How do I answer an ethical dilemma in CASPer?

To answer an ethical dilemma in CASPer, work in a fixed order rather than reaching for a principle. Name what is genuinely in tension and who bears each cost. Say which facts you are missing and what you would ask to get them. Weigh what the actual rules say against what each option costs the people involved. Then commit to one action, and say plainly what would change your mind. Finish by saying what the person gets from you afterwards. Acuity Insights states there is no single correct answer, so you are scored on that reasoning, not on which side you land.

Why does naming the tension come first?

Because an answer that has not identified the conflict is answering a different, easier question. Most applicants read a dilemma, feel which side is the respectable one, and write a confident paragraph defending it. What that answer never shows is that anything was at stake.

Write the tension as two costs with two names attached. Not “this is a conflict between honesty and loyalty”, which is a label. Rather: if I say nothing, the next patient is exposed to the same error; if I report her, a colleague of two years finds out from a manager rather than from me. Now the reader can see the actual problem, and everything you decide afterwards has something to push against.

What do you do about the facts you were not given?

Scenarios are under-specified deliberately. The strong move is to say which part is ambiguous, say what question would resolve it, and then branch: if the answer is this, I do that; if it is the other, I do this instead.

This is where most of the marks live and it is the step applicants skip when the clock is running. Be careful about one failure mode: saying you would find out more and then stopping. An answer that never decides is not cautious, it is incomplete. The branch is the decision, twice.

How should the rules and the costs be weighed?

Read the actual rule if the scenario gives you one, and say what it says. Applicants routinely lecture about policy in scenarios that contain a document nobody in the answer ever reads.

Then price both errors. Acting wrongly harms someone now. Not acting wrongly harms someone later, often someone who is not in the scenario at all. Saying which error you would rather make, and why, is the single most adult sentence you can put in an ethics answer.

This is level five of the method I teach, assess rules and pros and cons, and it sits after validate and after listen and empathize for a reason: weighing costs before you have found out what is happening is how you produce a confident answer to the wrong problem. Three further levels in the method are taught inside the CASPer programs, and they are what most reliably move an answer from competent to top quartile.

Why does the answer not end at the decision?

Because a decision that abandons the person scores below one that stays. Level six, solution and support, is the step where you say what happens to the human being on the other side of your choice. You told her you were raising it; do you sit with her while she files it. You declined to sign the form; do you tell her which part you would sign.

It costs one sentence and it changes how the whole answer reads, because it is the difference between someone applying a rule and someone who will be in the room afterwards.

A scenario, and two answers

You volunteer at a community clinic. On Friday your supervisor asks you to sign Thursday’s volunteer sign-in sheet, which you forgot to sign, and to date it Thursday. She explains that an unsigned entry triggers a compliance review that will take her a week of paperwork, and that you were definitely there, which is true.

A weak answer. “I would not backdate the document because that would be falsifying a record, which is dishonest regardless of intent. I would explain to my supervisor that I am uncomfortable doing this and suggest that she document the situation accurately instead. Integrity matters even in small administrative matters.”

A strong answer. “The true part of her position is the whole difficulty: I was there, so the sheet as she wants it signed would describe reality more accurately than the blank line does, and she is facing a week of work for my mistake. What I will not do is write Thursday’s date next to my name today, because the signature is not attesting that I attended, it is attesting when I signed, and a record that lies about that is exactly the kind of small false record that compliance reviews exist to catch. So I would sign it, today, with today’s date, and write next to it that I attended on Thursday and signed late. That is honest and it is still a signed sheet. Then I would say the rest to her directly rather than going around her: that I am not comfortable with the date, that this is my error and I will write whatever statement the review needs, and that I would rather spend the hour than have her spend the week. If she insisted on Thursday’s date, I would say no once more, plainly, and tell her I would raise it with whoever runs the volunteer program, and that I was telling her because she should not hear it from them first. I would not tell her she was asking me to commit fraud. She is under an administrative burden and asking for a shortcut, and treating that as misconduct would be both unkind and probably wrong.”

What separates them. Both refuse. But the weak answer refuses and then leaves: it names dishonesty, expresses discomfort, and hands the problem back with a suggestion. It never engages with the fact that the requested entry is substantively true, which is what makes the dilemma a dilemma. The strong answer concedes the true part first, distinguishes precisely what the signature attests to, then finds a third option that is honest and still solves her problem, takes on the cost itself, states what it would do if overruled and warns her before escalating, and finally declines to characterise her as a wrongdoer. Refuse, explain, offer an alternative, absorb the cost, warn before escalating, and do not moralise. That is the shape.

Key numbers

• Five steps: name the tension, name the missing fact, weigh rules and costs, decide, say what would change it.
• Acuity states there is no single correct answer, so the reasoning is the score.
• Decide and add a condition. Balance with no decision reads as avoidance.
• One different rater per scenario, so you owe no consistency to an earlier answer.
• Levels one, two, five and six of the method are named on this site; three are taught inside the program.

If you want your own ethics answers marked level by level, that is what the CASPer programs do.

Related: CASPer practice scenarios with model answers and common CASPer mistakes.

Last reviewed 17 September 2026. Written by Arvin Ardakani, final-year medical student, 4th quartile on CASPer four times.