Doctor's experiences of work related moral problems : responsibility without clear boundaries

Sammanfattning: For as far back as the history of the medical profession can be traced, it has been assumed that doctors learn professional moral knowledge together with medical knowledge. From the sixties, internal professional morality has publicly changed to external morality, described with vocabulary and concepts, connected to philosophical branches. Although now incorporated in medical ethics teaching, it is not known how well they cover the problems of the clinical world. The main purpose of this thesis is to study doctors experiences of moral problems in their everyday working life. The most prominent schools of modern medical ethics with their assumptions regarding e.g. human nature and fact/value relations are also studied and their impact (by focusing on some issues and omitting others) on our public, shared reality is described. According to a social constructionist approach (based on ideas from Alfred Schütz, Peter Berger and Thomas Luckmann) individuals perceive, interpret and act within a social life-world where things and events in every-day life have a self-evident meaning. Within a person s lifeworld, moral life is a form of societal participation where experience is connected to moral concepts as loyalty, deception and (un-) fairness. To find a concept relevant one must have a standard (e.g. regarding social roles and other aspects of human life). Fourteen experienced doctors provide accounts of everyday work related moral problems. The interview analysis is carried out with a phenomenological method. A moral problem occurs in a situation when, according to the professional standard related to being a doctor, values discussed in the thesis are violated to such an extent that the doctors obtain an insight of an existing moral problem. What counts as relevant in each situation (what makes the context), depends on how the doctors experience features within social and institutional settings in relation to the assignment they have internalised as being theirs. For the interviewed doctors, morality is allied with the question: How shall I live my life as a responsible professional? The medical assignment with its inevitable risk of hurting fellow human beings, makes for the doctors, medicine and morality inseparably intertwined. Reflecting on the boundaries of the profession s standard, is, for the doctors, different than working in concrete, practical situations where they often find themselves forced to take responsibility for political issues. Many of the doctors problems involve social and economic aspects and cannot be discussed merely from the framework of philosophically founded medical ethics theories. The doctors experienced problems are related to their comprehension of what kind of society, what kind of human relations, and what kind of health care we desire. In discussing these issues negotiating about the contents of our value concepts non-professionals experience as well as healthcare workers praxis-bound experience are necessary elements.