• The most commonly used ground is Ground C: the pregnancy has not exceeded 24 weeks and continuance would involve greater risk of injury to the physical or mental health of the woman than if the pregnancy were terminated.

• There is no upper gestational limit under Ground E (substantial risk of serious physical or mental handicap to the child) or Ground A (risk to the life of the woman).

• Doctors have a right to conscientious objection to participating in abortion, but this does not apply in an emergency where treatment is necessary to save the woman's life or prevent grave permanent injury.

• The woman's consent is required; no one else (including a partner or parent) has the legal right to consent to or refuse an abortion on her behalf.

Equality Act 2010

The Equality Act 2010 legally protects people from discrimination in the workplace and in wider society. It is relevant both to how you treat patients and how you interact with colleagues. The Act defines nine protected characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.

Caldicott Principles

The Caldicott Principles govern how patient-identifiable information is handled across health and social care. Originally established in 1997 following a review chaired by Dame Fiona Caldicott, there are now eight principles (the seventh was added in 2013, the eighth in 2020). Every NHS organisation must have a Caldicott Guardian -- a senior person responsible for protecting patient confidentiality.

The eight principles are:

6. Justify the purpose(s) for using confidential information.

7. Do not use personal confidential data unless absolutely necessary.

8. Use the minimum necessary personal confidential data.

9. Access should be on a strict need-to-know basis.

10. Everyone with access should be aware of their responsibilities.

11. Comply with the law -- every use must be lawful.

12. The duty to share information for individual care is as important as the duty to protect confidentiality.

13. Inform patients and service users about how their confidential information is used.

Pulling It All Together

In this station, interviewers are assessing your ability to think through a scenario methodically, balance competing ethical principles, and demonstrate that you would practise safely and compassionately. A useful structure for approaching any ethics question is to identify the ethical principles at play (autonomy, beneficence, non-maleficence, justice), consider the relevant legislation, think about what Good Medical Practice says, and then explain what you would actually do in practice - including who you would involve, such as seniors, the MDT, or specialist teams.