Moral distress in end-of-life decisions: A qualitative study of intensive care physicians.
J Crit Care
; 62: 185-189, 2021 04.
Article
in English
| MEDLINE | ID: covidwho-988304
ABSTRACT
PURPOSE:
The purpose is to explore triggers for moral distress, constraints preventing physicians from doing the right thing and ensuing consequences in making decisions for patients approaching end of life in intensive care. MATERIALS ANDMETHODS:
The qualitative study was undertaken in a tertiary referral intensive care unit in Northern Ireland in the United Kingdom. Drawing upon patient case studies of decisions about non escalation and/or withdrawal of life support, we undertook indepth interviews with senior and junior physicians. Interviews were transcribed verbatim and narratively analysed.RESULTS:
Eighteen senior and junior physicians involved in 21 patient case studies were interviewed. Analysis determined two predominant themes key moral distress triggers; and strategies and consequences. Junior residents reported most instances of moral distress, triggered by perceived futility, lack of continuity, protracted decisions and failure to ensure 'good death'. Senior physicians' triggers included constraint of clinical autonomy. Moral distress was far reaching, affecting personal life, working relationships and career choice.CONCLUSION:
This study is the first to explore physicians' moral distress in end-of-life decisions in intensive care via a narrative inquiry approach using case studies. Results have implications for the education, recruitment and retention of physicians, relevant in the Covid 19 pandemic.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Physicians
/
Terminal Care
/
Withholding Treatment
/
Decision Making
/
Psychological Distress
/
Morals
Type of study:
Prognostic study
/
Qualitative research
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
English
Journal:
J Crit Care
Journal subject:
Critical Care
Year:
2021
Document Type:
Article
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