ETHICAL PREDICAMENTS AND MORAL REASONING OF POST-GRADUATE INTERNS

MILAGROS F. NERI
MS BIOETHICS (APRIL 14, 2009)
Department of Philosophy


Abstract

Several studies have shown that the improvement in moral reasoning and moral development expected for the age and educational level of medical students are not occurring over the four years of undergraduate medical education. These findings have been partly attributed to the existence of a “hidden curriculum” which consists of informal processes at the level of organizational structure and culture.

A more problematic situation involves the post-graduate interns who are no longer under the control of medical schools and whose supervision is entirely dependent on the residents and consultants of their hospital affiliation.

This study, therefore, has the following objectives: 1) to describe the ethical predicaments of post-graduate interns deployed in different hospitals; 2) to explore how PGIs are affected by the ethical predicaments; 3) to determine the nature of the moral reasoning involved with each decision; and 4) to compare the moral reasoning stage of post-graduate interns in different hospital settings.

The study operates on the premise that the different hospital affiliations of PGIs have their own distinctive culture which may expose the PGIs to different ethical predicaments. Moral development stage of PGIs differs as a function of their hospital affiliation, gender, age and status of internship.

A postpositivist approach most closely parallels the epistemology of this research. A qualitative case study design was used with two FGDs and 4 group interviews in order to explore the world of the PGIs, their predicaments, affect and moral reasoning. A survey was subsequently conducted to determine the moral development stage of PGIs. The questionnaire which was based on the Defining Issues Test by Rest consists of case scenarios that were developed from the results of the FGDs.

Content analysis of the text was used to identify emerging and repeated themes. Common issues of PGIs involve conflict with residents and consultants as well as conflict in patient care. Conflict with nurses and laboratory staff was unique in the academic training hospital. Decision-making as to what course of action to take hinges on social consensus and care for patient. There were a total of 144 PGIs in the survey: 97 regular and 40 midyears, 101 females and 36 males with a mean age of 26. Seven respondents failed to indicate their sex and status of internship. There were 54 PGIs from academic training hospital, 38 from private, and 52 from government hospitals in Metro Manila. The overall moral development of PGIs is in the conventional stage oriented towards conformity with socially-agreed upon rules. There is no statistical difference as to age, gender, and hospital affiliation. It is only the status of internship in some cases (Cases 2, 3, 4) that were found to be statistically significant.

Given the above results, it seems that the fundamental moral motivation of PGIs is the preservation of relationship including that with the patient manifested by caring attitude. Therefore, both justice and care orientation is operable in the case of the PGIs in the study.