The ethical challenges associated with medical internship and residency

© 2009 Dr. Rosalind McDougallInternship and residency are the first years following graduation from medical school. Interns and residents work in hospitals as the junior members of hierarchical medical teams. To date there has been little systematic philosophical work that focuses specifically on this group. Instead, in ethical discussions, interns and residents tend to be included either with medical students or with their more senior colleagues. In this thesis, I argue that interns and residents differ from both medical students and more experienced doctors in ethically important ways. Their working context requires them to play multiple roles simultaneously, including doctor, subjugate team member, learner, and hospital employee. The demands of these multiple roles create a set of ethical challenges for junior doctors that is unique to their professional stage. Further, the potentially conflicting demands of these multiple roles limit the ways in which junior doctors can act in response to the ethical difficulties that they encounter. I thus propose that the ethical challenges associated with medical internship and residency can be fruitfully understood as role virtue conflicts. Aiming to produce a work of empirically-informed moral philosophy, I investigate junior doctors‟ ethical issues using a combination of literature review, semi-structured interviews, and philosophical analysis. In-depth interviews with fourteen Melbourne-based junior doctors formed a central element of this project, in order to ensure the project‟s focus on pressing practical issues. On the basis of these interviews and my review of research findings about junior doctors across various disciplines, I develop a typology of the kinds of ethical challenges associated with internship and residency. These include being involved in treatment perceived as futile, seniors discouraging disclosure of errors, and reporting unrostered hours. In addition to the typology of ethical issues, I develop and use a role-based framework as a way of analysing the ethical challenges faced by interns and residents. The method of ethical analysis that I propose conceptualises the good junior doctor as good qua four roles, each with a differing set of role virtues. I argue that this role-based framework both reflects and engages with junior doctors‟ specific position of agency and thus captures a fuller range of moral considerations than do other possible modes of analysis