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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.
Three new studies shared this week at the Society of NeuroInterventional Surgery (SNIS) 23rd Annual Meeting deliver a clear message: stroke care in the U.S. is improving, but those gains are not reaching everyone equally. Researchers found persistent disparities tied to race, geography, and socioeconomic status—factors that can shape whether a patient receives advanced treatment, how quickly they reach specialized care, and ultimately, whether they survive.
Stroke remains one of the nation’s leading causes of death and long-term disability. In recent years, breakthroughs in emergency response systems and minimally invasive procedures have expanded what’s possible in the critical first hours after a stroke. But the latest findings suggest that access to those life-saving advances still depends too heavily on who you are and where you live.
Study 1: Treatment gaps widen as strokes get more severe
The first study, “Racial Disparities in Endovascular Thrombectomy Widen with Stroke Severity: A National Inpatient Sample Analysis,” examined more than 325,000 acute ischemic stroke patients treated at U.S. teaching hospitals between 2018 and 2022.
The focus was endovascular thrombectomy (EVT), a minimally invasive procedure in which specialists remove a clot from a blocked artery in the brain. EVT can be a game-changer for eligible patients—but researchers found Black patients were less likely than white patients to receive it across all levels of stroke severity.
What stood out most: the disparity grew as stroke severity increased. At a National Institutes of Health Stroke Scale (NIHSS) score of 20, the predicted probability of receiving EVT was:
- 33% for white men
- 32% for white women
- 28% for Black men
- 26% for Black women
Co-first author Muhammed Amir Essibayi, MD, MSc, FRCP, noted that timely access becomes even more critical as severity rises—yet the treatment gap becomes more pronounced. The study also highlighted an intersectional pattern, with Black women consistently least likely to receive EVT.
Study 2: Hemorrhagic stroke deaths are falling—but disparities persist
The second study, “Reducing Inequalities in Stroke Events-Hemorrhagic Disparities (RISE-HD): A 10-year Statewide Analysis of Social Determinants of Mortality in Hemorrhagic Stroke,” analyzed more than 120,000 patients hospitalized with hemorrhagic stroke in Florida between 2013 and 2024.
There was good news: mortality rates declined significantly over the decade, suggesting real progress in stroke systems and hospital care.
But after adjusting for age, sex, and comorbidities, disparities remained. Black patients had higher odds of in-hospital mortality than white patients. Higher mortality was also associated with:
- Living in rural areas
- Having Medicaid or other non-commercial insurance
Researchers also found regional differences across Florida, pointing to uneven access to specialized stroke care.
Primary author Natália Vasconcellos, MD, MSc, emphasized that improving outcomes for everyone will require addressing barriers to specialized stroke systems—especially in underserved communities.
Study 3: The “Stroke Belt” has two different access problems
The third study, “Dual Pathways to Hemorrhagic Stroke Mortality Across the U.S. Stroke Belt: Rural Neurointerventional Isolation and Urban Structural Vulnerability,” looked at hemorrhagic stroke mortality across 433 counties in the “Stroke Belt,” a region long associated with higher stroke rates and worse outcomes.
Researchers compared factors linked to mortality in rural versus urban counties, including:
- Distance to the nearest Comprehensive Stroke Center
- Community-level socioeconomic disadvantage
- Racial and economic segregation
- HIV burden
They found the drivers of mortality differed sharply by setting:
- In rural counties, longer travel times to Comprehensive Stroke Centers were more strongly associated with higher mortality.
- In urban counties, racialized economic segregation and HIV burden were more strongly associated with poorer outcomes—even when specialized care was geographically closer.
Dylan Yates, a medical student at Tulane University School of Medicine, summarized the takeaway: the neurointerventional access gap in the Stroke Belt is “not one problem, it is two.” Solutions need to match the reality on the ground—strengthening transfer networks and specialty connections in rural areas, while addressing structural disadvantage and underinvestment in urban communities.
