Dilemmas of conscience in the practice of medicine: a phenomenological study

This article presents an interpretive phenomenological study that explores how physicians experience dilemmas of conscience in their day-to-day practice. Eighteen physicians of various ages and professional backgrounds were interviewed and asked to identify and discuss three instances when they experienced a dilemma of conscience. Preliminary findings from narrative analyses of these physician interviews suggest that dilemmas of conscience are ubiquitous, temporal and context-dependent; they cannot be reduced and understood as a focal phenomenon. Moral development appears to parallel acquisition of medical knowledge; participants' specific concerns and their clinical contexts evolved as they gained experience and insight. Participants learned how to negotiate dilemmas of conscience through time, mistakes, examples, actualization, rehearsals and struggles. Remaining engaged in care, developing partnerships and protecting spaces for dialogue can help create practices of accountability when dilemmas of conscience occur.