Tessy Thomas, DO
Geisinger Medical Center
Danville, Pennsylvania
Disclosure information not submitted.
Shelley Kumar, MSc, MS
Instructor of Pediatrics
Baylor College of Medicine/ Texas Children's Hospital, United States
Disclosure information not submitted.
F. Daniel Davis, PhD
Professor of Bioethics
Geisinger, United States
Disclosure information not submitted.
Satid Thammasitboon, MD
Associate Professor of Pediatrics
n/a, United States
Disclosure information not submitted.
Title: Key Insights on Pandemic Moral Distress: Role of Misaligned Ethical Values in Decision-making
Introduction: The ethical values—saving the most lives or life-years, life cycle equity, investment refinement, instrumental worth, and first-come, first-serve —had been operationalized by experts and policymakers in various ways to inform organizational guidelines for triaging scarce resources during a pandemic. Moral distress arises when healthcare professionals (HCPs) confront ethical problems, recognize a duty to resolve them, but due to internal and external constraints, are impeded from acting in ways that preserve their professional integrity. We explored how the inevitable misalignment of individual ethical values and organizational guidelines manifested, through perspectives of HCPs, as moral distress.
Methods: We conducted a secondary analysis of a database from an exploratory survey of pediatric critical care HCPs (337 clinicians, nurses, respiratory therapists, and others) via the Pediatric Acute Lung Injury and Sepsis Investigators Research Network from April-May 2020. We integrated descriptive statistics of quantitative data (4 survey items about ethical value orientation and prioritization of triage/resource allocation and moral distress) and thematic analysis of qualitative data with moral distress narratives to derive mixed insights.
Results: Though majority of HCPs (52%) prioritized “saving the most lives” value, a large number (48%) prioritized 5 other values; thus, highlighting HCPs’ lack of consensus and misalignment of ethical value prioritization for making clinical decisions. Moral distress was present, to varying extent, in the majority (86%) of respondents. The value prioritization by individuals had no effect on extent of moral distress. Thematic analysis revealed potential sources of moral distress: 1) Loss of power in decision-making; 2) Implicit ethical frameworks in guidelines; 3) Lack of organizational ethical forums; and 4) Misalignment of guiding values for society versus HCPs.
Conclusions: Moral distress exists in pediatric critical care HCPs due to unattended perspectivism or lack of rigorous dialogue to address variation and misalignment of ethical values amidst a pandemic. Opportunities exist to mitigate moral distress through addressing individual perspectives, clarifying ethical frameworks, and empowering HCPs to share ethical concerns in safe forums.