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I feel like I see trainee moral distress expressed in terms of an urgent need to have a "goals of care" conversation with the families (i.e., persuade them to stop treatment), but sometimes I wonder whether we clinicians might benefit from goals of care conversations ouselves.
I don't mean get our "living wills" sorted out (I wrote a whole book against living wills, after all), but rather to help us see the world a little better from the perspective of patients and families hungry to know that their loved one is honored by clinicians, that recovery
timelines are driven where possible by the patient's moral sensibilities, that decisional thresholds relevant to the patient/family are given their due (NB: their decisional thresholds are in general demonstrably much lower than clinicians' decisional thresholds), and that
clinicians care to communicate with them even when they're not seeking permission to stop. My own sense is that saying "I'm worried s/he might die soon, even as we continue to try our best to keep her with us" is much truer to the patient as a person and more relevant than
"we think we should stop treatment". What we really know as clinicians is our worry that they won't survive. We don't of ourselves really know when treatment should stop. So I try to focus on what we actually do know and what seems true to the patient as a person. I don't know
whether that actually helps with clinician moral distress (there I think we have room for some more careful study and trials), but in my own experience, I think it does wonders for the quality of the therapeutic bond with ICU family members. I'm not advocating denial, not by a
long shot. But I am advocating introspection and a gentle turning of the tables on what seems to me too often to be a reflex of moral distress-->pushing for a rapid stop to treatment.
