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.
Discover more from Daily News
Subscribe to get the latest posts sent to your email.
Community
What if universal rental assistance were implemented to deal with the housing crisis?
A significant number of American families facing unaffordable rents are living in motels. While many believe a housing shortage causes high rents, experts suggest that expanding rental assistance is more effective. Making subsidies available to all eligible low-income households could tackle this affordability crisis significantly.
What if universal rental assistance were implemented to deal with the housing crisis?
Alex Schwartz, The New School and Kirk McClure, University of Kansas
If there’s one thing that U.S. politicians and activists from across the political spectrum can agree on, it’s that rents are far too high.
Many experts believe that this crisis is fueled by a shortage of housing, caused principally by restrictive regulations.
Rents and home prices would fall, the argument goes, if rules such as minimum lot- and house-size requirements and prohibitions against apartment complexes were relaxed. This, in turn, would make it easier to build more housing.
As experts on housing policy, we’re concerned about housing affordability. But our research shows little connection between a shortfall of housing and rental affordability problems. Even a massive infusion of new housing would not shrink housing costs enough to solve the crisis, as rents would likely remain out of reach for many households.
However, there are already subsidies in place that ensure that some renters in the U.S. pay no more than 30% of their income on housing costs. The most effective solution, in our view, is to make these subsidies much more widely available.
A financial sinkhole
Just how expensive are rents in the U.S.?
According to the U.S. Department of Housing and Urban Development, a household that spends more than 30% of its income on housing is deemed to be cost-burdened. If it spends more than 50%, it’s considered severely burdened. In 2023, 54% of all renters spent more than 30% of their pretax income on housing. That’s up from 43% of renters in 1999. And 28% of all renters spent more than half their income on housing in 2023.
Renters with low incomes are especially unlikely to afford their housing: 81% of renters making less than $30,000 spent more than 30% of their income on housing, and 60% spent more than 50%.
Estimates of the nation’s housing shortage vary widely, reaching up to 20 million units, depending on analytic approach and the time period covered. Yet our research, which compares growth in the housing stock from 2000 to the present, finds no evidence of an overall shortage of housing units. Rather, we see a gap between the number of low-income households and the number of affordable housing units available to them; more affluent renters face no such shortage. This is true in the nation as a whole and in nearly all large and small metropolitan areas.
Would lower rents help? Certainly. But they wouldn’t fix everything.
We ran a simulation to test an admittedly unlikely scenario: What if rents dropped 25% across the board? We found it would reduce the number of cost-burdened renters – but not by as much as you might think.
Even with the reduction, nearly one-third of all renters would still spend more than 30% of their income on housing. Moreover, reducing rents would help affluent renters much more than those with lower incomes – the households that face the most severe affordability challenges.
The proportion of cost-burdened renters earning more than $75,000 would fall from 16% to 4%, while the share of similarly burdened renters earning less than $15,000 would drop from 89% to just 80%. Even with a rent rollback of 25%, the majority of renters earning less than $30,000 would remain cost-burdened.
Vouchers offer more breathing room
Meanwhile, there’s a proven way of making housing more affordable: rental subsidies.
In 2024, the U.S. provided what are known as “deep” housing subsidies to about 5 million households, meaning that rent payments are capped at 30% of their income.
These subsidies take three forms: Housing Choice Vouchers that enable people to rent homes in the private market; public housing; and project-based rental assistance, in which the federal government subsidizes the rents for all or some of the units in properties under private and nonprofit ownership.
The number of households participating in these three programs has increased by less than 2% since 2014, and they constitute only 25% of all eligible households. Households earning less than 50% of their area’s median family income are eligible for rental assistance. But unlike Social Security, Medicare or food stamps, rental assistance is not an entitlement available to all who qualify. The number of recipients is limited by the amount of funding appropriated each year by Congress, and this funding has never been sufficient to meet the need.
By expanding rental assistance to all eligible low-income households, the government could make huge headway in solving the rental affordability crisis. The most obvious option would be to expand the existing Housing Choice Voucher program, also known as Section 8.
The program helps pay the rent up to a specified “payment standard” determined by each local public housing authority, which can set this standard at between 80% and 120% of the HUD-designated fair market rent. To be eligible for the program, units must also satisfy HUD’s physical quality standards.
Unfortunately, about 43% of voucher recipients are unable to use it. They are either unable to find an apartment that rents for less than the payment standard, meets the physical quality standard, or has a landlord willing to accept vouchers.
Renters are more likely to find housing using vouchers in cities and states where it’s illegal for landlords to discriminate against voucher holders. Programs that provide housing counseling and landlord outreach and support have also improved outcomes for voucher recipients.
