The Bridge
What the ‘moral distress’ of doctors tells us about eroding trust in health care
The article discusses the ethical dilemmas faced by healthcare providers when families demand life-sustaining treatments for patients unlikely to benefit, highlighting moral distress and trust issues.
Daniel T. Kim, Albany Medical College
I sit on an ethics review committee at the Albany Med Health System in New York state, where doctors and nurses frequently bring us fraught questions.
Consider a typical case: A 6-month-old child has suffered a severe brain injury following cardiac arrest. A tracheostomy, ventilator and feeding tube are the only treatments keeping him alive. These intensive treatments might prolong the child’s life, but he is unlikely to survive. However, the mother – citing her faith in a miracle – wants to keep the child on life support. The clinical team is distressed – they feel they’re only prolonging the child’s dying process.
Often the question the medical team struggles with is this: Are we obligated to continue life-supporting treatments?
Bioethics, a modern academic field that helps resolve such fraught dilemmas, evolved in its early decades through debates over several landmark cases in the 1970s to the 1990s. The early cases helped establish the right of patients and their families to refuse treatments.
But some of the most ethically challenging cases, in both pediatric and adult medicine, now present the opposite dilemma: Doctors want to stop aggressive treatments, but families insist on continuing them. This situation can often lead to moral distress for doctors – especially at a time when trust in providers is falling.
Consequences of lack of trust
For the family, withdrawing or withholding life-sustaining treatments from a dying loved one, even if doctors advise that the treatment is unlikely to succeed or benefit the patient, can be overwhelming and painful. Studies show that their stress can be at the same level as people who have just survived house fires or similar catastrophes.
While making such high-stakes decisions, families need to be able to trust their doctor’s information; they need to be able to believe that their recommendations come from genuine empathy to serve only the patient’s interests. This is why prominent bioethicists have long emphasized trustworthiness as a central virtue of good clinicians.
However, the public’s trust in medical leaders has been on a precipitous decline in recent decades. Historical polling data and surveys show that trust in physicians is lower in the U.S. than in most industrialized countries. A recent survey from Sanofi, a pharmaceutical company, found that mistrust of the medical system is even worse among low-income and minority Americans, who experience discrimination and persistent barriers to care. The COVID-19 pandemic further accelerated the public’s lack of trust.
In the clinic, mistrust can create an untenable situation. Families can feel isolated, lacking support or expertise they can trust. For clinicians, the situation can lead to burnout, affecting quality and access to care as well as health care costs. According to the National Academy of Medicine, “The opportunity to attend to and ease suffering is the reason why many clinicians enter the healing professions.” When doctors see their patients suffer for avoidable reasons, such as mistrust, they often suffer as well.
At a time of low trust, families can be especially reluctant to take advice to end aggressive treatment, which makes the situation worse for everyone.
Ethics of the dilemma
Physicians are not ethically obligated to provide treatments that are of no benefit to the patient, or may even be harmful, even if the family requests them. But it can often be very difficult to say definitively what treatments are beneficial or harmful, as each of those can be characterized differently based on the goals of treatment. In other words, many critical decisions depend on judgment calls.
Consider again the typical case of the 6-month-old child mentioned above who had suffered severe brain injury and was not expected to survive. The clinicians told the ethics review committee that even if the child were to miraculously survive, he would never be able to communicate or reach any “normal” milestones. The child’s mother, however, insisted on keeping him alive. So, the committee had to recommend continuing life support to respect the parent’s right to decide.
Physicians inform, recommend and engage in shared decision-making with families to help clarify their values and preferences. But if there’s mistrust, the process can quickly break down, resulting in misunderstandings and conflicts about the patient’s best interests and making a difficult situation more distressing. https://www.youtube.com/embed/MY4e4l-eAFk?wmode=transparent&start=0 Moral distress in health care.
Moral distress
When clinicians feel unable to provide what they believe to be the best care for patients, it can result in what bioethicists call “moral distress.” The term was coined in 1984 in nursing ethics to describe the experience of nurses who were forced to provide treatments that they felt were inappropriate. It is now widely invoked in health care.
Numerous studies have shown that levels of moral distress among clinicians are high, with 58% of pediatric and neonatal intensive care clinicians in a study experiencing significant moral distress. While these studies have identified various sources of moral distress, having to provide aggressive life support despite feeling that it’s not in the patient’s interest is consistently among the most frequent and intense.
