Within this paper, we discuss Moral Distress Reflective Debriefs as a promising approach to address and mitigate moral distress experienced by healthcare professionals. We briefly review the empirical and theoretical literature on critical incident stress debriefing and psychological debriefing to highlight the potential benefits of this modality. We then describe the approach that we take to facilitating reflective group discussions in response to morally distressing patient cases (“Moral Distress Reflective Debriefs”). We discuss how the debriefing literature and other clinical ethics activities influenced the development of our approach. In particular, we focus on the role of the clinical ethicist as a facilitator with particular emphasis on encouraging perspective-taking and nurturing ethical attunement in a supportive manner. We suggest that this approach reduces the narrowing effects of frustration and anger that are often reported when individuals experience moral-constraint distress. Finally, we provide an example of Moral Distress Reflective Debriefs, elucidating how this supportive process complements ethics consultation and can mitigate the negative effects of moral distress.
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All names are pseudonyms and some facts of the case have been altered to maintain anonymity.
Because we are adopting a broad definition of moral distress, we are subcategorizing different types of moral distress as suggested by Morley. We are interpreting the type experienced from Maggie’s description of the moral events and the emotions she seemed to be expressing.
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The authors would like to acknowledge Mahwish Ahmad, Marguerite Augustine, Jane Jankowski and Hilary Mabel, Staff Clinical Ethicists at the Cleveland Clinic (Center for Bioethics) for the ethical guidance and expertise they provided during these challenging clinical ethics cases and for kindly reviewing this paper. We also want to acknowledge and thank Laura Longbrake, LISW-S (Cleveland Clinic) for the collaboration and expertise she has provided in developing Moral Distress Reflective Debriefs, her work in continued facilitation as well as her feedback on an earlier version of this manuscript.
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Morley, G., Horsburgh, C.C. Reflective Debriefs as a Response to Moral Distress: Two Case Study Examples. HEC Forum (2021). https://doi.org/10.1007/s10730-021-09441-z
- Moral distress
- Clinical ethics
- Ethics consultation