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Ethical Dilemmas and Moral Distress in Healthcare
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Ethical Dilemmas and Moral Distress in Healthcare

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Health Policy".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 15306

Special Issue Editor

Dr. Florin Oprescu

E-Mail Website
Guest Editor
Health Promotion, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD 4556, Australia
Interests: health communication; health promotion and education; mental health promotion; injury surveillance and control; educational research
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue focuses on "Ethical Dilemmas and Moral Distress in Healthcare". Submissions of original articles, systematic reviews, short communications, types of articles. All manuscripts will follow standard journal peer-review practices, and those accepted for publication will appear in the Special Issue on "Ethical Dilemmas and Moral Distress in Healthcare". We look forward to receiving your contributions to the Special Issue.

Dr. Florin Oprescu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (7 papers)

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Research

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10 pages, 240 KiB  
Article
Exploring the Connections between Medical Rehabilitation, Faith and Spirituality
by Laszlo Irsay, Viorela Mihaela Ciortea, Theodor Popa, Madalina Gabriela Iliescu and Alina Deniza Ciubean
Healthcare 2024, 12(12), 1202; https://doi.org/10.3390/healthcare12121202 - 15 Jun 2024
Viewed by 691
Abstract
(1) Background: Patients who undergo a medical rehabilitation treatment are often facing a physical, emotional and spiritual crisis, mostly due to pain, loss of limb functionality, the memory of the pre-disease days or questions about their role and value in life. Most of [...] Read more.
(1) Background: Patients who undergo a medical rehabilitation treatment are often facing a physical, emotional and spiritual crisis, mostly due to pain, loss of limb functionality, the memory of the pre-disease days or questions about their role and value in life. Most of the time, the physician does not have the ability to deal with these issues or to provide the expected responses. The aim of this study was to analyze the patient’s perception on spirituality and faith while going through a medical rehabilitation program. (2) Methods: The current study included 173 patients treated in the Rehabilitation Department of the Clinical Rehabilitation Hospital in Cluj-Napoca, Romania. Of them, 91 comprised the study group and were assessed in 2023, while 82 comprised the control group and were assessed in 2007. All patients answered a 34-item questionnaire designed by the authors regarding the role of religion, spirituality and prayer in their post-disease life. (3) Results: The results show that 99% of the patients assessed believe in God, 80% pray every day, 50% have less pain after praying and 44% trust their priest the same as they trust their doctor. When comparing groups, results from 2023 show that more patients pray every day, while fewer are afraid of dying, think their disease is serious or wish for the medical team to pray with them, compared to 2007. (4) Conclusions: The physician should not neglect the faith of the patient and should use it to achieve a better rehabilitation outcome. Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)
14 pages, 245 KiB  
Article
Attitude of the Lithuanian Public toward Medical Assistance in Dying: A Cross-Sectional Study
by Benedikt Bachmetjev, Artur Airapetian and Rolandas Zablockis
Healthcare 2024, 12(6), 626; https://doi.org/10.3390/healthcare12060626 - 10 Mar 2024
Cited by 1 | Viewed by 1037
Abstract
Euthanasia and assisted suicide, involving the intentional termination of a patient’s life, are subjects of global debate influenced by cultural, ethical, and religious beliefs. This study explored the attitudes of the general public toward euthanasia, finding varying levels of support. A cross-sectional study [...] Read more.
Euthanasia and assisted suicide, involving the intentional termination of a patient’s life, are subjects of global debate influenced by cultural, ethical, and religious beliefs. This study explored the attitudes of the general public toward euthanasia, finding varying levels of support. A cross-sectional study was conducted. This research specifically evaluated the perspectives of 5804 Lithuanian residents using a survey distributed through social media, which presented medical scenarios on life-preserving interventions. Analysis indicated that gender, religion, experience in caring for patients in a terminal condition, education, and age significantly influenced the attitudes of the respondents toward end-of-life decisions. Specifically, factors like being non-religious or having less experience in caring for the terminally ill correlated with a more positive opinion regarding euthanasia and other forms of medical assistance in dying. Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)