However, it might be more effective to forgo the voucher program altogether and simply give eligible households cash to cover their housing costs. The Philadelphia Housing Authority is currently testing out this approach.
The idea is that landlords would be less likely to reject applicants receiving government support if the bureaucratic hurdles were eliminated. The downside of this approach is that it would not prevent landlords from renting out deficient units that the voucher program would normally reject.
Homeowners get subsidies – why not renters?
Expanding rental assistance to all eligible low-income households would be costly.
The Urban Institute, a nonpartisan think tank, estimates it would cost about $118 billion a year.
However, Congress has spent similar sums on housing subsidies before. But they involve tax breaks for homeowners, not low-income renters. Congress forgoes billions of dollars annually in tax revenue it would otherwise collect were it not for tax deductions, credits, exclusions and exemptions. These are known as tax expenditures. A tax not collected is equivalent to a subsidy payment.
For example, from 1998 through 2017 – prior to the tax changes enacted by the first Trump administration in 2017 – the federal government annually sacrificed $187 billion on average, after inflation, in revenue due to mortgage interest deductions, deductions for state and local taxes, and for the exemption of proceeds from the sale of one’s home from capital gains taxes. In fiscal year 2025, these tax expenditures totaled $95.4 billion.
Moreover, tax expenditures on behalf of homeowners flow mostly to higher-income households. In 2024, for example, over 70% of all mortgage-interest tax deductions went to homeowners earning at least $200,000.
Broadening the availability of rental subsidies would have other benefits. It would save federal, state and local governments billions of dollars in homeless services. Moreover, automatic provision of rental subsidies would reduce the need for additional subsidies to finance new affordable housing. Universal rental assistance, by guaranteeing sufficient rental income, would allow builders to more easily obtain loans to cover development costs.
Of course, sharply raising federal expenditures for low-income rental assistance flies in the face of the Trump administration’s priorities. Its budget proposal for the next fiscal year calls for a 44% cut of more than $27 billion in rental assistance and public housing.
On the other hand, if the government supported rental assistance in amounts commensurate with the tax benefits given to homeowners, it would go a long way toward resolving the rental housing affordability crisis.
This article is part of a series centered on envisioning ways to deal with the housing crisis.
Alex Schwartz, Professor of Urban Policy, The New School and Kirk McClure, Professor of Urban Planning, University of Kansas
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Discover more from Daily News
Subscribe to get the latest posts sent to your email.
Daily News
Bad Bunny’s Super Bowl Halftime Show Fits the NFL’s Long Game to Win Latin America
The NFL aims to expand its reach into Latin America through strategic marketing and high-profile performers like Bad Bunny at the Super Bowl halftime show. While the choice has sparked controversy, particularly among conservatives, the league sees it as a business move to attract more fans, particularly in Mexico and Brazil.
Last Updated on February 7, 2026 by Daily News Staff
Jared Bahir Browsh, University of Colorado Boulder
Bad Bunny’s Super Bowl show is part of long play drawn up by NFL to score with Latin America
Donald Trump, it is fair to assume, will be switching channels during this year’s Super Bowl halftime show.
The U.S. president has already said that he won’t be attending Super Bowl LX in person, suggesting that the venue, Levi’s Stadium in Santa Clara, California, was “just too far away.” But the choice of celebrity entertainment planned for the main break – Puerto Rican reggaeton star Bad Bunny and recently announced pregame addition Green Day – didn’t appeal. “I’m anti-them. I think it’s a terrible choice. All it does is sow hatred. Terrible,” Trump told the New York Post.
National Football League Commissioner Roger Goodell likely didn’t have the sensibilities of the U.S. president in mind when the choice of Bad Bunny was made.
One of the top artists in the world, Bad Bunny performs primarily in Spanish and has been critical of immigration enforcement, which factored into the backlash in some conservative circles to the choice. Bad Bunny’s anti-ICE comments at this year’s Grammy Awards will have only stoked the ire of some conservatives.
But for the NFL hierarchy, this was likely a business decision, not a political one. The league has its eyes on expansion into Latin America; Bad Bunny, they hope, will be a ratings-winning means to an end. It has made such bets in the past. In 2020, Shakira and Jennifer Lopez were chosen to perform, with Bad Bunny making an appearance. The choice then, too, was seen as controversial.
Raising the flag overseas
As a teacher and scholar of critical sports studies, I study the global growth of U.S.-based sports leagues overseas.
Some, like the National Basketball Association, are at an advantage. The sport is played around the globe and has large support bases in Asia – notably in the Philippines and China – as well as in Europe, Australia and Canada.
The NFL, by contrast, is largely entering markets that have comparatively little knowledge and experience with football and its players.
The league has opted for a multiprong approach to attracting international fans, including lobbying to get flag football into the 2028 Olympics in Los Angeles.
