Making sense of value conflicts at the margins of the medical profession

By Henk Jasper van Gils-Schmidt and Sabine Salloch

In our paper, “Taking a Moral Holiday? Physicians’ practical identities at the margins of professional ethics”, we discuss value conflicts that physicians come across at the margins of their professional practice. For example, the conflict one may experience as a psychiatrist when considering to speak out against a public figure about a suspected mental disease or the question whether one, as a physician, is always obliged to diagnose and treat family members and friends (apart from emergency situations). By introducing the theory of Christine M. Korsgaard, which centers around the concept of practical identity, we illustrate three main types of such conflicts “at the margins” that occur in the intersection between professional ethics and moral demands originating from other sources. We identify either how such conflicts can be solved or how the emotional and moral burden can be explained by framing them in terms of conflicts between practical identities. We furthermore point out that prominent theories of professional ethics – e.g., the reference to an internal morality of medicine, contractualism or theories of supererogation – are less suitable for such sense-making activity on the edge of physicians’ job activities.

We felt the need to explore a different way, a different theoretical outlook, to make sense of such value conflicts, because although they are “merely” at the margins of the profession, they are often central to the life of doctors and other medical professionals. One such example is of medical staff that stayed in hotel rooms during the uncertain times at the start and middle of the pandemic as not to infect and be a danger to their family at home. Other situations refer to physicians’ commitment to sustainability that can run into conflict with high-quality patient care. How can we make sense from a theoretical point of view from such conflicts that are experienced as very pressing? To what extend can codes of professional ethics still maintain authority if they come into conflict with deeply felt non-professional moral obligations? And how can theory help us to understand and deal with such value conflicts as they occur in our lives?

Exploring potential answers to these questions motivated our paper. We chose an ethical approach that puts the idea of “what we value in ourselves” central to its theoretical foundations. In this way, we were able to conceptualize the conflicts that occur at the margins of the medical profession – which we interpret as conflicts between different values that give a sense of purpose to a person´s life – and discuss potential ways of dealing, or making sense of, such conflicts. We found that our intuitions in this regard where resonated both in teaching classes for medical students – who were able to quickly pick up the notion of “practical identities” and apply them to situations –as well as in situations experienced by ourselves, e.g. as a mother and medical ethicist in dealing with the 8 year old son becoming a research subject.


Paper title: Taking a Moral Holiday? Physicians’ practical identities at the margins of professional ethics

Authors: Henk Jasper van Gils-Schmidt1 and Sabine Salloch2


1) Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany;

2) Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany

Competing interests: We have no competing interests to declare.

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