Conscious of Conscience: Moral Distress as a Trigger for Deeper Reflection on Harm

Abstract

Though clinicians aspire to benefit their patients and not harm them, conflict arises when patient and clinician disagree on what constitutes benefit and harm. Here, we report a case in which a patient has strong opinions on which treatments are appropriate for him. The clinician disagrees on the nature of the patient's illness and on the proposed treatments. However, she felt forced to ignore her intuition and conscience, which led to moral distress. This experience inspires her to reflect on her own moral development and the healthcare system around her. One framework that helps make sense of such moral distress is that offered by Curlin and Tollefsen in their 2021 book The Way of Medicine: Ethics and the Healing Profession. There, they distinguish between two contrasting accounts of medicine's purpose. In one, the Provider of Services Model (PSM), health care is a service provided to patients, and clinicians are viewed as technicians. In the other, the Way of Medicine (WoM), clinicians are entrusted to work collaboratively to support and promote their patients’ health. In our case, the clinician was stuck in the PSM, which exposed her to moral distress. A framework based on the WoM, on the other hand, protects against moral distress and therefore benefits both patients and clinicians. We argue that a virtue ethics framework can help clinicians facing similar dilemmas better care for themselves and more effectively “do no harm.”