A Jurisprudential and Ethical Analysis of the Possibility of Modifying or Waiving Residency Obligations in Cases of Psychological Distress: A Case Study of Iran’s Healthcare System

Abstract

Residency is one of the most challenging stages of medical education, and due to educational pressures and clinical responsibilities, is associated with a high prevalence of psychological harm. Nevertheless, the regulations governing residency obligations in Iran’s healthcare system emphasize the continuation of commitments and the imposition of financial penalties in the event of withdrawal from the program, while the impact of psychological harm on the persistence of such obligations has not been adequately addressed. Accordingly, this study, using a descriptive-analytical method, sought to elucidate the jurisprudential-ethical possibility of modifying or terminating residency obligations under conditions of psychological harm. The findings indicated that the primary principle is the obligation to fulfill residency commitments; however, when the continuation of such obligations causes psychological harm to the resident or aggravates existing harm, the general applicability of this obligation is restricted based on the Islamic jurisprudential principles of La Darar (no harm) and Nafi ‘Usr wa Haraj (the negation of undue hardship and intolerable difficulty). Since the purpose of these principles is to prevent harm and eliminate undue hardship, their effects vary in proportion to the severity of the harm. Therefore, in cases where the harm is manageable, temporary modification of residency obligations is justified, whereas in situations where no viable measure can alleviate the harm, termination of the binding nature of the obligation is warranted. Accordingly, the unrestricted application of the current regulations governing residency obligations in cases involving psychological harm is inconsistent with the principles of La Darar and Nafi ‘Usr wa Haraj. Pursuant to Article 4 of the Constitution of the Islamic Republic of Iran, these regulations should therefore be reconsidered, and a mechanism based on specialized professional assessment should be established for the modification or termination of residency obligations. Furthermore, from an ethical perspective, theories of normative ethics and the four principles of biomedical ethics may be regarded as providing support for such a mechanism.