Watching the Responsibility Clock: Medical Care, Ethics, and Medical Shift Work

Abstract

The article by Dubov and colleagues (2016) evokes the inadvertent possibility of adverse ethical outcomes arising from the worldwide trend toward mandated work practices. These outcomes include the undermining of key elements of the medical relationship, such as the commitment both to caring for one's patients and to the profession itself. The adoption of inflexible rules about working hours, according to which doctors refuse to alter their work practices regardless of circumstances, may also undermine the trust of the public in medicine and erode the ability of doctors to discharge their responsibilities to their patients, their colleagues, and society. In calling into question safe working hours or medical shift work as an unquestioned good, we do not posit that doctors should be subjected to exploitative work practices that compromise their or their patients' well-being; rather, we wish to highlight some fundamental threats to the culture of medicine that may be imposed under the guise of safety (Fremantle et al. 2015). An underlying ethical purpose of health care professionals is the provision of care to their patients. To be able to achieve this it is necessary for the professionals to care for themselves. This means that the processes according to which care is shaped and delivered are implicated in the outcomes they themselves generate. This leads to a paradox. On the one hand, as is clearly demonstrated in the literature, excessive working hours lead to underperformance, increased risks, and actual harms, and judicious management of human resources both enhances health outcomes and minimizes economic costs. On the other hand, the application of rigid, dogmatically applied rules about when doctors can and cannot work puts at risk some of the most fundamental values on which the entire profession of medicine rests.