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Moral Disagreements During Residency Training

Peter McL. Black, MD, PhD
JAMA. 1985;254(24):3467-3468. doi:10.1001/jama.1985.03360240079040.
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Moral disagreements with the attending physician are not often discussed in residency training, possibly because they are difficult to manage. All of us have probably been part of such disagreements, however, and may remember how vitiating they were for everyone involved. In this issue of The Journal, Winkenwerder1 describes with eloquence and concern one such disagreement and its management.

It is instructive to review the situation presented in this article. The attending physician followed the guidelines currently accepted for making decisions for incapacitated patients; he asked the family to be the surrogate decision maker and used the patient's best interests as the criterion for decision making. Moreover, the decision was to affirm life, a decision legally required by some courts unless prior court approval has been obtained.3 Despite this, the resident was left with "a conscience that was disturbed."

How might Winkenwerder's conscience have been assuaged? He suggests


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