Moral Distress In The Everyday Life Of An Intensivist


Moral Distress In The Everyday Life Of An Intensivist


Daniel Garros


doi: 10.3389/fped.2016.00091


Frontiers In Pediatrics




Judgment (ethics); Physicians; Critical Care Medicine; Research; Practice; Pediatric Research; Decision Making; Rj1-57
Moral Distress; Ethics; Medical; End-of-life Care; Decision-making; Pediatric Critical Care Medicine


A regular work day for intensivists can be emotionally draining, as we witness suffering, fear, pain,
tragedies, unfair treatment of children, death…. We may experience the mental stress of dealing with
nursing shortages, increasing family demands, and frustration related to interpersonal conflicts (e.g.,
between parents and specialists) among other issues (1). For the most part, we learn to manage this
type of stress.
Several studies involving nearly every medical and surgical specialty indicate, however, that
approximately one of every three physicians experiences burnout at any given time. Burnout is characterized
by behaviors such as losing enthusiasm for work (emotional exhaustion), treating people as
if they were objects (depersonalization), and having a sense that work is no longer meaningful (low
personal accomplishment) (2).
Physicians, like other health-care professionals, can be at risk for another phenomenon, that of
moral distress (MoD). This concept emerged in nursing ethics: “a challenge that arises when one
has an ethical or moral judgment about care that differs from those who are in charge” (3). Thus,
institutional constraints were seen as its key source (inadequate staffing, other professionals’ influence,
family or patient choices, administrative agendas, institutional policies, and legislation) (3).
Unlike a moral dilemma in which one is uncertain what ethical action to take, MoD is experienced
by those who feel constrained from acting on their ethical judgment. Constraints are still recognized
frequently as external, institutional ones (4). Internal constraints may be related to perceived powerless,
lack of knowledge, increased moral sensitivity, or even lack of full understanding of a particular
situation. It could also represent a lack of “moral courage” (5).
In 2006, Nathaniel extended the definition, highlighting the consequences of not acting according
with ones’ moral judgment and be participating in perceived moral wrongdoing (6). The word
perceived is very crucial, since we may feel strongly that an action is unethical while a colleague
may feel just as strongly the opposite. It is well known that MoD in pediatric intensive care (PICU)
can be linked to aggressive treatment, witnessing repeated suffering, futile care, and high levels of
chronic disability post discharge and may be aggravated by work environment issues such as power
imbalances, improper communication, decision-making conflicts, unrealistic expectations, lack of
resources or personnel, and a high index of medical errors (2, 7) Corley and colleagues have developed
a scale (MDS), containing 20 clinical situations to assess the frequency to which MoD occurs, as
well as the intensity of the feeling (8) This scale, now on its second version, has been utilized in several
studies (4, 5), including some in the PICU environment (9). As MoD has been more thoroughly
investigated, discussion about the topic has become more prominent in the bioethics literature, with
several journal issues being fully dedicated to the theme (10, 11).


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Citation List Month

September 2016 List


Daniel Garros, “Moral Distress In The Everyday Life Of An Intensivist,” Pediatric Palliative Care Library, accessed May 23, 2024,