This month’s journal club was led by Dr. Efrat Lelkes, a pediatric critical care and palliative care physician. We discussed “Moral Distress in Neonatology” by Prentice et al., which examined longitudinal rates of moral distress among clinical caregivers in neonatal intensive care units in Australia. The authors found that moral distress was reported on approximately 15% of the surveyed occasions, though instances of distress were recorded for nearly all (91%) patients. Disagreements between the patient’s family and the treatment team about appropriate levels of care was the greatest cause of moral distress among clinicians. The paper also found that rates of moral distress differed depending on one’s role (nurse, resident, physician, etc.) and length of time in practice, but prior training in ethics made no difference to incidences of distress.
We examined the paper’s findings in relation to our own experiences, noting the potential systemic and cultural differences in healthcare environments and practices that might lead to higher or lower rates of moral distress among the care team. We also touched on the impact that improved communication and community building might have in mitigating the rate or intensity of distress when caring for critically ill patients. Lastly, we discussed if moral distress could be an unavoidable cost of working at the edge of medicine where certainty is harder to come by.