Philosophical Physicians

I started reading philosophy the way I think many of us do: with questions about my own nature, the nature of the people around me, and the nature of the world and cultures we live in. 

In my case, I had questions about residency training. What is traditionally obvious in medical training is the strict vertical hierarchy, but there’s another subtle, powerful voice at play: the hidden curriculum. Who is allowed to speak. Who is protected. Who is expected to absorb harm silently in the name of ‘education.’

As a surgical resident, I often sat at the back of weekly didactics and thought about how much better medicine, and society, could be if we treated people as individuals rather than interchangeable parts. What if, instead of forcing everyone to merely survive, we gave each person what they needed to actually thrive? What if everyone's potential was maximized? What if trainees were given the time, tools, and support they needed to truly flourish instead of forcing everyone into the same regimen? That same regimen that has been largely unchanged for more than half a century.

Since starting residency, I have been introduced to Immanuel Kant (1724-1804), largely considered the father of deontological ethics. At its core, deontology is concerned not with outcomes, but with moral duties. Kant argued that an action is only moral if you would accept it as a universal rule, something anyone could do, at any time, under the same circumstances. Do you want to lie? You can, but only if you believe it would be acceptable for anyone to lie whenever they wanted. You have to ask yourself whether you would want to live in a world governed by that rule. Kant also believed that people possess intrinsic moral worth. Human beings are ends in themselves, never merely means to an end. You cannot ethically use people, no matter how noble the goal.

Viewed through that lens, the current residency system becomes deeply uncomfortable.

Residency does not openly declare that it is acceptable to use people as means to an end, but it functions as though it is acceptable because the daily mechanics of training rewards endurance over wellbeing, silence over dissent, and output over trainees’ dignity and autonomy. Residents become labor, coverage, and throughput. Exhaustion is normalized, even lauded. Humiliation is reframed as a teaching technique. Suffering is justified by the claim that everyone before them endured the same.

Kant would not be interested in whether residency produces competent physicians in the end. He would ask whether the process itself is morally permissible. Would you want a world where it is acceptable to routinely deprive people of sleep in the name of professional formation or tradition? Where training excuses cruelties? Where a person’s worth fluctuates based on their position in the hierarchy? 

The hidden curriculum teaches that endurance is virtue, silence is safer, and that being treated as less than human is the price of admission. Deontology rejects that logic entirely. If residents are people of intrinsic value, then their dignity cannot be suspended for training. Their humanity is not a negotiable cost.

A system that creates excellence by violating dignity is not ethically neutral; it is ethically compromised. And a profession devoted to the care of human beings should not require the suspension of humanity as its entrance fee. The question, then, is not whether residency works, but whether we are willing to accept a system that would be indefensible if applied universally. If we would not choose this training for everyone, why do we accept it for anyone?

‍