Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study

Dzeng, Elizabeth; Colaianni, Alessandra; Roland, Martín; Levine, David; Kelly, Michael P.; Barclay, Stephen; Smith, Thomas J.

doi:10.1007/s11606-015-3505-1

Cited by 111 publications

(127 citation statements)

References 46 publications

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“…As the literature indicates, moral distress may be spreading to medicine and other professions [28,35,36,[100][101][102][103]. This may reflect that a variety of health professionals are increasingly finding themselves in moral binds similar to those experienced by nurses.…”

Section: Resultsmentioning

confidence: 99%

What Moral Distress in Nursing History Could Suggest about the Future of Health Care

2017

AMA Journal of Ethics

133

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The concept of moral distress was defined in 1984 as (a) the psychological distress of (b) being in a situation in which one is constrained from acting (c) on what one knows to be right. A substantial literature on the subject has developed, primarily in nursing ethics. The aforementioned elements of distress are applied here to areas of clinical and organizational significance: (a) distress from causing intimate pain during care of the dying, (b) constraints stemming from proximate and background challenges of health care organizations, and (c) changing perspectives on therapeutic technologies derived from global environmental perspectives. Although moral distress may be increasing in clinical settings, nursing advocates are developing positive ways to cope with it that can help clinicians in general. IntroductionAfter its first use in nursing over 30 years ago, the concept of moral distress has proven applicable to a growing range of problematic situations. This essay outlines a few motifs in the development of the concept in nursing ethics and then considers some current applications of the concept. Starting with the bedside care of the dying, it sets moral distress in successively wider contexts, concluding with some morally problematic global environmental challenges that health care services will need to address during the next decades.

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Section: Resultsmentioning

confidence: 99%

What Moral Distress in Nursing History Could Suggest about the Future of Health Care

2017

AMA Journal of Ethics

133

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“…Repeated episodes of moral distress may result in burnout, withdrawal from direct patient care activities, job dissatisfaction, and attrition from the health care professions [2,5]. It has also been implicated as a factor in empathy erosion in nurses, medical residents, and fellows [5,6].…”

Section: Commentarymentioning

confidence: 99%

How Should Resident Physicians Respond to Patients' Discomfort and Students' Moral Distress When Learning Procedures in Academic Medical Settings?

Miller¹

2017

AMA Journal of Ethics

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In this scenario, a medical student, Lauren, experiences moral distress because she feels that learning to perform a procedure on a patient who requested not to be used for "practice" puts her own interests above the patient's. Lauren might also worry that the resident physician is misrepresenting her abilities. The resident physician could help alleviate Lauren's distress and align her interests with the patient's by more clearly explaining the training situation to the patient and seeking the patient's approval. Lauren might also manage the situation by assuring the patient of the resident's supervisory role. This article argues that trainees should have the opportunities to practice procedures and difficult conversations in simulated settings and that institutions should support a culture of "speaking up" to ensure patients' and learners' safety. CaseLauren is a medical student who is doing her clinical year rotation in neurology. She has never performed a lumbar puncture (LP), also known as a spinal tap, but a patient on the neurology inpatient service requires one for diagnosis. Her resident physician, Adam, suggests that she attempt to perform one.

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“…In this issue of JGIM, Dzeng and colleagues take on the issue of medical futility from the perspective of the young physicians persuaded (or coerced) to deliver it. 1 In interviews with 22 residents and fellows training in three institutions, the authors found a striking degree of moral distress among trainees who felt they had been forced to participate in futile care. These findings raise two further questions.…”

mentioning

confidence: 99%

Equanimity, Ambiguity, and the Physician’s Task

Kravitz

2015

J GEN INTERN MED

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Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study

Cited by 111 publications

References 46 publications

What Moral Distress in Nursing History Could Suggest about the Future of Health Care

What Moral Distress in Nursing History Could Suggest about the Future of Health Care

How Should Resident Physicians Respond to Patients' Discomfort and Students' Moral Distress When Learning Procedures in Academic Medical Settings?

Equanimity, Ambiguity, and the Physician’s Task

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