How Healthcare Is Causing 'Moral Injury' to Doctors


March 13, 2019

In This Article

Serious Decisions That Weigh Heavily

"Because so many dilemmas have life-and-death consequences, they're very serious decisions that weigh heavily on physicians as professionals and, more generally, as people," says Brendel. "They create a great deal of tension. Physicians take on a very critical responsibility to put patients' health interests first."

Medical ethical dilemmas become increasingly tougher because often there are few right or wrong answers.

[E]thics is not about finding one answer, or the one right answer, but about developing an array of ethically allowed options.

"Sometimes it takes a while for physicians to get used to the fact that the multiplicity of variables makes situations far more complex than they may have been used to in other settings," Brendel says. "When you're learning medicine, there's a very clear path: If you have an illness, here's the treatment or here's the set of options for treatment," says Brendel.

But there may not be a clear path in the real medical world. "There's never or rarely going to be an answer that makes everyone happy," says Brendel. "As physicians, we need to learn how to deal with some of our moral concerns that don't get included in the process."

"Doing work with ethics is not about finding one answer, or the one right answer, but about developing an array of ethically allowed options," she said.

What Can Help Prevent Moral Injury?

Bernstein says that this emotional injury to physicians can only stop when our current healthcare system changes, when there's a noticeable difference in the unremitting pressure on physicians and the constant stumbling blocks that prevent them from delivering the kind of healthcare that they feel will be best for patients.

The ethical elements that can lead to distress and moral injury can be elucidated by a better understanding of the role of bioethics. Physicians need more education and training in making ethical decisions, says Brendel.

"Awareness and education are very important," says Brendel. Still, she says, even within ethics courses, you can't learn everything you need to know. Many medical specialty organizations, including the American Psychiatric Association, have an ethics committee where members can call in with ethical questions and get guidance from the committee, she says.

Ethics education has become a requirement in medical school and in postgraduate medical training, says Brendel. Even beyond that, many states have ethics training requirements for maintaining a license.

"If a physician didn't feel like these weighty challenges affected them, then something is wrong," says Brendel. "But the challenges shouldn't become so weighty that physicians are stuck with them."


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: