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Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians

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Abstract

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.

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Acknowledgements

The authors are grateful to the anonymous reviewers for their helpful comments. We also wish to thank Miss Neta Cohen for the graphical design of Fig. 1.

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Authors and Affiliations

  1. School of Psychology, Tel Aviv University, 30 Haim Levanon Street, Postal code 699780, Tel Aviv, Israel

    Y. Bokek-Cohen

  2. School of Education, Sakhnin College Academic for Teacher Education, Sakhnin, Israel

    I. Marey-Sarwan

  3. School of Nursing, Tel Aviv Jaffa Academic College, 2 Rabenu Yerucham St., Postal code 6161001, Tel Aviv, Israel

    M. Tarabeih

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  1. Y. Bokek-Cohen
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  2. I. Marey-Sarwan
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  3. M. Tarabeih
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Contributions

YBC, IMS, and MT planned the research design and the interview guide. MT conducted the personal interviews. YBC, IMS analyzed the data. YBC, IMS, and MT wrote the draft of the manuscript. IMS and MT critically read the first draft. YBC, IMS, and MT approved the final version of the manuscript.

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Correspondence to Y. Bokek-Cohen.

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Bokek-Cohen, Y., Marey-Sarwan, I. & Tarabeih, M. Deontological Guilt and Moral Distress as Diametrically Opposite Phenomena: A Case Study of Three Clinicians. Bioethical Inquiry (2023). https://doi.org/10.1007/s11673-023-10300-4

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