The experience of ethical issues at the end of life for first and second year doctors

Abstract

Background The professional situation of junior doctors is unique in ethically important ways. Studies show that junior doctors struggle with ethical challenges especially in end of life care and often feel unsupported by senior team members. Aim The purpose of this study was to examine the real life experiences of ethical issues at the end of life for 1st and 2nd year doctors. Method This inductive qualitative research involved 1:1 interviews with 6 first year and 7 second year doctors, quarterly over 12 months by a senior palliative medicine physician experienced in qualitative research leading to 21 hours of recorded interviews. Outcomes The ethical issues categories are: care and decisions based on patients’ older age, prognosis, the dying patient, family requests, resuscitation status decisions, issues specific to 2nd year doctors, rural hospital experience and to out-of-hours duties. The ethical challenges recounted by these doctors suggested an “ethical sensitivity” already created during their undergraduate training. Through practice as doctors in their first 12-24 months, they demonstrated an “ethical awakening” as they are confronted with the duty to make decisions on behalf of another human being. In this challenging space when they are responsible for patients at the end of life, they need senior support. Lack of this senior support leads to moral distress and demoralization. If support is available, they demonstrate professional growth and are invigorated by the opportunity to make decisions. Conclusion If “ethical sensitivity” and “ethical awakeness” are what we as educators wish to promote for the well being of patients and doctors, then once “awoken” we have an obligation to support the early career doctor. We too must be “ethically awake” and “ethically sensitized” to their needs in these formative years. A program of support involving senior doctors is suggested for the first 12-24 months of clinical practice.