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Ethical Dilemmas

An ethical dilemma arises when there is a conflict between two or more sets of human values, both of which hold equal merit but cannot be fully honoured simultaneously. These dilemmas often require careful reflection and thoughtful decision-making.

In a health-care setting, decisions must prioritize the wellbeing of the individuals involved, respect autonomy, minimize harm, promote the greater good, and adhere to legislation and professional codes of ethics.

Ethical Frameworks and Practical Steps

Ethical decision-making is a shared responsibility across all roles in health care. Every staff member, whether in a clinical setting or non-clinical setting, must strive to act in a way that upholds respect, minimizes harm, and maintains boundaries and privacy. Ethical frameworks provide structured approaches to guide decisions in complex scenarios. To navigate such dilemmas, tools like the Ottawa Personal Decision Guide can help clarify the decision-making process. This guide supports individuals in exploring options, identifying decision-making needs, and planning actionable steps. By breaking down complex situations, it enables individuals to make more informed and confident choices.

The Ethical Decision Guide prepared by WRHA Ethics Services offers a systematic process to support health-care workers in ethical decision-making. Please note that going through these guides may evoke strong emotional feelings or Post-Traumatic Stress (PTS).

1. Identify the problem

  • What is the decision to be made?
  • Whose values are central? What are they?

2. Reflect on the problem

  • Think about principles (e.g., autonomy, beneficence, non-maleficence, and justice)
  • Consider obligations (e.g., relevant laws, professional standards and duties)
  • Consider and reflect on other factors (e.g., relationships, circumstances, or constraints)

3. Deliberate

  • What ripple effect do you expect?

4. Resolve the problem

  • Make a choice and evaluate
  • Address any moral distress or policy implications

Understanding Moral Distress in Health Care

Moral distress occurs when health-care workers know the ethically appropriate action to take but feel unable to act due to institutional constraints, power imbalances, or external pressures. This internal conflict can lead to frustration, guilt, and a sense of powerlessness, affecting both personal wellbeing and professional satisfaction.

It is also likely to occur during public health emergencies, such as the pandemic, where decisions often involve competing priorities and limited resources affecting patient care and the safety of health-care workers.

Over time, unresolved moral distress can lead to emotional exhaustion, reduced job satisfaction, burnout, and moral injury.

Identifying Moral Distress

Moral distress can feel like being “trapped” in a situation where every option seems wrong or misaligned with one’s values. Health-care workers may feel isolated, as moral distress is not openly discussed. Over time, if unresolved, moral distress can lead to moral injury – a deeper psychological impact resulting in burnout or the staff member leaving the profession entirely. Health-care workers may experience moral distress in situations such as:

  • feeling forced to provide care that contradicts their ethical values,
  • observing colleagues engaging in practices they perceive as unethical, but feeling unable to intervene, or
  • facing systemic issues that prevent delivering equitable care to all patients.

Common symptoms of Moral Distress include:

  • Emotional responses – anger, sadness, guilt, or frustration.
  • Physical symptoms – headaches, fatigue, or insomnia.
  • Behavioural changes – withdrawal, decreased motivation, or questioning one’s professional role.

Addressing Moral Distress

  1. Recognize it – naming and understanding the emotions and ethical conflicts involved is step one.
  2. Seek Support – use organizational ethics resources, or consult with peers and mentors, to process the situation.
  3. Advocate for Change – engage in conversations about systemic issues contributing to your moral distress and propose improvements.

Reach out for Support

Regional ethics services and committees can provide valuable guidance and consultation. Here are the key contacts in your region if you need support:

  • Shared Health Provincial Ethics Services:
    • Dr. Tyler Peikes, Clinical Ethicist at Health Sciences Centre (HSC), is available through the HSC switchboard for consultation
  • CancerCare Manitoba Ethics Committee:
    • Contact the co-Chairs of the Ethics Committee through the office of CCMB’s President and CEO by calling 204-787-2241 or 204-787-2186 and leaving a message.
  • Winnipeg Regional Health Authority Ethics Services:
  • Prairie Mountain Health Ethics Services:
  • Interlake-Eastern Regional Health Authority Ethics Services:
  • Southern Health-Santé Sud:
  • Northern Health Region Ethics Services:

Regional Ethics Services and Guides

Additional Tools & Resources

References

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