Weekend Edition on NPR aired an interesting piece this morning on the correlation between medical students' development of medical skills vs. development of moral conviction. They cited two rather disturbing studies which concluded that the further a student progresses in medical school, the harder it becomes to continue developing their moral and ethical standards in caring for patients.
The primary deterrent to this development rests on the "system" which places interns and their decisions under the direct control of the people responsible for their evaluations, and consequently, their successful career launch. Interviews with these young doctors revealed feelings of mental conflict when they were placed in positions where they were told how to handle patients and their close relatives in morally or ethically sensitive situations. In many cases, they felt coerced to ignore their gut feelings in order to appease the doctor in charge. Interestingly, students' loss of guilt or conflict in these situations increased the further they progressed in their training - in direct opposition to the gain in medical skills during training.
Therefore, the study hypothesizes, when doctors finally enter real positions of authority, they have traveled backward, instead of forward, in what is considered the "normal" evolution of a persons' moral and ethical sensitivity. Hear the NPR piece with study references here.
Not being a doctor, I cannot say this is true, but I can relate it to the larger world, where the ramifications tend to be subtler. As well as being depicted as an issue in medicine on such shows as E.R., this denial of self autonomy manifests itself in all of academia (particularly the sciences), as well as existing in healthy doses in the corporate world.
My husband is a scientist who holds views that are unpopular (but cannot be disproved) in the academic scientific community. Anyone who disagrees with unproven, yet widely accepted hypotheses is ridiculed and ignored, without any objective review of their work. Students are coerced into espousing the beliefs of the professors who control whether or not they will receive their graduate degree. Anyone who thinks objectively or independently is discouraged from considering other viewpoints. Most significantly, the peer review process is the final blow against independent thought. I'm sure here, too, there’s a direct correlation between the volume of information absorbed and the increasing acceptance of how to work the "system" by maintaining the status quo.
One of the reasons I'm here now, writing this blog, maintaining physician-central, and working on other research projects is because I don't feel I can ever go back to the corporate hierarchy that regularly made me question whether I would be expected to do something I didn't personally feel comfortable with. In some cases, it seemed the less ethical a person was, the higher they rose, and the more authority they gained over more people. Political alliances and the party line seemed more important than the product or service we were ostensibly entrusted with providing.
The point is, this is a phenomenon that is inherent in all institutions. Doctors and hospitals are not immune, it just seems more sensational when you apply it to the ultimate moral dilemmas surrounding life and death.
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Posted by: ellaela-bv | December 15, 2008 at 12:07 PM