Moral distress and clinician burnout
3rd February 2025
Moral distress happens when healthcare workers feel unable to act according to their ethical beliefs due to rules or other pressures. This can lead to burnout and negatively impact patient care. Factors like hospital culture, family demands for treatments that may not help, and providing unnecessary treatments can all contribute to moral distress. Previous research found that doctors in training had different approaches to end-of-life care—some only recommended treatments they believed were beneficial, while others gave patients all possible options without guiding them. This study looks at how a doctor’s ethical approach affects their experience of moral distress.
This study is part of a larger project looking at why some patients receive aggressive medical treatment at the end of life. Researchers interviewed 16 doctor trainees from the U.S. and 14 from the U.K. to understand their experiences of moral distress when providing end-of-life care. The trainees were chosen to include different training levels and genders. The interviews were analyzed to find common themes.
Results showed that moral distress was more frequently described among physician trainees with a “best interest” approach, in other words they would recommend only the treatments they believe will help the patient. Doctors with an alternative “autonomy” approach – giving all possible options without making a recommendation – experienced less intense moral distress. This finding held true among both US and UK physician trainees. Many physicians with a “best interest” approach noted a gap between their assessment of what treatments were beneficial and the treatments that they were actually delivering. Conversely doctors felt less uncomfortable giving treatments that might not help if they knew it was what the patient wanted.
Rosenwohl-Mack, S., Dzeng, E. The Effects of Individual Ethical Frameworks on Clinician Moral Distress. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-024-09284-7