Playing the field
When it comes to the traditional tackle game, the NFL has held global aspirations for over three-quarters of a century. Between 1950-1961, before they merged, the NFL and American Football League played seven games against teams in Canada’s CFL to strengthen the relationship between the two nations’ leagues.
Developing a fan base south of the border has long been part of the plan.
The first international exhibition game between two NFL teams was supposed to take place in Mexico City in 1968. But Mexican protest over the economy and cost of staging the Olympics that year led the game, between the Detroit Lions and Philadelphia Eagles, to be canceled.
Instead, it was Montreal that staged the first international exhibition match the following year.
In 1986, the NFL added an annual international preseason game, the “American Bowl,” to reach international fans, including several games in Mexico City and one in Monterrey.
But the more concerted effort was to grow football in the potentially lucrative, and familiar, European market.
After several attempts by the NFL and other entities in the 1970s and ’80s to establish an international football league, the NFL-backed World League of Football launched in 1991. Featuring six teams from the United States, one from Canada and three from Europe, the spring league lost money but provided evidence that there was a market for American football in Europe, leading to the establishment of NFL Europe.
But NFL bosses have long had wider ambitions. The league staged 13 games in Tokyo, beginning in 1976, and planned exhibitions for 2007 and 2009 in China that were ultimately canceled. These attempts did not have the same success as in Europe.
Beyond exhibitions
The NFL’s outreach in Latin America has been decades in the making. After six exhibition matches in Mexico between 1978 and 2001, the NFL chose Mexico City as the venue of its first regular season game outside the United States.
In 2005, it pitted the Arizona Cardinals against the San Francisco 49ers at Estadio Azteca in Mexico City. Marketed as “Fútbol Americano,” it drew the largest attendance in NFL history, with over 103,000 spectators.
The following year, Goodell was named commissioner and announced that the NFL would focus future international efforts on regular-season games.
The U.K. was a safe bet due to the established stadium infrastructure and the country’s small but passionate fan base. The NFL International Series was played exclusively in London between 2007 and 2016.
But in 2016, the NFL finally returned to Mexico City, staging a regular-season game between the Oakland – now Las Vegas – Raiders and Houston Texans.
And after the completion of upgrades to Latin America’s largest stadium, Estadio Azteca, the NFL will return to Mexico City in 2026, along with games in Munich, Berlin and London. Future plans include expanding the series to include Sydney, Australia, and Rio de Janeiro, Brazil, in 2026.
The International Player Pathway program also offers players from outside the United States an opportunity to train and earn a roster spot on an NFL team. The hope is that future Latin American players could help expand the sport in their home countries, similar to how Yao Ming expanded the NBA fan base in China after joining the Houston Rockets, and Shohei Ohtani did the same for baseball in Japan while playing in Los Angeles.
Heading south of the border
The NFL’s strategy has gained the league a foothold in Latin America.
Mexico and Brazil have become the two largest international markets for the NFL, with nearly 40 million fans in each of the nations.
Although this represents a fraction of the overall sports fans in each nation, the raw numbers match the overall Latino fan base in the United States. In recent years the NFL has celebrated Latino Heritage Month through its Por La Cultura campaign, highlighting Latino players past and present.
Latin America also offers practical advantages. Mexico has long had access to NFL games as the southern neighbor to the United States, with the Dallas Cowboys among the most popular teams in Mexico.
For broadcasters, Central and South America offer less disruption in regards to time zones. Games in Europe start as early as 6:30 a.m. for West Coast fans, whereas Mexico City follows Central time, and Brasilia time is only one to two hours ahead of Eastern time.
The NFL’s expansion plans are not without criticism. Domestically, fans have complained that teams playing outside the U.S. borders means one less home game for season-ticket holders. And some teams have embraced international games more than others.
Another criticism is the league, which has reported revenues of over US$23 billion during the 2024-25 season – nearly double any other U.S.-based league – is using its resources to displace local sports. There are also those who see expansion of the league as a form of cultural imperialism. These criticisms often intersect with long-held ideas around the league promoting militarism, nationalism and American exceptionalism.
Bad Bunny: No Hail Mary attempt
For sure, the choice of Bad Bunny as the halftime pick is controversial, given the current political climate around immigration. The artist removed tour dates on the U.S. mainland in 2025 due to concerns about ICE targeting fans at his concerts, a concern reinforced by threats from the Department of Homeland Security that they would do just that at the Super Bowl.
But in sticking with Bad Bunny, the NFL is showing it is willing to face down a section of its traditional support and bet instead on Latin American fans not just tuning in for the halftime show but for the whole game – and falling in love with football, too.
