Moral Distress and Community Care
Jaime Konerman-Sease, PhD, Assistant Professor, Clinical Ethics, University of Minnesota; and Anuradha Gorukanti, MD, Co-Founder, Introspective Spaces
Moral distress is a significant dilemma in post-pandemic healthcare. Moral distress is caused when clinicians are prevented from doing the right thing due to institutional or systemic barriers. For example, many clinicians feel significantly distressed when institutional policy requires that they must resuscitate a full code even if it will provide no benefit and cause significant bodily harm. Discussion about moral distress has increased in the ethics literature, and institutions are aware that they play a role in creating an environment that leads to health care worker burnout and moral distress. Clinical ethicists promote the practice of moral distress debriefs to respond to events in clinical practice which lead to moral distress. Institutions might address moral distress internally through self-care education sessions orchestrated by human resources. Sometimes they encourage individual therapy-like sessions through the employee assistance program. Many do not address it at all.
In this presentation, we argue that the current approach to addressing moral distress fails to adequately attend to the needs of the soul. Decontextualized spiritual practices and hour-long group processing sessions might provide a brief relief from the effects of moral distress, but they do not genuinely contribute to healing or constitute authentic care for the distressed clinician. Neither do they contribute to addressing the root of moral distress - institutional limitations and failures. Authentic care for moral distress means attending to the soul in relational context - moving beyond individual self-care practices to the community practices embedded in praxis, ethics, spirituality, and religion. Once connected in a genuine community, health care workers can then begin to imagine possible solutions to the root cause of moral distress and address the concerns at the level of the institution.
We begin with critiquing the use of secularized spiritual practices to address the problem of moral distress. These ersatz spiritual practices are coopted into productivity tools, embraced to keep the system of healthcare running efficiently and without authentic care for the distressed health care worker. We ground our critique in examples of community care in our own traditions - one presenter drawing on the Buddhist Sanghas and the other relying on medieval Catholic monasticism. With an intentionally inter-faith approach, we explore how community is essential for genuine wellbeing. We draw out that authentic community is built not simply on shared space and interpersonal interactions, but shared commitments, beliefs, and values. Only after an authentic community is established can community-members engage in the work to transform the institution which causes distress. We conclude with imagining if authentic community responses to moral distress can really occur in the secular healthcare environment or if moral distress can only truly be addressed outside of the healthcare institution that created it.
In this presentation, we argue that the current approach to addressing moral distress fails to adequately attend to the needs of the soul. Decontextualized spiritual practices and hour-long group processing sessions might provide a brief relief from the effects of moral distress, but they do not genuinely contribute to healing or constitute authentic care for the distressed clinician. Neither do they contribute to addressing the root of moral distress - institutional limitations and failures. Authentic care for moral distress means attending to the soul in relational context - moving beyond individual self-care practices to the community practices embedded in praxis, ethics, spirituality, and religion. Once connected in a genuine community, health care workers can then begin to imagine possible solutions to the root cause of moral distress and address the concerns at the level of the institution.
We begin with critiquing the use of secularized spiritual practices to address the problem of moral distress. These ersatz spiritual practices are coopted into productivity tools, embraced to keep the system of healthcare running efficiently and without authentic care for the distressed health care worker. We ground our critique in examples of community care in our own traditions - one presenter drawing on the Buddhist Sanghas and the other relying on medieval Catholic monasticism. With an intentionally inter-faith approach, we explore how community is essential for genuine wellbeing. We draw out that authentic community is built not simply on shared space and interpersonal interactions, but shared commitments, beliefs, and values. Only after an authentic community is established can community-members engage in the work to transform the institution which causes distress. We conclude with imagining if authentic community responses to moral distress can really occur in the secular healthcare environment or if moral distress can only truly be addressed outside of the healthcare institution that created it.