What to watch for: where the system can improve
Across all three studies, the common thread is that medical innovation alone doesn’t guarantee equitable outcomes. Researchers pointed toward targeted interventions that could help close the gap, including:
- More consistent, equitable treatment pathways for advanced stroke procedures like EVT
- Stronger stroke transfer networks to reduce delays—especially in rural regions
- Expanded access to specialty stroke care and Comprehensive Stroke Centers
- Community-level investment and structural reforms in underserved urban neighborhoods
For patients and families, these findings also reinforce the importance of recognizing stroke symptoms quickly and calling 911 immediately. Time is brain—yet the system must ensure that “time” and “access” don’t vary based on race, ZIP code, or insurance status.Source: Society of NeuroInterventional Surgery (SNIS), July
Related Links
- Society of NeuroInterventional Surgery (SNIS) — https://www.snisonline.org
- NIH: Stroke (overview, symptoms, treatment) — https://www.ninds.nih.gov/health-information/disorders/stroke
- CDC: Stroke (risk factors, prevention, data) — https://www.cdc.gov/stroke/
- American Stroke Association (ASA): Stroke resources — https://www.stroke.org/
- NIH Stroke Scale (NIHSS) basics (clinical context) — https://www.stroke.nih.gov/resources/scale.htm
- Find a certified stroke center (The Joint Commission) — https://www.qualitycheck.org/
SOURCE Society of NeuroInterventional Surgery
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Association of Black Cardiologists to Celebrate Legacy and Leadership at 16th Annual Spirit of the Heart Awards
The Association of Black Cardiologists (ABC) is bringing its signature celebration of impact back to New York City this fall—spotlighting leaders and organizations working to make cardiovascular care more equitable, more accessible, and more effective. The 16th Annual Spirit of the Heart Awards Program & Fundraiser is set for Saturday, October 3, 2026 (6:00 p.m.–9:00 p.m.) at Cipriani Wall Street in Manhattan.
For ABC, the evening is more than a high-profile awards program. It’s a cornerstone fundraising event that helps power the organization’s year-round work—supporting medical student scholarships, fellowships, education, and programs designed to strengthen the pipeline of diverse clinicians and researchers while improving outcomes in communities that carry a disproportionate burden of heart disease.
A fundraising night with long-term stakes
ABC leaders say the Spirit of the Heart Awards is built around a simple idea: celebrating progress while investing in the people who will drive the next wave of change.
Event co-chair Icilma Fergus, MD—Director of the Cardiovascular Disparities Center at Mount Sinai Medical Center and Board Chair of ABC—framed the night as a forward-looking commitment.
“This gathering is about more than one evening of celebration; it is about investing in the future of cardiovascular health for years to come,” Fergus said in the announcement. She added that the support generated through the event helps expand opportunities for aspiring clinicians, researchers, and leaders whose work can transform care and improve lives nationwide.
Honorary Chairperson: Samin K. Sharma, MD
ABC announced Samin K. Sharma, MD as the event’s Honorary Chairperson. Sharma serves as Chief of Clinical Cardiology, Director of the Cardiovascular Clinical Institute, and the Anandi Lal Sharma Professor of Medicine at the Icahn School of Medicine at Mount Sinai.
In the release, ABC highlighted Sharma’s international reputation in interventional cardiology and physician education, noting that he has trained cardiovascular specialists from around the world while advancing the field through research, mentorship, and patient care.
“I am honored to serve as Honorary Chairperson for this important event,” Sharma said. “The Spirit of the Heart Awards Program reflects the power of partnership, philanthropy, and leadership to advance cardiovascular health.”
A full weekend of impact, including policy
The awards program is part of a broader weekend of programming. On Friday, October 2, ABC will host its Annual Policy Pulse Summit at Venable LLP in New York City, convening leaders to discuss policy issues shaping the future of cardiovascular health.
What to expect at the Spirit of the Heart Awards
ABC is positioning the evening as both a celebration and a community gathering—bringing together leaders from healthcare, philanthropy, industry, and advocacy.
