Moral Distress in the PICU

Moral distress is a condition experienced when moral choices and actions are constrained. It differs from a moral dilemma, in which the "right" action is not known; moral distress arises when the "right" action is known but cannot be undertaken.

PICU nurse at computer (photo by Goble)Responses to moral distress can include feeling frustrated, angry, helpless, desperate, or betrayed. Unresolved moral distress can drive health professionals out of their place of employment and even out of their discipline.

In 2008, Austin (Principal Investigator for the present study), Kelecevic, Goble, and Mekechuk examined the existing literature and published research on moral distress in the PICU. Their paper "An Overview of Moral Distress and the Paediatric Intensive Care Team" (Nursing Ethics, Jan. 2009) identified the following ethical issues:

    •  Parents refusing treatment
    •  Informed consent for treatment
    •  End-of-life decision-making
    •  Futility of care 
    •  Formal decision-making structures  
    •  Variable experiences by discipline
    •  Variable attitudes by individual
    •  Power and authority

The stories collected in the present study have referred to those issues and more: 

   •  Parents seeking aggressive treatment for their children
   •  Healthcare professionals seeking aggressive treatment for patients
   •  Emotional conflict arising from healthcare professionals' own role as parents

For sample stories from our study's participants, and what the study revealed about resolution strategies, see Results.