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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In a significant move aimed at addressing the ongoing housing crisis in Arizona, the state Senate has passed Senate Bill 1229, a piece of legislation that could transform the way municipalities regulate home designs and development standards. This bipartisan bill passed on March 5, 2025, with a narrow vote of 16-13, attracting support from both Democrats and Republicans who are united in their objective to enhance housing affordability in the Grand Canyon State.
Key Provisions of Senate Bill 1229
One of the most notable aspects of SB 1229 is its proposal to prevent municipalities from mandating shared amenities that require a Homeowners Association (HOA) for maintenance. This change is seen as a step toward safeguarding homeowners’ rights to decide the features, structure, and design of their properties without being subjected to burdensome regulations.
Moreover, the bill aims to prohibit cities from requiring certain elements such as screening, walls, or fencing on residential properties. It will also establish boundaries on how cities can regulate lot sizes and building setbacks. These provisions are designed to empower homeowners and help make housing more accessible.
Addressing the Housing Crisis
The initiative comes in light of a severe housing crisis that has plagued Arizona, making homeownership increasingly elusive for many residents. The language within the bill highlights the ongoing struggle for citizens in obtaining affordable housing: “It has become virtually impossible for many citizens of this state to achieve the American Dream of owning their own home.”
Supporters assert that the current highly-restrictive regulations contribute to this crisis and that SB 1229 presents a commonsense solution for families, teachers, first responders, and young professionals who have found themselves priced out of the housing market.
Bipartisan Support and Community Impact
Notably, the bill garnered a rare coalition of support from both parties, with nine Republicans and seven Democrats voting in favor. This broad backing could play a crucial role in advancing the bill to the House, where it may have a better chance of avoiding a veto from Governor Katie Hobbs.
State Senator Shawnna Bolick, a Republican representing District 2, expressed that this new legislation is a much-needed remedy to the housing challenges faced by many Arizona families. She emphasized that it aims to help working-class citizens secure homes that meet their needs and budget.
Echoing these sentiments, Democratic Senator Analise Ortiz shared her own struggles in the current housing market. “At 31, I cannot afford to own a home where I was born and raised and currently govern,” she stated. Ortiz’s personal experience underscores the urgency for legislative changes that prioritize affordable housing options for all residents.
Conclusion
As Arizona grapples with a pervasive housing crisis, Senate Bill 1229 represents a pivotal step towards unlocking new possibilities for homeownership and easing regulatory burdens that have long stymied development. By promoting flexibility in housing regulations, this legislation aims to pave the way for a brighter future for countless residents seeking to realize their dream of homeownership in Arizona.
The upcoming discussions in the House will be crucial in determining the fate of this bill. As passionate advocates for housing reform continue to support this initiative, many Arizona residents will be watching closely to see how it unfolds.
Related Links:
https://www.kawc.org/news/2024-05-09/arizona-senate-passes-measure-on-affordable-housing
STM Daily News is a vibrant news blog dedicated to sharing the brighter side of human experiences. Emphasizing positive, uplifting stories, the site focuses on delivering inspiring, informative, and well-researched content. With a commitment to accurate, fair, and responsible journalism, STM Daily News aims to foster a community of readers passionate about positive change and engaged in meaningful conversations. Join the movement and explore stories that celebrate the positive impacts shaping our world.
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100 Percent of Sales Fund Local Charities on March 26 “Day of Giving”
MANASQUAN, N.J. /PRNewswire/ — Hoping to raise a record-breaking amount for charity this March, Jersey Mike’s Subs, known for its authentic fresh sliced/fresh grilled subs, asks customers to eat a sub and help a local cause. (View/download b-roll)
To celebrate the company’s 15th Annual Month of Giving, Jersey Mike’s locations across the country are joining forces with more than 200 local charities.
During the month of March, customers will have the option to round up their purchase to the nearest dollar or donate $1, $3, or $5 when placing their order. Charities include hospitals, youth organizations, food banks and more.
The campaign culminates in the nationwide event, Day of Giving, on Wednesday, March 26, when local Jersey Mike’s owners and operators will donate every single dollar that comes in to local charities.
At the first nationwide fundraiser in 2011, all of Jersey Mike’s 454 locations raised $600,000 for 66 charities. Since then, Jersey Mike’s annual Month of Giving has raised more than $113 million for hundreds of local charities.
This March, Jersey Mike’s hopes to exceed last year’s record-breaking national fundraising total of $25 million and help local charities striving to fulfill their missions and make a difference.
“I would like to extend a personal invitation to you and your family to visit Jersey Mike’s Subs throughout the month of March, and especially on Day of Giving when 100 percent of sales goes to help a great local cause,” said Peter Cancro, Jersey Mike’s founder and CEO, who this year celebrates 50 years since he bought his first sub shop at age 17.
In each market, Jersey Mike’s owners select charities that support local neighborhoods to build stronger communities.
For more information, visit jerseymikes.com/mog.
About Jersey Mike’s
Jersey Mike’s Subs, with more than 4,000 locations open and in development, serves authentic fresh sliced/fresh grilled subs on in-store freshly baked bread — the same recipe it started with in 1956. Passion for giving in Jersey Mike’s local communities is reflected in its mission statement “Giving…making a difference in someone’s life.” For more information, please visit our website or follow us on Facebook, Instagram, TikTok, and X. Join the conversation at #JerseyMikesGives.
Contact: Kyle Potvin, [email protected], 917-838-4500
SOURCE Jersey Mike’s Subs
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Metro Updates
Welcome to the latest updates on the progress of Metro projects in the Westside area of Los Angeles! As part of LA Metro’s commitment to improving transportation and community infrastructure, there are several important developments to share.
Upcoming Wilshire Boulevard Construction – What to Expect
Mark your calendars! Starting on March 17, 2025, the contractor will initiate deck removal and street restoration for the future Wilshire/Rodeo Station. Thanks to the City of Beverly Hills, an alternative closure plan has been approved, drastically reducing the originally planned 18 weekend closures to a streamlined three-week full closure.
During this closure, Wilshire Boulevard will be completely shut down between just west of Crescent Drive and just east of El Camino Drive. This essential closure will facilitate deck removal, street restoration, and restoration of water service lines, all while minimizing disruption to the community. Additionally, please be advised that the intersection of Wilshire Boulevard and Beverly Drive will be closed during this period.
For detailed information and the latest updates, visit the official website here. For immediate concerns, feel free to contact the Metro Hotline at 213.922.6934 or the Beverly Hills Customer Service at 310.285.2467.
D Line Section 1 & 2 Community Meeting – Beverly Hills Stations
On March 12, 2025, Metro is hosting an in-person community meeting to provide the public with an update on the D Line Extension’s Beverly Hills stations. This informative session will cover key construction progress, project milestones, and the anticipated benefits of the new Wilshire/La Cienega and Wilshire/Rodeo stations. Stay tuned for more details!
D Line Art Workshop
In an exciting initiative, Metro Art is inviting the Veteran community to a free art workshop designed to uplift Veteran stories. This fun and engaging event will allow participants to learn new artistic skills and collaborate with an artist in designing construction site banners for the future D Line Metro station that will serve the West LA VA.
Event Details:
- Date: March 8, 2025
- Time: 10 AM – 1 PM (Drop In)
- Location: Heroes Golf Course, 11301 Wilshire Blvd, Los Angeles, CA 90073
Art supplies and refreshments will be provided, and all ages and experience levels are welcome! Click here for the event flyer and to RSVP.
Stay tuned for more updates on these projects and how they will enhance mobility and community engagement in the Westside of Los Angeles!
Visit the website for details and the latest updates: https://bit.ly/41by7K4
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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