The Ethics Exam

Dr. Helena Voss had administered the Medical Ethics final exam seventeen times in her career, but she'd never seen a question like number fifteen before.

She stood at the front of the lecture hall, watching her students hunched over their blue books, pens scratching against paper with the desperate intensity of people whose futures hung in the balance. The familiar sounds of academic stress filled the room—suppressed coughs, shifting chairs, the occasional frustrated sigh.

Helena walked slowly between the rows, her heels clicking against the linoleum floor. She knew most of these faces by now. Third-year medical students, bright and driven, each one convinced they were destined to save lives. In six months, they'd begin their clinical rotations. In four years, they'd be doctors.

If they passed today.

She paused beside Marcus Chen's desk. The boy was brilliant but anxious, always second-guessing himself. He was currently staring at his exam paper with a frown that suggested he'd reached the question that didn't belong.

Helena had found it that morning when she'd arrived early to set up the exam room. Question fifteen, printed neatly on every copy, as if it had always been there. But she'd written this exam herself, and she was certain there had been only fourteen questions.

Question 15: You are the attending physician in an emergency room when five patients arrive simultaneously from a multi-car accident. You have limited resources and must choose who receives immediate care. Patient A is a 34-year-old single mother of three. Patient B is a 67-year-old retired judge. Patient C is a 19-year-old college student. Patient D is a 45-year-old homeless man with a history of addiction. Patient E is a 28-year-old convicted felon currently serving parole. All have similar injuries and equal chances of survival if treated immediately. Choose one to save, and explain your reasoning in detail.

Helena had tried to rationalize its appearance. Perhaps the department had added a question without telling her. Maybe her computer had pulled text from an old exam. But when she'd checked her files, called the department, even examined the original document on her laptop, the question wasn't there.

It only existed on the printed copies.

She'd considered postponing the exam, but forty-seven students had already arrived, some having driven hours from their clinical placements. The question was disturbing but not inappropriate for a medical ethics course. She'd decided to let it stand.

Now, watching her students grapple with it, she wondered if she'd made a mistake.

Sarah Martinez raised her hand. "Professor Voss, there's something wrong with question fifteen."

Helena approached her desk. Sarah was one of her best students—thoughtful, compassionate, destined for pediatrics. Her exam paper was nearly complete except for the final question.

"What seems to be the problem?"

"It's asking me to choose who lives and who dies, but... that's not how triage works. You don't choose one person and let the others die. You prioritize based on medical need and resources, but you try to save everyone you can."

"Sometimes," Helena said carefully, "ethical dilemmas don't have clean answers. Sometimes doctors do have to make impossible choices."

Sarah's eyes were troubled. "But this feels different. It's like... like it wants me to play God."

Other students were looking up now, conversations breaking out across the room despite exam protocol. Helena noticed that several had stopped writing entirely, their pens resting on their desks as they stared at the problematic question.

"Professor?" This from James Wright, a student who rarely spoke in class. "I can't answer this question."

"What do you mean you can't answer it?"

"I mean I literally can't write anything. Every time I try to put pen to paper for number fifteen, my hand stops moving."

Helena frowned. "That's ridiculous. You're just overthinking it."

But as she watched, James pressed his pen to the paper and began to write. His hand moved smoothly until it reached the space below question fifteen, where it froze completely. He strained visibly, his face reddening with effort, but the pen remained motionless.

"I can't," he whispered. "It won't let me."

A murmur of unease rippled through the room. Helena quickly moved to the next student, then the next. The pattern was consistent—some students, like Sarah, could write but felt compelled not to. Others, like James, found themselves physically unable to respond to the question.

But a few were writing furiously, their answers growing longer and more detailed by the minute.

Helena read over the shoulder of one such student, Rebecca Torres, a quiet girl who'd never stood out in class discussions. Her response was chilling in its clinical detachment:

Patient D should be eliminated first as he contributes nothing to society and drains resources through his addiction. Patient E's criminal history makes him expendable. Patient B's age reduces his remaining productive years. Between A and C, the single mother has already reproduced and fulfilled her biological function, while the college student represents greater future potential...

"Miss Torres," Helena interrupted. "This isn't what medical ethics teaches."

Rebecca looked up, her eyes strangely vacant. "I'm just answering the question. It asked me to choose, so I'm choosing efficiently."

Helena stepped back, her heart racing. Something was very wrong here. She'd taught medical ethics for over a decade, and she'd never seen students respond like this to a difficult question. The divisions were too stark, the reactions too extreme.

She walked to the front of the room and called for attention. "I want everyone to stop writing and look at me."

The room fell silent, but she noticed that several students continued writing, as if they hadn't heard her at all.

"How many of you can see question fifteen clearly?"

Hands went up around the room, about half the class.

"And how many of you are having difficulty with that question specifically?"

The same hands remained raised.

Helena felt a chill run down her spine. She pulled out her own copy of the exam and looked at it again. Question fifteen was there, printed in the same font as the rest, but now she noticed something else. The paper felt different under her fingers, older, somehow. The text seemed to shift slightly when she wasn't looking directly at it.

"Professor Voss?" Sarah's voice was small, frightened. "I think something's happening to the others."

Helena looked where Sarah was pointing. The students who had been writing enthusiastically were now completely motionless, their pens still pressed to paper, their eyes staring straight ahead without blinking.

She rushed to Rebecca's desk and gently touched the girl's shoulder. Rebecca didn't respond. Her pulse was steady, her breathing normal, but she might as well have been carved from stone.

Helena grabbed Rebecca's exam paper, and what she saw made her stomach drop. The girl's answer had changed. Where before there had been a cold but recognizable ethical argument, now there were symbols—strange, angular marks that hurt to look at directly.

And they were still being written, though Rebecca's hand wasn't moving.

"Everyone out," Helena commanded, her voice sharp with authority. "Leave everything and exit the room immediately."

The responsive students stood quickly, but those who had been writing remained frozen at their desks.

"Leave them," Helena said as Sarah moved toward her motionless classmates. "We need help."

As the conscious students filed out, Helena took one last look at the exam question that had started it all. But question fifteen was gone. In its place was a single line of text:

Thank you for your participation in the selection process.

Helena dropped the paper and ran for the door, but not before she glimpsed the truth written in symbols at the bottom of the page, symbols that somehow made perfect, terrible sense.

This hadn't been an exam at all.

It had been an interview.

And some of her students had just been hired for a job they never applied for, by an employer that wasn't quite human.

Outside in the hallway, as she called for security and tried to explain the inexplicable, Helena wondered if she'd ever see those frozen students again. And if she did, would they still be the same people who had walked into her classroom that morning?

The answers, she suspected, were written in a language she was grateful she couldn't read.