“The angel intern would do all of it”: Junior doctors, ethics and role conflict

Rosalind McDougall1,2

1 Melbourne School of Population and Global Health, University of Melbourne VIC 3010, rmcdo@unimelb.edu.au
2 Children’s Bioethics Centre, Royal Children’s Hospital, Melbourne

Medical internship has long been the subject of sociological study. However, ethical analysis of this crucial intersection between medical school and professional practice has been very limited.  To date there has been little systematic philosophical work that focuses specifically on junior doctors.  Instead, in ethical discussions, interns and residents tend to be included either with medical students or with their more senior colleagues.

In this paper, 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.

On the basis of in-depth qualitative interviews with fourteen Melbourne-based junior doctors and a 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.

I also develop and use a role-based framework as a way of analysing the ethical challenges faced by interns and residents.  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.


Biography

Dr Rosalind McDougall is a Research Fellow in Ethics at the Melbourne School of Population and Global Health at the University of Melbourne, and at the Children’s Bioethics Centre at the Royal Children’s Hospital, Melbourne.  She studied at the University of Melbourne and the University of Oxford, and has published widely in clinical ethics and reproductive ethics.  Her research interests include paediatric clinical ethics, parenthood, and the ethical challenges faced by junior doctors.

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