ETHICAL DECISION-MAKING AS AN INTERVENTION FOR MORAL DISTRESS EXPERIENCED BY PSYCHIATRY RESIDENTS

Abstract

Moral distress in the healthcare field includes feelings of frustration, anger, guilt, anxiety, depression, despair, and powerlessness to carry out ethically appropriate actions to patients in line with personal values in the setting of external constraints. Psychiatry residents are particularly vulnerable to experiencing moral distress due to the coercive aspects of psychiatric treatment, constraints in the medical system, and the internal conflicts caused by a resident’s identity as a trainee physician and competing duties to an individual patient, healthcare organizations, health care professionals, and society. Psychiatrists make complex assessments that often cannot be made with absolute certainty, but regardless, they are tasked with the duty to identify and ultimately act on their risk assessments. These unrealistic societal expectations are especially difficult for psychiatry residents who have not yet had the experience to grow their knowledge and confidence in their decision-making skills yet still must make difficult decisions in their new role as physicians. Ethical decision-making can be used to alleviate moral distress, and a consistent utilization of an ethical decision-making framework can help guide decisions that are both objective and thoughtful. The ethical framework proposed includes considerations of the patient's capacity to consent or refuse medical treatment, the urgency of the medical condition, the feasibility of the actions needed to address the medical condition, and the countertransference of the treatment team. This framework helps guide clinicians by ensuring they understand and address the ethical considerations involved in treating patients and the moral distress that arises from these difficult choices.