Watching a patient suffer feels like a dereliction of duty to many health care workers. But as long as they are appropriately respecting the patient’s right to decide – or a parent’s, in the case of a minor – they are not violating their professional duty, as my colleagues and I argued in a recent paper. Doctors sometimes express their distress as a feeling of guilt, of “having blood on their hands,” but, we argue, they are not guilty of any wrongdoing. In most cases, the distress shows that they’re not indifferent to what the decision may mean for the patient.
Clinicians, however, need more support. Persistent moral distresses that go unaddressed can lead to burnout, which may cause clinicians to leave their practice. In a large American Medical Association survey, 35.7% of physicians in 2022-23 expressed an intent to leave their practice within two years.
But with the right support, we also argued, feelings of moral distress can be an opportunity to reflect on what they can control in the circumstance. It can also be a time to find ways to improve the care doctors provide, including communication and building trust. Institutions can help by strengthening ethics consultation services and providing training and support for managing complex cases.
Difficult and distressing decisions, such as the case of the 6-month-old child, are ubiquitous in health care. Patients, their families and clinicians need to be able to trust each other to sustain high-quality care.
Daniel T. Kim, Assistant Professor of Bioethics, Albany Medical College
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Bridge
Trump’s Project 2025 agenda caps decades-long resistance to 20th century progressive reform
The content discusses the ideological struggle in U.S. governance, highlighting conservative backlash against progressive reforms like the New Deal and Great Society, culminating in Project 2025’s agenda for Trump’s potential administration.
Colin Gordon, University of Iowa
For much of the 20th century, efforts to remake government were driven by a progressive desire to make the government work for regular Americans, including the New Deal and the Great Society reforms.
But they also met a conservative backlash seeking to rein back government as a source of security for working Americans and realign it with the interests of private business. That backlash is the central thread of the Heritage Foundation’s “Project 2025” blueprint for a second Trump Administration.
Alternatively disavowed and embraced by President Donald Trump during his 2024 campaign, Project 2025 is a collection of conservative policy proposals – many written by veterans of his first administration. It echoes similar projects, both liberal and conservative, setting out a bold agenda for a new administration.
But Project 2025 does so with particular detail and urgency, hoping to galvanize dramatic change before the midterm elections in 2026. As its foreword warns: “Conservatives have just two years and one shot to get this right.”
The standard for a transformational “100 days” – a much-used reference point for evaluating an administration – belongs to the first administration of Franklin D. Roosevelt.
Social reforms and FDR
In 1933, in the depths of the Great Depression, Roosevelt faced a nation in which business activity had stalled, nearly a third of the workforce was unemployed, and economic misery and unrest were widespread.
But Roosevelt’s so-called “New Deal” unfolded less as a grand plan to combat the Depression than as a scramble of policy experimentation.
Roosevelt did not campaign on what would become the New Deal’s singular achievements, which included expansive relief programs, subsidies for farmers, financial reforms, the Social Security system, the minimum wage and federal protection of workers’ rights.
Those achievements came haltingly after two years of frustrated or ineffective policymaking. And those achievements rested less on Roosevelt’s political vision than on the political mobilization and demands made by American workers.
A generation later, another wave of social reforms unfolded in similar fashion. This time it was not general economic misery that spurred actions, but the persistence of inequality – especially racial inequality – in an otherwise prosperous time.
LBJ’s Great Society
President Lyndon B. Johnson’s Great Society programs declared a war on poverty and, toward that end, introduced a raft of new federal initiatives in urban, education and civil rights.
These included the provision of medical care for the poor and older people via Medicaid and Medicare, a dramatic expansion of federal aid for K-12 education, and landmark voting rights and civil rights legislation.
As with the New Deal, the substance of these policies rested less with national policy designs than with the aspirations and mobilization of the era’s social movements.
Resistance to policy change
Since the 1930s, conservative policy agendas have largely taken the form of reactions to the New Deal and the Great Society.
The central message has routinely been that “big government” has overstepped its bounds and trampled individual rights, and that the architects of those reforms are not just misguided but treasonous. Project 2025, in this respect, promises not just a political right turn but to “defeat the anti-American left.”
After the 1946 midterm elections, congressional Republicans struck back at the New Deal. Drawing on business opposition to the New Deal, popular discontent with postwar inflation, and common cause with Southern Democrats, they stemmed efforts to expand the New Deal, gutting a full employment proposal and defeating national health insurance.
