Moral Distress Consultation Collaborative (MDCC)

What is moral distress?

Ethical dilemmas are a part of healthcare, as uncertainty about which path to take among possible “right” paths is common in complex medical situations. But what happens when we do know the right action to take but cannot take it? When a man with sickle cell disease does not receive adequate pain control due to a clinician’s biased belief that he is drug seeking? When a homeless man with chest pain in the emergency department is not attended to for hours because he has been labelled as a “frequent flyer”? When doctors and nurses are pressured to continue certain treatments—not because they’re appropriate but because there’s fear of litigation? These situations are morally distressing, that is, they are situations in which clinicians believe they know the right action to take but are constrained from taking that action.

Healthcare organization leaders, clinical ethics consultants, and others are recognizing the impact of moral distress on clinicians. Interventions to address morally distressing situations are developing, one of which is moral distress collaborative consultation (MDCC).

What is a moral distress consult?

The purpose of MDC is to assist healthcare providers experiencing moral distress through facilitated discussion and identification of strategies to overcome barriers to taking appropriate action. The root causes of moral distress often expand beyond the scope of the patient level to that of the unit and system levels of the hospital. So, while the MDC may provide assistance in patient ethical dilemmas, another important goal is assisting staff in identifying and addressing problems at the unit and/or system level such as poor team communication, inefficient unit routines, and ineffective institutional protocols that arise repeatedly and impact patient care negatively.

If you would like to be part of this collaborative or would like more information, please contact Beth Epstein (meg4u@virginia.edu) or Charlene Kaufman (cmk2b@virginia.edu).

Providing educational resources so that others can build their own moral distress consult services is integral to the goals of the MDCC. Here is information and helpful tips for developing a MDC and training new consultants.

Training New Consultants

Consultants for moral distress consultation often come from a wide variety of backgrounds, including but not limited to: healthcare, social work, public health, law, and ethics.

More recently, an intensive 4-day training session on clinical ethics consultation including moral distress consultation has been developed and conducted using the Core Competencies for Healthcare Ethics Consultation². Beginning with the October 2021 HEC Intensive, one full day will be dedicated to moral distress consultation and led by members of the MDCC.

Developing an MDC Service

MDC is not a one-size-fits-all service. Each healthcare organization will have a slightly different process and practice. However, some fundamental factors are consistent. We are available to provide on-site or virtual training to explore the elements of MDC and how they might be adopted for healthcare organizations. Please contact Beth Epstein (meg4u@virginia) for more information.

Page References

1. Hamric AB, Epstein EG. A Health System-wide Moral Distress Consultation Service: Development and Evaluation. HEC Forum. 2017 Jun; 29(2): 127-143. doi: 10.1007/s10730-016-9315-y. PMID: 28070806.
2. American Society of Bioethics and Humanities. (2011). Core competencies for health care ethics consultation (2nd ed.). Glenview: ASBH.

By providing an inter-institutional support structure that enables consultants to collaborate, the MDCC project hopes to impact ethical decisions in healthcare through dissemination of best practices and engagement in clinical, professional, and organizational ethics research.

Many opportunities for collaboration are possible including:

• Evaluating the structure and process of MDC.
• Evaluating the reasons for consultation, comparing pre-COVID causes with those identified during the pandemic.
• Evaluating the organizational milieu in which effective MDC services can function.
• Developing best practices for MDC.
• Identifying effective measures of MDC outcomes and methods for evaluating MDC services.
• Multi-institutional studies of MDC and its effect on staff empowerment, mattering, burnout, well-being, teamwork.

Dawn Bourne, DNP, FNP, MSN, RN

• Mark Swope

• Bex Forcier

• Heather Fitzgerald, DBe, RN, HEC-C

• Alissa Swota, PhD

• A longitudinal study of the impact of Schwartz Center Rounds on moral distress
• Moral distress, moral residue, and the crescendo effect
• Enhancing understanding of moral distress: the Measure of Moral Distress for Healthcare Professionals
• Understanding and addressing moral distress
• Moral distress among healthcare professionals: Report of an institution-wide survey
• A health system-wide moral distress consultation service: Development and evaluation
• Self-inflicted moral distress: opportunity for a fuller exercise of professionalism
• The experience of moral distress in an academic family medicine clinic
• Effect of a moral distress consultation service on moral distress, empowerment, and a healthy work environment
• Moral distress in intensive care unit professionals is associated with profession, age, and years of experience
• Dilemmas of moral distress: moral responsibility and nursing practice
• Moral distress as a characteristic of physician training: understanding and ameliorating a harmful phenomenon