Feelings of guilt are human emotions that may arise if a person committed an action that contradicts basic moral mores or failed to commit an action that is considered moral according to their ethical standards and values. Psychological scholarship distinguishes between altruistic guilt (AG) and deontological guilt (DG). AG results from having caused harm to an innocent victim, either by acting or failing to act, whereas DG is caused by violating a moral principle. Although physicians may be expected to experience frequent feelings of guilt in their demanding and intensive work, it is surprising to find that this issue has not been explored in the professional literature on medical ethics. To that end, we conducted a qualitative study that included personal in-depth interviews with Sunni Muslim gynaecologists. These doctors provide underground infertility care and perform religiously forbidden treatments involving sex selection and gamete donation. They opened their hearts and spoke about the emotionally taxing pangs of conscience they suffer. Analysing their narratives led us to characterize their feelings of guilt as DG. We discuss the causes for their plight and the way they cope with it, compare DG to the concept of moral distress, and call for future research on clinicians’ feelings of guilt and pangs of conscience.

内疚感是一种人类情绪，如果一个人做出了与基本道德准则相矛盾的行为，或者没有做出根据其道德标准和价值观被认为是道德的行为，则可能会产生这种情绪。心理学学术区分利他罪孽（AG）和道义罪孽（DG）。AG 是由于行为或不行为对无辜受害者造成伤害而造成的，而 DG 则是由于违反道德原则而造成的。尽管医生在高强度的工作中可能会经常感到内疚，但令人惊讶的是，医学伦理专业文献中并未探讨这个问题。为此，我们进行了一项定性研究，其中包括对逊尼派穆斯林妇科医生的个人深入访谈。这些医生提供地下不孕症护理，并进行宗教禁止的治疗，包括性别选择和配子捐赠。他们敞开心扉，讲述了他们所遭受的情感上的良心煎熬。通过分析他们的叙述，我们将他们的内疚感描述为 DG。我们讨论了他们陷入困境的原因以及他们应对的方式，将 DG 与道德困境的概念进行比较，并呼吁未来对临床医生的内疚感和良心痛苦进行研究。