Moral Damage to Health Care Professionals and Trainees: Legalism and other Consequences for Patients and Colleagues

Abstract

Health care professionals' and trainees' conceptions of their responsibilities to patients can change over time for a number of reasons: evolving career goals, desires to serve different patient populations, and changing family obligations, for example. Some changes in conceptions of responsibility are healthy, but others express moral damage. Clinicians' changes in their conceptions of what they are responsible for express moral damage when their responses to others express a meager, rather than robust, sense of what they owe others. At least two important expressions of moral damage in the context of health care are these: callousness and divestiture. Callousness describes the poor condition of a clinician's capacity for moral perception; when her capacity to accurately appreciate features of moral relevance that configure others' needs, vulnerabilities, and desert of care diminishes, such that she fails to respond with care to those for whom she has duties to care, she is callous. Callousness has been explored in detail elsewhere,1 and so the focus of this paper is divestiture. A clinician divests when the value of responding with care to others becomes less centrally and importantly constitutive of his personal and professional identity. Divestiture has important consequences for patients and health professions education, which I will explore here.

Professionalism, fidelity and relationship-preservation

“…Moral distress happens to a clinician when she is motivated by good reasons to do some action, but barred (by parental refusal in the case of vaccines) from acting as she is motivated to act. 10 All of these sources of frustration are worth canvassing, but we must also consider that physicians' responses to frustration, whatever the sources, are probably just as influential during clinical encounters as families' anti-intellectual mistrust, ill-founded or unusual beliefs, or unreasonable behaviors. Even when families' concerns are ill-informed, they should be recognized by clinicians as important when they come from parents' impulses to protect their child.…”

Challenges for Policy Makers and Organizational Leaders: Addressing Trends in Mental Health Inequalities

“…Implement programs focusing on clinicians' practices of clinical moral perception (26,27) to help caregivers resist viewing patients with mental illness as"difficult" and to help caregivers maintain compassionate views toward patients.…”

Responding to Callous Humor in Health Care

“…chronic or terminal conditions, or time and resource constraints that make it difficult to adequately address patients' needs. 14,15 Interestingly, when practitioners reflexively respond to these constraints by making callous jokes, moral distress can be intensified or even increased, especially when practitioners are aware that they are responding callously to others. 14 In what follows, we explore what happens when jokes don't bring people together but instead distance health care professionals from patients, from colleagues, and from their own feelings of vulnerability.…”

“…14,15 Interestingly, when practitioners reflexively respond to these constraints by making callous jokes, moral distress can be intensified or even increased, especially when practitioners are aware that they are responding callously to others. 14 In what follows, we explore what happens when jokes don't bring people together but instead distance health care professionals from patients, from colleagues, and from their own feelings of vulnerability. Drawing on our experiences in medical education and end-of-life care, we specifically focus on how we might respond to a colleague who uses callous humor in a way that undermines compassionate care.…”