It ’s Not the Death, It’s the Dying: Moral Distress in Palliative Care

by Vickie LeffEvery day, we get involved in unbelievable and incredible situations. Tragedy, sadness, horrific trauma, despair, and hopelessness all wrap themselves around the cases we drop into. We step onto the stage and become part of the story.Moral distress – the discomfort, angst, and frustration related to situations in which we think we know the “right thing” to do, but cannot due to the situation – is endemic to palliative care and hospice work. Some examples are:Aggressive chemotherapy for a dying cancer patient with days to live.Dumping the truth on a patient overwhelmed and alone.Following the treatment wishes of a family that which are incongruent with the patient who can ’t speak for themselves.Prolonging dying because a family says they are waiting for a miracle.It ’s not the same as the stress we feel day to day about our work as palliative care clinicians. This feels different; it gets under our skin, and stays with us. What do we do with these feelings? How do we recover when our souls have been tattered? How do we suffocate the intense desire to “chang e the system”? How do we do this and remain present and authentic to our patients and families looking at their situation?I scream in my head: Why is the family not letting him die peacefully? Why is the team pushing him out the door, don ’t they know he’s dying? It’s a useless exercise, but it helps alleviate (momentarily!) my anxiety whe...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: leff moral distress social work social worker Source Type: blogs

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