They struck back at organized labor with the 1947 Taft-Hartley Act, which undercut federal law by allowing states to pass anti-union “right to work” laws. And they launched an infamous anti-communist purge of the civil service, which forced nearly 15,000 people out of government jobs.
In 1971, the U.S. Chamber of Commerce commissioned Lewis Powell – who would be appointed by Republican President Richard Nixon to the Supreme Court the next year – to assess the political landscape. Powell’s memorandum characterized the political climate at the dawn of the 1970s – including both Great Society programs and the anti-war and Civil Rights movements of the 1960s – as nothing less than an “attack on the free enterprise system.”
In a preview of current U.S. politics, Powell’s memorandum devoted special attention to a disquieting “chorus of criticism” coming from “the perfectly respectable elements of society: from the college campus, the pulpit, the media, the intellectual and literary journals, the arts and sciences, and from politicians.”
Powell characterized the social policies of the New Deal and Great Society as “socialism or some sort of statism” and advocated the elevation of business interests and business priorities to the center of American political life.
Building a conservative infrastructure
Powell captured the conservative zeitgeist at the onset of what would become a long and decisive right turn in American politics. More importantly, it helped galvanize the creation of a conservative infrastructure – in the courts, in the policy world, in universities and in the media – to push back against that “chorus of criticism.”
This political shift would yield an array of organizations and initiatives, including the political mobilization of business, best represented by the emergence of the Koch brothers and the powerful libertarian conservative political advocacy group they founded, known as Americans for Prosperity. It also yielded a new wave of conservative voices on radio and television and a raft of right-wing policy shops and think tanks – including the Heritage Foundation, creator of Project 2025.
In national politics, the conservative resurgence achieved full expression in President Ronald Reagan’s 1980 campaign. The “Reagan Revolution” united economic and social conservatives around the central goal of dismantling what was left of the New Deal and Great Society.
Powell’s triumph was evident across the policy landscape. Reagan gutted social programs, declared war on organized labor, pared back economic and social regulations – or declined to enforce them – and slashed taxes on business and the wealthy.
Publicly, the Reagan administration argued that tax cuts would pay for themselves, with the lower rates offset by economic growth. Privately, it didn’t matter: Either growth would sustain revenues, or the resulting budgetary hole could be used to “starve the beast” and justify further program cuts.
Reagan’s vision, and its shaky fiscal logic, were reasserted in the “Contract with America” proposed by congressional Republicans after their gains in the 1994 midterm elections.
This declaration of principles proposed deep cuts to social programs alongside tax breaks for business. It was perhaps most notable for encouraging the Clinton administration to pass the Personal Responsibility and Work Opportunity Act of 1996, “ending welfare as we know it,” as Clinton promised.
Aiming at the ‘deep state’
Project 2025, the latest in this series of blueprints for dramatic change, draws most deeply on two of those plans.
As in the congressional purges of 1940s, it takes aim not just at policy but at the civil servants – Trump’s “deep state” – who administer it.
In the wake of World War II, the charge was that feckless bureaucrats served Soviet masters. Today, Project 2025 aims to “bring the Administrative State to heel, and in the process defang and defund the woke culture warriors who have infiltrated every last institution in America.”
As in the 1971 Powell memorandum, Project 2025 promises to mobilize business power; to “champion the dynamic genius of free enterprise against the grim miseries of elite-directed socialism.”
Whatever their source – party platforms, congressional bomb-throwers, think tanks, private interests – the success or failure of these blueprints rested not on their vision or popular appeal but on the political power that accompanied them. The New Deal and Great Society gained momentum and meaning from the social movements that shaped their agendas and held them to account.
The lineage of conservative responses has been largely an assertion of business power. Whatever populist trappings the second Trump administration may possess, the bottom line of the conservative cultural and political agenda in 2025 is to dismantle what is left of the New Deal or the Great Society, and to defend unfettered “free enterprise” against critics and alternatives.
Colin Gordon, Professor of History, University of Iowa
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Community
Blizzard Entertainment Raises Over $2 Million for CureDuchenne: A Tribute to Community and Legacy
Blizzard Entertainment and World of Warcraft players raised over $2 million for CureDuchenne, honoring Mats Steen, a devoted player lost to Duchenne muscular dystrophy, while promoting awareness and community support.
