"Just do your job": technology, bureaucracy, and the eclipse of conscience in contemporary medicine

The Impact of Moral Distress on Staff and Novice Nurses

ABSTRACT

Moral distress is an interior affliction associated with exterior conflicts between one's values, obligations, and actions. This article builds understanding of moral distress among nurses and the importance of reducing its harmful impact, particularly to novice nurses. Moral distress is defined along with ethical issues and concepts related to moral distress, its current impact, coping with moral distress and building moral reserve, and the significance of acting according to one's conscience.

The Virtue of Hope in Medical Training

While many of the challenges of contemporary medical training are characterized uniformly as "burnout," such a diagnosis is nonspecific and overlooks the degree to which the flourishing of medical practitioners depends on the development and exercise of virtue. The virtue of hope, in particular, is indispensable to sound medical practice generally and the flourishing of trainees. It is only through sound apprehension of the nature of the virtue of hope, the challenges to the cultivation of hope that residency poses, and practices that allow such cultivation, that contemporary trainees can learn to care well for patients and flourish in their own right.

Summary

While the general term "burnout" is used to describe many of the challenges of contemporary medical training, a more precise characterization that unifies these challenges is a deficiency of the virtue of hope. Medical trainees face many obstacles to the cultivation of hope during training, but learning both to correctly identify this deficiency, and practices which prove a fitting response, offers a way forward.

"Many roads lead to Rome and the Artificial Intelligence only shows me one road": an interview study on physician attitudes regarding the implementation of computerised clinical decision support systems

Research regarding the drivers of acceptance of clinical decision support systems (CDSS) by physicians is still rather limited. The literature that does exist, however, tends to focus on problems regarding the user-friendliness of CDSS. We have performed a thematic analysis of 24 interviews with physicians concerning specific clinical case vignettes, in order to explore their underlying opinions and attitudes regarding the introduction of CDSS in clinical practice, to allow a more in-depth analysis of factors underlying (non-)acceptance of CDSS. We identified three general themes from the results. First, 'the perceived role of the AI', including items referring to the tasks that may properly be assigned to the CDSS according to the respondents. Second, 'the perceived role of the physician', referring to the aspects of clinical practice that were seen as being fundamentally 'human' or non-automatable. Third, 'concerns regarding AI', including items referring to more general issues that were raised by the respondents regarding the introduction of CDSS in general and/or in clinical medicine in particular. Apart from the overall concerns expressed by the respondents regarding user-friendliness, we will explain how our results indicate that our respondents were primarily occupied by distinguishing between parts of their job that should be automated and aspects that should be kept in human hands. We refer to this distinction as 'the division of clinical labor.' This division is not based on knowledge regarding AI or medicine, but rather on which parts of a physician's job were seen by the respondents as being central to who they are as physicians and as human beings. Often the respondents' view that certain core parts of their job ought to be shielded from automation was closely linked to claims concerning the uniqueness of medicine as a domain. Finally, although almost all respondents claimed that they highly value their final responsibility, a closer investigation of this concept suggests that their view of 'final responsibility' was not that demanding after all.

Conscientious Objection, Not Refusal: The Power of a Word

Conscientious objection (CO) in medicine grew out of the need to protect healthcare providers who objected to performing abortions after the Roe v. Wade decision in the 1970s which has since over time expanded to include sterilization, contraception, in vitro fertilization, stem cell research, and end-of-life issues. Since 2006, there has been a growing amount of published literature arguing for the denial of CO. Over the last three years, there has also been an increase in calling this conscientious refusal. This article will argue that the term conscientious objection is more accurate than conscientious refusal because those who object are not refusing to provide care. CO also emphasizes that there are reasoned arguments behind one's decision not to perform certain actions because of one's own principles and values.

SUMMARY

How something is presented matters. Objection emphasizes the thought behind the action while refusal gives the impression that medical care is not given.

Suffering Absence: Hauerwas and the Challenges to Faithful Presence in Contemporary Medical Training

In this essay, the author draws on the theologian Stanley Hauerwas' work to describe the central challenge of the contemporary medical trainee as an inability to be present to suffering patients. While the central challenge to the physician was once the moral resources required for such presence, today it is the temporal and bureaucratic demands bearing upon the contemporary resident preclude even the opportunity for this presence. In order to seek out such spaces when time does become available, the contemporary trainee requires a moral community, as Hauerwas notes "like a church," to remind him or her of the moral commitment to be present to suffering patients even in the midst of such structural challenges.

Summary

Contemporary residents must actively seek out the opportunity to be present to suffering patients and require moral communities to sustain this commitment.

Conscientious objection to abortion: why it should be a specified legal right for doctors in South Korea

Background

In 2019, the Constitutional Court of South Korea ruled that the anti-abortion provisions in the Criminal Act, which criminalize abortion, do not conform to the Constitution. This decision will lead to a total reversal of doctors’ legal duty from the obligation to refuse abortion services to their requirement to provide them, given the Medical Service Act that states that a doctor may not refuse a request for treatment or assistance in childbirth. I argue, confined to abortion services in Korea that will take place in the near future, that doctors should be granted the legal right to exercise conscientious objection to abortion.

Main text

Considering that doctors in Korea have been ethically and legally obligated to refrain from abortions for many years, imposing a universal legal duty to provide abortions that does not allow exception may endanger the moral integrity of individual doctors who chose a career when abortion was illegal. The universal imposition of such a duty may result in repudiation of doctors as moral agents and damage trust in doctors that forms the basis of medical professionalism. Even if conscientious objection to abortion is granted as a legal right, most patients would experience no impediment to receiving abortion services because the healthcare environment of Korea provides options in which patients can choose their doctors based on prior information, there are many doctors who would be willing to provide an abortion, and Korea is a relatively small country. Finally, the responsibility to effectively balance and guarantee the respective rights of the two agents involved in abortion, the doctor and the patient, should be imposed on the government rather than individual doctors. This assertion is based on the government’s past behaviours, the nature of its relationship with doctors, and the capacity it has to satisfy both doctors’ right to conscientious objection and patients’ right to legal medical services.

Conclusion

With regard to abortion services that will be sought in the near future, doctors should be granted the legal right to exercise conscientious objection based on the importance of doctor’s moral integrity, lack of impediment to patients, and government responsibility.