Jared Bahir Browsh, Assistant Teaching Professor of Critical Sports Studies, University of Colorado Boulder
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Discover more from Daily News
Subscribe to get the latest posts sent to your email.
STM Daily News
Chinamaxxing: The Viral Trend Turning Geopolitics Into Aesthetic Fantasy
A viral social media trend called “Chinamaxxing” is turning geopolitics into aesthetic comparison—revealing more about generational frustration than China itself.
At first glance, the videos seem harmless enough.
Clean subways gliding into spotless stations. Neon skylines glowing at night. Clips of high-speed trains, cashless stores, orderly crowds. Overlaid text reads something like, “Meanwhile in China…” or “They figured it out.”
This is “Chinamaxxing,” a loosely defined but increasingly visible social media trend where mostly young users frame China as a model of efficiency, stability, and modernity—often in contrast to life in the West.
What makes the trend notable isn’t just its subject, but its tone. Chinamaxxing is rarely explicit political advocacy. It’s not a manifesto. It’s a mood. Aesthetic admiration blended with subtle critique, delivered through short, visually compelling clips that invite comparison without context.
And that’s precisely why it has sparked debate.
What Is “Chinamaxxing,” Really?
Despite the provocative name, Chinamaxxing isn’t a coordinated movement or ideology. It’s better understood as an algorithm-driven pattern—a recurring style of content that rewards certain visuals and emotional cues.
Most Chinamaxxing content emphasizes:
- Infrastructure and urban design
- Technology embedded in daily life
- Perceived order and efficiency
- Implicit contrast with Western dysfunction
What it typically omits:
- Political repression and censorship
- State surveillance
- Limits on speech and dissent
- The lived diversity of Chinese experiences
The result is a highly curated portrayal—less about China as a nation, and more about what viewers want to believe is possible somewhere else.
Why It’s Gaining Traction Now
The rise of Chinamaxxing says as much about the West as it does about China.
For many young users, particularly Gen Z, the backdrop is familiar: rising housing costs, student debt, healthcare anxiety, political polarization, and a growing sense that institutions no longer function as promised.
In that environment, visually persuasive content showing order and functionality carries emotional weight. It offers relief from chaos—real or perceived.
Social platforms amplify this effect. Short-form video rewards clarity, contrast, and immediacy. A clean subway platform communicates more in five seconds than a policy analysis ever could. Nuance does not trend well. Aesthetics do.
The Social and Political Criticism
Critics argue Chinamaxxing crosses a line from curiosity into distortion.
By focusing exclusively on infrastructure and surface-level efficiency, the trend risks:
- Normalizing authoritarian governance through lifestyle framing
- Reducing political systems to consumer experiences
- Ignoring the tradeoffs that make such systems possible
Supporters counter that Western media has long flattened China into a single negative narrative, and that admiration for specific aspects of another society is not the same as endorsing its government.
Both perspectives, however, miss something important.
What the Trend Actually Reveals
Chinamaxxing isn’t primarily about China. It’s about disillusionment.
It reflects a generation that:
- Feels let down by existing systems
- Engages politics emotionally rather than institutionally
- Uses visual culture to express dissatisfaction indirectly
In this context, China becomes a projection surface—not because it is perfect, but because it appears functional.
That distinction matters.
Why This Matters
Chinamaxxing highlights how political understanding is evolving in the digital age. Governance is increasingly consumed not through debate or civic participation, but through comparison clips, memes, and aesthetics.
The risk isn’t admiration. It’s oversimplification.
When complex societies are reduced to visuals alone, public discourse loses depth. But when those visuals resonate, they also signal real unmet needs: stability, competence, and trust in institutions.
Ignoring that signal would be a mistake.
The STM Daily News Perspective
Chinamaxxing is not an endorsement, a conspiracy, or a joke. It is a cultural artifact—one that reflects generational anxiety, algorithmic storytelling, and the widening gap between expectations and reality.
The question it raises isn’t whether China is better.
It’s why so many people feel their own systems are no longer working.
Related Reading
- BBC News: China Coverage and Global Context
- The Atlantic: Technology, Media, and Internet Culture Analysis
- Pew Research Center: Global Attitudes and Political Perception
- The New York Times: China and International Affairs
- Brookings Institution: China Policy and Global Governance
More on This Topic from STM Daily News
Stay tuned to STM Daily News for more stories exploring internet culture, social media trends, and how digital platforms shape public perception. We’ll be publishing in-depth pieces that break down the societal impact of viral phenomena like Chinamaxxing, the psychology behind online political trends, and the evolving language of Gen Z culture.
Want alerts? Be sure to subscribe to our newsletter for the latest insights and analysis.
Author
Discover more from Daily News
Subscribe to get the latest posts sent to your email.