In a remarkable display of unity and compassion, Blizzard Entertainment® and the gaming community of World of Warcraft® have come together to raise over $2 million for CureDuchenne, a nonprofit dedicated to finding a cure for Duchenne muscular dystrophy (DMD). Inspired by the poignant documentary “The Remarkable Life of Ibelin,” the initiative has touched hearts and changed lives, honoring the legacy of the late Mats Steen, a devoted player known as Ibelin.
Honoring Mats Steen’s Legacy
Mats Steen, a young man from Norway, was diagnosed with Duchenne muscular dystrophy at a young age, a condition that steals muscle strength, leading to severe physical limitations and, tragically, premature death. Mats lost his life at just 25, but his journey didn’t end there; his story is one of connection, joy, and community. Through World of Warcraft, Mats discovered a vibrant world filled with friendships and adventures that transcended his physical challenges.
His family, upon his passing, uncovered the wealth of community and connection that the game provided him—a life filled with support and laughter that they had never fully appreciated. In remembrance of Mats, players worldwide adopted a limited-edition in-game pet, a fox named Reven, with all proceeds supporting the critical work of CureDuchenne.
The Impact of the Fundraising Campaign
The response from the gaming community has been nothing short of extraordinary. The opportunity to adopt Reven provided players a chance to honor Mats’ legacy while contributing to a noble cause. The campaign not only garnered significant financial support—$2 million to date—but also raised awareness about Duchenne muscular dystrophy, a condition that affects around 300,000 individuals globally.
According to Debra Miller, Founder and CEO of CureDuchenne, this partnership has been a breakthrough. “Not only has it raised critical funds for research,” she said, “but it has also generated awareness for Duchenne muscular dystrophy. The World of Warcraft community has demonstrated that gaming can be a powerful force for good.”
A Community United
The success of this fundraising initiative emphasizes the strength of the community and the impact that gaming can have in addressing real-world issues. The World of Warcraft community rallied together, showcasing the power of connection and shared purpose. The campaign reached across borders and time zones, allowing players from diverse backgrounds to unite in support of a common cause.
Holly Longdale, Executive Producer of World of Warcraft, expressed gratitude for the community’s generosity. “Your kindness helps enable the incredible work of CureDuchenne and honors the deeply impactful life of Mats Steen. We invite everyone to continue supporting CureDuchenne and to carry on Ibelin’s legacy with compassion and joy.”
The Future of Duchenne Research
The funds raised are critical for advancing research efforts aimed at finding treatments and improving care for those living with Duchenne muscular dystrophy. CureDuchenne is committed to accelerating research initiatives and to supporting families affected by this progressive disease. Their work includes funding early-stage scientific research, enhancing patient care, and providing educational resources to families.
CureDuchenne’s mission is clear: to bring treatments to everyone affected by this relentless disease, regardless of their financial status or geographical location. As the organization continues its vital work, the funding from the Blizzard partnership will play a crucial role in driving groundbreaking research forward.
The collaboration between Blizzard Entertainment and the World of Warcraft community serves as a shining example of how gaming can transcend entertainment to become a force for social good. The $2 million raised for CureDuchenne is more than a financial contribution; it symbolizes a tribute to personal legacy and a community united by purpose.
As we remember Mats Steen and cherish the friendships forged in virtual worlds, let us continue to advocate for those living with Duchenne muscular dystrophy. Together, we can harness the power of community and gaming to drive change, support vital research, and ultimately, help find a cure. If this campaign inspires you, consider supporting CureDuchenne or participating in similar initiatives within the gaming community to make a difference. For more information on how to contribute, visit CureDuchenne.
About Blizzard Entertainment, Inc.
Best known for iconic video game universes including Warcraft®, Overwatch®, Diablo®, and StarCraft®, Blizzard Entertainment, Inc. (www.blizzard.com), a division of Activision Blizzard, which Microsoft acquired (NASDAQ: MSFT), is a premier developer and publisher of entertainment experiences. Blizzard Entertainment has created some of the industry’s most critically acclaimed and genre-defining games over the last 30 years, with a track record that includes multiple Game of the Year awards. Blizzard Entertainment engages tens of millions of players around the world with titles available on PC via Battle.net®, Xbox, PlayStation, Nintendo Switch, iOS, and Android.
SOURCE CureDuchenne
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The 16th Street Train Station in West Oakland, a historic landmark that has stood as a silent witness to over a century of cultural and industrial evolution, is now one step closer to restoration. Recently listed on the National Register of Historic Places, the station’s new status has ignited hope and momentum for its revival. This milestone, celebrated by preservationists and community members alike, could be the key to unlocking the funding and support needed to breathe new life into this iconic structure.
