Justifying the Consequences of Trainee Medicine

By Connor Brenna and Sunit Das.

Are we doing the best we can for our patients?

At face-value, this seems to be a straightforward (albeit broad) question. In this piece, we dive deeper into the ethics of trainee medicine to find that the answer is really contingent on how one interprets who it is that we as medical professionals serve. In the process, we suggest that we are in fact not doing the best we can for our patients, per say: we are regularly teleologically suspending the ardent commitment we have to them for an even greater ethical imperative, which is doing the best we can for all people served by the healthcare system.

The core ethical pillars of medicine revolve deontologically around individual patients, and traditional professional values bind us to providing optimal, unreserved, tailored care to each one. Despite this ethical obligation, in the context of trainee medicine we find optimal care is being—consciously or unconsciously—forgone for individual patients. In the operating room of any academic hospital, when a staff surgeon assigns responsibility to a less experienced trainee, they are choosing suboptimal care for the patient being operated on. Many checks and balances exist within the medical education system to protect patients from being harmed by these decisions, but nonetheless an ethical tension exists at the heart of our profession.

On the other hand, there are several benefits to the inclusion of trainees in medical management, within and beyond the operating room. Chief among them, we are assured that several decades from now when our current contingent of surgeons is no longer able to practice, there will be newcomers to the field who can replace them. By knowingly foregoing optimal care in the present moment we are putting a tension on the social contract that medical professionals maintain with the general public, but this ensures a longitudinal availability of quality healthcare for patients beyond those immediately in front of us.

We therefore propose in our paper that a fundamental tension exists between the deontological values of medical professionals, and the utilitarian values of the medical system within which they operate. Even while existing in the centre of this tension, however, there is a role (and responsibility) for individual practitioners to foster deontological relationships with their patients, forming strong doctor-patient units that can negotiate the practical imperfections of the medical system together.


Paper title: Imperfect by design: the problematic ethics of surgical training.

Author: Connor T. A. Brenna1 and Dr. Sunit Das1-3


1 Faculty of Medicine, University of Toronto Medical School, University of Toronto, Toronto, ON

2 Division of Neurosurgery, University of Toronto, Toronto, ON

3 Centre for Ethics, University of Toronto, Toronto, ON

Competing interests: None declared.

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