Elizabeth Dzeng1,2,3,4, Alessandra Colaianni5, Martin Roland6, David Levine5, Michael P Kelly6, Stephen Barclay6, Thomas J Smith7,8. 1. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, USA. elizabeth.dzeng@ucsf.edu. 2. Program in Palliative Care, Johns Hopkins School of Medicine, Baltimore, USA. elizabeth.dzeng@ucsf.edu. 3. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. elizabeth.dzeng@ucsf.edu. 4. Department of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA. elizabeth.dzeng@ucsf.edu. 5. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, USA. 6. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. 7. Program in Palliative Care, Johns Hopkins School of Medicine, Baltimore, USA. 8. Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Abstract
BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.
BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.
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