A Moment of Celebration and Reflection
“I am ecstatic,” said Feleciai Favroth, treasurer of the Oakland Heritage Alliance, which spearheaded the station’s nomination for historic designation. “This could be the key to make the station a viable rehab project.” Favroth’s enthusiasm is shared by many who have long advocated for the station’s preservation, recognizing its profound historical and cultural significance.
The listing on the National Register of Historic Places not only honors the station’s legacy but also makes it eligible for a 20% federal income tax credit for restoration costs. Similar incentives have played a crucial role in reviving other Bay Area landmarks, such as Oakland’s Fox Theater and Richmond’s Ford Assembly Plant. “The bottom line of the tax credit is it just makes things much more financially feasible and attractive for developers,” said Kara Brunzell, an architectural historian who worked on the nomination.
A Daunting Financial Challenge
Despite this significant achievement, the road to restoration remains steep. The station requires an estimated $50 million for seismic retrofitting and restoration—a daunting sum that has stymied previous efforts to save the building. “Just because we’re on the registry doesn’t mean the station is saved,” Favroth cautioned. Over the decades, multiple owners have attempted to restore the station, but none have secured the necessary funding.
The current owner, City Ventures, has proposed a 77-unit townhome-style development called “Signal House” around the station site. However, the plan, under review since May 2023, does not include the station’s rehabilitation. City Ventures has hired OE Consulting to explore fundraising options for the station’s repairs. According to OE Consulting, the search is on for an “anchor funder”—a major donor willing to provide the initial funds to kickstart the restoration and allow the community to decide the station’s future use.
A Vision for the Future
The Oakland Heritage Alliance is now focused on securing funding for a feasibility study to explore the station’s potential. “You have to do something that’s financially viable because that’s the big thing nowadays with historical preservation. ‘Can the asset financially sustain itself?’” Favroth explained. Proposed ideas for the station’s reuse include an event venue, offices, a technology hub, or a business incubator.
Brunzell emphasized the station’s architectural and historical significance, comparing it to Grand Central Station in its grandeur and solidity. Designed in the Beaux Arts style by renowned architect Jarvis Hunt and opened in 1912, the station was a key hub for both local and long-distance trains during the heyday of rail travel. “You could come into the station from distant parts on the Southern Pacific, get off on the ground floor, walk upstairs, and get on a local streetcar to take you to your hotel. That was really important and unusual for the time,” Brunzell said.
Honoring African American History
The 16th Street Train Station is also one of the first to be designated under a new category that recognizes the history of African Americans in California. For Favroth, the station holds deep personal significance. Like many African Americans, her family has a direct connection to the station. Her aunts passed through it when they migrated to Oakland from Louisiana in the 1940s during the Great Migration. “I wanted to be able to honor their history and their memory,” Favroth said. “And this station has a strong tie to our history.”
The station served as a gateway for thousands of Black families seeking new opportunities in the West, and its surrounding neighborhood became a vibrant center of African American culture, commerce, and activism. Restoring the station is not just about preserving a building—it’s about reclaiming a piece of history that reflects the resilience and contributions of the Black community.
A Community Effort
The push to restore the 16th Street Train Station is a testament to the power of community advocacy and collaboration. From preservationists and historians to local officials and developers, a diverse coalition is working to ensure the station’s future. While challenges remain, the historic designation has provided a critical boost, offering both recognition and financial incentives to support the restoration effort.
As the project moves forward, the focus will be on balancing historical preservation with modern needs, ensuring that the station becomes a sustainable and inclusive space for the community. For West Oakland, the restoration of the 16th Street Train Station represents more than just the revival of a building—it’s a chance to honor the past, inspire the present, and build a brighter future.
The Bridge is a section of the STM Daily News Blog meant for diversity, offering real news stories about bona fide community efforts to perpetuate a greater good. The purpose of The Bridge is to connect the divides that separate us, fostering understanding and empathy among different groups. By highlighting positive initiatives and inspirational actions, The Bridge aims to create a sense of unity and shared purpose. This section brings to light stories of individuals and organizations working tirelessly to promote inclusivity, equality, and mutual respect. Through these narratives, readers are encouraged to appreciate the richness of diverse perspectives and to participate actively in building stronger, more cohesive communities.
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