The event will be co-emceed by:
- Sandra Bookman, award-winning journalist and anchor of Eyewitness News on ABC7/WABC-TV New York
- Thomas Cunningham IV, President and Chief Content Officer of BrandCunningham
The program is expected to include:
- Presentation of the Spirit of the Heart Awards
- Recognition of medical student scholarship recipients
- Special guest appearances
- A live auction
- Musical entertainment
Event co-chair Barbara Hutchinson, MD, PhD, President of Chesapeake Cardiac Care, emphasized the role of sustained collaboration in moving the needle on heart health.
“The Spirit of the Heart Awards Program is a reminder that lasting progress in cardiovascular health is achieved through vision, partnership, and sustained commitment,” Hutchinson said.
How to attend, sponsor, or support
ABC is directing attendees and supporters to its event site for tickets, sponsorship opportunities, and donations:
- Event info / tickets / sponsorship / donations: https://abcardioevents.org
About the Association of Black Cardiologists
Founded on the belief that “every heart counts,” the Association of Black Cardiologists works to promote prevention and treatment of cardiovascular disease and to advance health equity by eliminating disparities. ABC’s membership is open to all, regardless of race, ethnicity, or vocation. The organization’s work spans education, advocacy, research, patient and community outreach, and leadership development.
- Organization website: https://abcardio.org
Source and media contact
- Press release source (PRNewswire): https://www.prnewswire.com/news-releases/association-of-black-cardiologists-to-celebrate-legacy-and-leadership-at-16th-annual-spirit-of-the-heart-awards-302206000.html
Media Contact (from the release):
- Akeia Blue, VP of Communications
- 419395@email4pr.com
- 240-321-9227
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Supreme Court rules against trans girls participating in single‑sex sports, but leaves open larger questions of trans rights
The U.S. Supreme Court ruled on June 30, 2026, that West Virginia and Idaho did not violate the Constitution by preventing transgender students from joining female sports teams, and that states can restrict who participates on women’s and girls sports teams based on a student’s sex assigned at birth.
Marie-Amelie George, Wake Forest University
The U.S. Supreme Court ruled on June 30, 2026, that West Virginia and Idaho did not violate the Constitution by preventing transgender students from joining female sports teams, and that states can restrict who participates on women’s and girls sports teams based on a student’s sex assigned at birth.
This ruling, focused squarely on transgender students participating on single-sex sports teams, does not resolve other major questions that are important to trans rights. These issues include what bathrooms transgender or nonbinary students can use at school, as well as whether transgender individuals can update their names and gender markers on identity documents.
The court folded two related cases that address sports team participation at the middle, high school and college levels – Little v. Hecox and West Virginia v. B.P.J. – into one single decision that resolved both. The justices ruled 6-3 on the cases.
This ruling backs 25 other states that, over the past few years, have passed new laws restricting transgender students from participating on female sports teams.
Twenty-one states also have some sort of restriction on transgender and nonbinary students using school bathrooms designated by sex.
As a legal scholar and expert on LGBTQ+ rights, I believe that based on the court’s reasoning, it is likely that the conservative majority on the court would uphold states’ right to restrict school bathroom use based on sex assigned at birth. However, this ruling leaves bigger questions regarding transgender students’ broader rights in school, at work and elsewhere unanswered.
A political flash point
There were estimated to be fewer than 10 transgender athletes who participated in collegiate athletics in 2024.
But the issue of transgender students participating on sports teams is a hot-button issue for the Trump administration and Republicans, who argue that transgender female students have a biological advantage in competitive sports over athletes assigned female at birth.
The issue is nuanced and depends on factors including the athletes’ age and whether they have undergone gender-affirming hormonal therapy.
Some recent research shows that transgender female athletes who have undergone gender affirming hormone therapy have a comparable level of strength to cisgender female athletes.
What the rulings covered
At issue in these two Supreme Court cases were what protections Title IX – which bars sex-based discrimination in education programs and activities that receive federal funding – as well as the equal protection clause of the 14th Amendment gave transgender students.
