SCCM Resource Library-Ethics and Moral Distress Consultation Shape an Institutional Approach

Pdf Summary

The document presents a case study focusing on ethical challenges and moral distress in healthcare, arising from the care of an 84-year-old woman with severe multi-organ failure and a dire prognosis, intensified by her daughters' wish for aggressive treatment against medical advice. The patient, without an advanced directive, was subject to decisions by her daughters, who rejected palliative care discussions and demanded she remain alert during their visits, opting for full code status. This led to a conflict between providing care that prolonged her suffering versus adhering to the family's wishes, leaving healthcare professionals morally distressed.<br /><br />The ethical consult service and moral distress consult service of the medical intensive care unit (MICU) eventually recommended writing a do-not-resuscitate (DNR) order against the daughters' objections, contextualizing the action within ethical permissibility. Although the DNR was communicated to the family and the patient died peacefully two days later, MICU staff faced ongoing distress due to the adversarial relationship with the family.<br /><br />The article underscores moral distress—a scenario where healthcare professionals recognize the ethically appropriate action but can't execute it due to constraints like policy or surrogate decisions, leading to workplace dissatisfaction and ethical conflict. Recognizing these issues, the medical center's ethics and moral distress consult services facilitated a policy revision to support shared decision-making and protect healthcare workers from providing interventions contrary to ethical standards.<br /><br />Furthermore, advocacy efforts expanded beyond institutional levels, prompting legislative amendments to ensure clarity around patient and healthcare team dynamics where treatment is considered medically inappropriate. The article exemplifies how ethical consult services can foster systemic changes to address moral distress, thereby underscoring the institution's duty as a moral community accountable to both its staff and patients.

Asset Subtitle

Ethics End of Life, Behavioral Health and Well Being, 2020, 00:06:40

Asset Caption

This article was originally published in the Summer 2020 Issue of Critical Connections. This case study and analysis is about an 84-year-old woman with metastatic non-small cell lung cancer whose daughters are her surrogate decision makers. The daughters insist on aggressive treatment and have declined to speak with palliative medicine regarding transition of goals of care. Critical Connections, the critical care industry's only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team. Mary Faith Marshall, PhD, HEC-C, FCCM Elizabeth G. Epstein, PhD, RN, HEC-C, FAAN Dawn W. Bourne, DNP, FNP-C, HEC-C Sandra D. Mahanes, CCNS, CCRN, DNP

Meta Tag

Content Type Article

Knowledge Area Ethics End of Life

Knowledge Area Behavioral Health and Well Being

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Membership Level Professional

Membership Level Associate

Tag Medical Legal Issues

Tag Advance Directives

Tag Well Being

Year 2020

Keywords

ethical challenges

moral distress

healthcare

multi-organ failure

advanced directive

palliative care

do-not-resuscitate

shared decision-making

ethical consult services

legislative amendments

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