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.
Urbanism
LA Metro’s D Line Extension Phase 1 Officially Opens, Bringing Subway Service to Mid-Wilshire and Beverly Hills
LA Metro’s D Line Extension: LA Metro officially opens Phase 1 of the D Line Subway Extension, connecting Downtown Los Angeles, Mid-Wilshire, and Beverly Hills with three new underground stations.
The future of transportation in Los Angeles has officially arrived.
LA Metro’s D Line Extension Phase 1 Officially Opens
The Los Angeles County Metropolitan Transportation Authority (Metro) officially opened Section 1 of the long-awaited D Line Subway Extension on May 8, 2026, expanding underground rail service westward through the historic Mid-Wilshire corridor and into Beverly Hills.
The 3.92-mile extension is one of Metro’s most ambitious transit infrastructure projects and marks a major milestone in Los Angeles public transportation. The new section extends subway service beyond the current Wilshire/Western station in Koreatown and introduces three new underground stations:
- Wilshire/La Brea
- Wilshire/Fairfax
- Wilshire/La Cienega
The expansion is part of Metro’s larger “Twenty-Eight by ’28” initiative designed to improve mobility across the region ahead of the 2028 Olympic and Paralympic Games.
Downtown Los Angeles to Beverly Hills in About 20 Minutes
With the extension now open, riders can travel from Union Station in Downtown Los Angeles to Beverly Hills in approximately 20 minutes with no transfers required.
The D Line extension is expected to significantly improve travel along the heavily congested Wilshire Boulevard corridor, offering commuters, visitors and residents a faster and more reliable alternative to driving.
“Traveling through Mid-Wilshire to experience the culture, cuisine and commerce across diverse neighborhoods will be easier, faster and more accessible,” said Fernando Dutra, Metro Board Chair and City of Whittier Council Member.
Metro CEO Stephanie Wiggins also highlighted the importance of the project in connecting Angelenos to some of the city’s most iconic destinations.
“Angelenos and visitors alike will love the extended service from Downtown Los Angeles to Beverly Hills, delivering greater access to the iconic and culturally diverse communities, institutions and destinations that define the deep history along Wilshire Boulevard,” Wiggins said.
New Stations Connect Riders to Cultural Landmarks
Wilshire/La Brea Station
Located near Hancock Park and the western edge of Koreatown, the station provides access to cultural and entertainment destinations including:
- Korean Cultural Center
- Marciano Art Foundation
- Ebell Theater
- Popular restaurants including Republique and Sycamore Kitchen
Wilshire/Fairfax Station
Known as the heart of Museum Row, this station serves some of Los Angeles’ most recognizable cultural institutions and attractions, including:
- Los Angeles County Museum of Art (LACMA)
- Academy Museum of Motion Pictures
- Petersen Automotive Museum
- La Brea Tar Pits
- The Grove
- Original Farmers Market
The station also connects neighborhoods including Little Ethiopia, Park La Brea and the historic Fairfax District.
Wilshire/La Cienega Station
Serving as the eastern gateway to Beverly Hills, the station provides convenient access to Restaurant Row and destinations including the Beverly Center.
A Major Milestone for Los Angeles Transit
The D Line extension has been decades in the making and is widely considered one of the most important transit projects in Los Angeles history.
The project was funded primarily through Measure R, the voter-approved transportation sales tax passed in 2008, along with substantial federal funding support that included:
- $1.25 billion Full Funding Grant Agreement (FFGA)
- $66.4 million supplemental New Starts funding
- $749.3 million TIFIA loan
All three stations feature modern amenities including public artwork, enhanced lighting, cell phone service, bicycle hubs and improved pedestrian access.
Metro officials hope the extension will encourage more residents and visitors to use public transportation while helping reduce roadway congestion ahead of major international events scheduled for Los Angeles later this decade.
What’s Next for the D Line?
Construction is already underway on future phases of the D Line extension.
Phase 2 will continue west into Beverly Hills and Century City, while Phase 3 will eventually extend subway service to UCLA and the West Los Angeles VA campus.
