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Enabling first and second year doctors to negotiate ethical challenges in end-of-life care: a qualitative study
  1. Sinead Donnelly1 and
  2. Simon Walker2
  1. 1Palliative Medicine, University of Otago Wellington, Wellington, New Zealand
  2. 2Bioethics, University of Otago - Dunedin Campus, Dunedin, New Zealand
  1. Correspondence to Dr Sinead Donnelly, Palliative Medicine, University of Otago Wellington, Wellington 6242, New Zealand; sinead.donnelly{at}


Objective To understand the unique ethical and professional challenges confronting first and second year doctors in caring for people who are dying, and to learn what factors help or hinder them in managing these.

Method 6 first year and 7 second year doctors were interviewed one-to-one by a senior palliative medicine physician (SD), quarterly over 12 months, using a semistructured approach. Thematic analysis was conducted with the findings, following the general inductive approach.

Results 21 hours of recorded interviews were analysed by SD, and ethical and professional issues were identified. These were discussed with SW, and sorted into seven broad categories. The participants’ accounts of the issues convey a strong ethical sensitivity, developed through their undergraduate training. A recurring challenge for them through their first 12–24 months of work as doctors is being responsible for the decisions, knowing that what they do can have life and death consequences. The participants frequently describe senior doctors as an important source of support, and the lack of such support as leading to moral distress and demoralisation. Another important factor is having opportunity to discuss and reflect on the decisions after they are made. Where such reflection had been facilitated properly, participants displayed considerable growth in their ability to manage ethical challenges.

Conclusion Senior support and opportunities for reflection need to be recognised as key factors in enabling first and second year to respond appropriately to ethical challenges in end-of-life care, and in sustaining their well-being through this critical stage of their professional life.

  • end of life care
  • education and training
  • clinical decisions

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  • Contributors This paper is based on research undertaken by SD as part of a Masters in Medical Science (MMedSc) degree completed in March 2020. She designed the project, interviewed the participants, generated the initial analysis and coding. She wrote the first draft of this paper and the contributed to all subsequent versions. SW was one of two supervisors for the MMedSc. He advised on the design of the project, reviewed the analysis and coding, revised the initial draft of the paper and worked on all subsequent drafts. Both authors read and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by University of Otago Health Research Ethics Committee reference code H17/115 on 7 October 2017.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. Deidentified participant data available from Sinead Donnelly (first author) Full details of the study available in Master's thesis format archived at University of Otago.