Little v. Hecox challenged Idaho’s 2020 law that allows only students whose sex was designated female at birth to participate on girls and women’s school sports team.
Lindsay Hecox, a transgender female student at Boise State University, alongside a cisgender student, filed a lawsuit against the state in 2020. Hecox, now 24, could not try out for the school’s track and cross country team because of the law. She instead ran at the club level.
In West Virginia v. B.P.J., a transgender middle school student athlete named Becky Pepper-Jackson similarly sued the state so she could continue participating in track and field. Pepper-Jackson won a state title in girls shot put in May 2026.
The state’s 2021 Save Women’s Sports Act requires public middle schools, high schools and colleges to designate all school athletic teams by biological sex.
Understanding Title IX and how it applies
The Supreme Court determined that states are permitted to restrict sports team participation under Title IX and its regulations, which explicitly permit schools to have separate male and female sports teams.
The opinion started by emphasizing there are “enduring” physical differences between males and females, and that if there were unified sports teams, females could be at a disadvantage.
“Separate sports teams for biological males and biological females are reasonable: Given the inherent physical differences between the sexes, allowing only biological females to play on women’s and girls’ teams can reduce the risk of physical injury and ensure fair competition,” the court ruled in its opinion on West Virginia v. B.P.J., authored by Justice Brett Kavanaugh. Chief Justice John Roberts and Justices Samuel Alito, Clarence Thomas, Neil Gorsuch and Amy Coney Barrett joined the ruling.
Pepper-Jackson argued that this part of Title IX did not have relevance to her case because she had taken puberty blockers and never gone through male puberty.
As a result, she argued, she did not have heightened levels of testosterone or other physical differences that could raise the concern of a competitive advantage over cis female students in sports. She also posed no physical safety concerns for her teammates.
The court’s majority rejected this argument, saying that the Title IX regulations did not speak to this issue. The court recognized that although the laws might produce unfair results for someone like Pepper-Jackson, this did not make the restrictions improper.
The court added that Pepper-Jackson and other students in her position need to take up their concerns with state legislatures.
The court’s liberal wing – Justices Sonia Sotomayor, Elena Kagan and Ketanji Brown Jackson – agreed with the conservative majority that the laws did not violate Title IX.
The role of the equal protection clause
The court also addressed the equal protection clause of the U.S. Constitution, which says that the government must apply its laws fairly and cannot treat people differently without a valid reason.
The court’s conservative majority ruled that the laws distinguished based on sex, and as a result they scrutinized the laws more carefully. However, the court concluded that the athletic restrictions nevertheless passed constitutional muster.
Here, too, the court’s majority cited the interests of safety and competitive fairness as important justifications for the laws.
The liberal justices disagreed with their colleagues’ analysis. In their view, the laws were too broad to satisfy the Constitution, because they banned transgender girls who had never experienced male puberty from female sports teams.
A side step
The decision is a narrow one. The court went to great lengths to emphasize that it was focused on sports, and that the court was not being asked about transgender people’s rights more broadly.
In the court’s telling, sports are unique because competition depends on the physiology and physical differences between those assigned male and female at birth. That is important, because there are few circumstances in which the physical differences between males and females continue to be relevant.
In the past, many occupations and schools were sex-segregated. Today, bathrooms, school sports teams, changing facilities, some college residence halls, juvenile detention centers and prisons are among the last places that remain segregated by sex.
Moreover, the court avoided ruling on the constitutional standard that should apply when transgender people are discriminated against. Under constitutional doctrine, courts will more closely scrutinize laws that discriminate against historically powerless minority groups, such as people of color and women.
One of the open questions in transgender rights litigation is whether transgender people qualify for that more searching review.
This case did not resolve that issue.
The court’s narrow ruling on transgender athletes ultimately did not resolve other key issues for transgender rights, which the court will likely be asked to address at a later date.
Marie-Amelie George, Associate Professor of Law, Wake Forest University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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