Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Inquiry

Abstract

Background: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about balance of benefits and burdens experienced by patients.

Objective: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life, and how these challenges contribute to moral distress.

Design: Semi-structured in-depth qualitative interviews

Participants: 22 internal medicine residents and fellows across three American academic medical centers.

Approach: This qualitative study was exploratory in nature, intended to deepen conceptual understanding of underlying phenomena that drive physician attitudes and behavior.

Key Results: Physician trainees experience significant moral distress when they feel obligated to provide treatments at or near the end of life that they believe to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life.

Conclusions: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.