Embedded Ethics Program in MICU and CVICU to Alleviate Moral Distress (Bruce)

Moral distress occurs when health care professionals cannot carry out what they believe to be ethically appropriate actions because of institutional (external) or personal (internal) constraints. Moral distress is a phenomenon that has identifiable constraints, psychological characteristics, and causes. Moral distress typically manifests in frustration, anger, anxiety, guilt, withdrawal, and self-blame. While moral distress certainly involves psychological distress, the principle distinction between moral distress and psychological distress is that moral distress includes the perceived violation of one's core values and duties, resulting in feelings of being constrained from taking ethically appropriate action. (Epstein, E.G., & Hamric, A.N. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330-342). This study will qualitatively assess an intervention (an “Embedded Ethics Program”) developed to alleviate moral distress. We hypothesize that an embedded ethicist’s frequent presence in the units and participation in decision-making processes will mitigate moral distress, which we believe, arises due in part to uncertainty about clinical endpoints and patient/surrogates goals. Our first aim is to qualitatively identify factors or triggers underlying moral distress. Our second aim is to develop and implement our intervention. Our third aim is to evaluate whether our intervention addressed moral distress factors and subsequently reduced moral distress among hospital personnel.

Funded by: Houston Methodist Hospital and Houston Methodist Research Institute Multidisciplinary Research Grant Program.

The Center for Medical Ethics and Health Policy team is led by Director Amy L. McGuire, J.D., Ph.D.