Once completed, the D Line will provide a direct subway connection between Downtown Los Angeles and the Westside, dramatically reshaping mobility across one of Southern California’s busiest corridors.
Learn More
For official project details and station information, visit:
Metro D Line Opening Information
Stay connected with STM Daily News for the latest updates on Los Angeles transportation, Metro expansion projects, infrastructure developments, local news, technology, culture, and more. Visit STM Daily News for breaking stories, in-depth coverage, and exclusive content from across Southern California and beyond.
Last Updated on May 4, 2026 by Daily News Staff
Cinco de Mayo is a holiday that commemorates the Mexican army’s victory over the French Empire at the Battle of Puebla on May 5, 1862. In the United States, the holiday has become a celebration of Mexican-American culture and heritage, often involving parades, parties, and traditional foods such as tacos and margaritas.
How will you celebrate Cinco de Mayo?
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The Knowledge
Metrolink Offers Fare-Free Rides for Earth Day 2026 Across Southern California
Metrolink offers fare-free rides for Earth Day 2026 across Southern California, encouraging sustainable travel and reduced emissions.
Last Updated on April 21, 2026 by Daily News Staff
Metrolink Offers Fare-Free Rides for Earth Day 2026
LOS ANGELES — April 22, 2026 — In a continued push toward sustainable transportation, Metrolink will once again offer systemwide free rides on Earth Day, inviting commuters and travelers to leave their cars behind and explore a cleaner way to move across the region.
A One-Day Opportunity to Ride Free
On Wednesday, April 22, passengers can board any Metrolink train — including the Arrow service — without purchasing a ticket. The initiative is part of the broader celebration of Earth Day, encouraging environmentally conscious travel choices.
The fare-free program is designed to appeal to both regular riders and first-time users, particularly those navigating Southern California’s persistent traffic congestion and rising fuel costs.
Encouraging Sustainable Travel Habits
“Earth Day is a reminder that small changes, like choosing public transit over driving one day a week, can have a meaningful impact on our environment,” said Doug Chaffee, chair of the Metrolink Board.
With gas prices continuing to strain household budgets, the agency hopes the initiative will inspire more residents to consider rail as part of their regular commute.
Regional Connections Expand Access
Metrolink’s Earth Day promotion aligns with similar efforts by other Southern California transit providers. Riders can seamlessly connect to services operated by: LA Metro and the Orange County Transportation Authority, Riverside County Transportation Commission, San Bernardino County Transportation Authority and Ventura County Transportation Commission.
These partnerships extend the reach of fare-free travel across a six-county region, making it easier for riders to explore destinations without relying on personal vehicles.
Service Adjustments and Rider Tips
Passengers should note that trains will operate on a reduced weekday schedule, implemented earlier this spring. Despite the adjustment, all Metrolink lines and station cities remain in service.
For those planning a trip:
- No ticket is required — simply board the train
- Bikes are welcome, with capacity ranging from three bikes per standard car to nine in designated bike cars
- A curated destination guide highlights attractions within walking or biking distance of stations
Environmental and Economic Impact
Metrolink is also promoting its Personal Impact Calculator, a digital tool that allows riders to estimate how switching from driving to rail can reduce greenhouse gas emissions and lower fuel expenses.
A Broader Trend in Public Transit
Fare-free transit days have gained traction nationwide as agencies look to boost ridership and promote sustainability. Southern California’s expansive commuter rail network makes it particularly well-suited for such initiatives, offering a viable alternative to one of the country’s most car-dependent regions.
Bottom Line
Metrolink’s Earth Day promotion is more than a one-day free ride — it’s a strategic effort to shift commuter behavior, reduce environmental impact, and showcase the convenience of regional rail. For Southern Californians, April 22 presents a low-risk opportunity to rethink how they travel.
Source: Metrolink
https://metrolinktrains.com/news/metrolink-goes-fare-free-for-earth-day-on-april-22
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