Review

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13 pages, 608 KiB  
Review
Moral Distress of Nurses Working in Paediatric Healthcare Settings
by Ana Cristina Ribeiro Miranda, Sara Duarte Fernandes, Sílvia Ramos, Elisabete Nunes, Janaína Fabri and Sílvia Caldeira
Healthcare 2024, 12(13), 1364; https://doi.org/10.3390/healthcare12131364 - 8 Jul 2024
Viewed by 1312
Abstract
This scoping review aims to map the evidence on moral distress of nurses working in paediatric healthcare settings from homecare to hospital. It was conducted according to the Joanna Briggs Institute. International databases were searched according to the specific thesaurus and free search [...] Read more.
This scoping review aims to map the evidence on moral distress of nurses working in paediatric healthcare settings from homecare to hospital. It was conducted according to the Joanna Briggs Institute. International databases were searched according to the specific thesaurus and free search terms. Independent screening and analysis were conducted using Rayyan QCRI. This review considered a total of 54 studies, including quantitative and qualitative studies, systematic reviews, and grey literature; English and Portuguese languages were included. Moral distress is a phenomenon discussed in nursing literature and in the paediatric context but is considered absent from discussion in clinical practice. It is caused by disproportionate care associated with overtreatment. Nurses can present a variety of symptoms, characterising moral distress as a highly subjective experience. The paediatric contexts of practice should promote a healthy ethical climate and work towards a moral community built with peer support, education, communication, leadership, and management involvement. Moral distress is still a complex and challenging multidimensional concept, and the aim should be to promote a culture of prevention of the devastating consequences of moral distress and work towards moral resilience. Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)
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14 pages, 499 KiB  
Review
Conscientious Objection and Other Motivations for Refusal to Treat in Hastened Death: A Systematic Review
by Madalena Martins-Vale, Helena P. Pereira, Sílvia Marina and Miguel Ricou
Healthcare 2023, 11(15), 2127; https://doi.org/10.3390/healthcare11152127 - 26 Jul 2023
Cited by 3 | Viewed by 2008
Abstract
Background: Conscientious objection (CO) in the context of health care arises when a health care professional (HCP) refuses to participate in a certain procedure because it is not compatible with their ethical or moral principles. Refusal to treat in health care includes, in [...] Read more.
Background: Conscientious objection (CO) in the context of health care arises when a health care professional (HCP) refuses to participate in a certain procedure because it is not compatible with their ethical or moral principles. Refusal to treat in health care includes, in addition to CO, other factors that may lead the HCP not to want to participate in a certain procedure. Therefore, we can say that CO is a form of refusal of treatment based on conscience. Hastened death has become an increasingly reality around the world, being a procedure in which not all HCPs are willing to participate. There are several factors that can condition the HCPs’ refusal to treat in this scenario. Methods: With the aim of identifying these factors, we performed a systematic review, following the PRISMA guidelines. On 1 October 2022, we searched for relevant articles on Pubmed, Web of Science and Scopus databases. Results: From an initial search of 693 articles, 12 were included in the final analysis. Several motivations that condition refusal to treat were identified, including legal, technical, social, and CO. Three main motivations for CO were also identified, namely religious, moral/secular, and emotional/psychological motivations. Conclusions: We must adopt an understanding approach respecting the position of each HCP, avoiding judgmental and discriminatory positions, although we must ensure also that patients have access to care. The identification of these motivations may permit solutions that, while protecting the HCPS’ position, may also mitigate potential problems concerning patients’ access to this type of procedure. Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)
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Other

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20 pages, 1717 KiB  
Systematic Review
AI and Ethics: A Systematic Review of the Ethical Considerations of Large Language Model Use in Surgery Research
by Sophia M. Pressman, Sahar Borna, Cesar A. Gomez-Cabello, Syed A. Haider, Clifton Haider and Antonio J. Forte
Healthcare 2024, 12(8), 825; https://doi.org/10.3390/healthcare12080825 - 13 Apr 2024
Cited by 6 | Viewed by 5109
Abstract
Introduction: As large language models receive greater attention in medical research, the investigation of ethical considerations is warranted. This review aims to explore surgery literature to identify ethical concerns surrounding these artificial intelligence models and evaluate how autonomy, beneficence, nonmaleficence, and justice are [...] Read more.
Introduction: As large language models receive greater attention in medical research, the investigation of ethical considerations is warranted. This review aims to explore surgery literature to identify ethical concerns surrounding these artificial intelligence models and evaluate how autonomy, beneficence, nonmaleficence, and justice are represented within these ethical discussions to provide insights in order to guide further research and practice. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Five electronic databases were searched in October 2023. Eligible studies included surgery-related articles that focused on large language models and contained adequate ethical discussion. Study details, including specialty and ethical concerns, were collected. Results: The literature search yielded 1179 articles, with 53 meeting the inclusion criteria. Plastic surgery, orthopedic surgery, and neurosurgery were the most represented surgical specialties. Autonomy was the most explicitly cited ethical principle. The most frequently discussed ethical concern was accuracy (n = 45, 84.9%), followed by bias, patient confidentiality, and responsibility. Conclusion: The ethical implications of using large language models in surgery are complex and evolving. The integration of these models into surgery necessitates continuous ethical discourse to ensure responsible and ethical use, balancing technological advancement with human dignity and safety. Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)
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16 pages, 1770 KiB  
Systematic Review
Factors of Hospital Ethical Climate among Hospital Nurses in Korea: A Systematic Review and Meta-Analysis
by Yoon Goo Noh and Se Young Kim
Healthcare 2024, 12(3), 372; https://doi.org/10.3390/healthcare12030372 - 1 Feb 2024
Cited by 1 | Viewed by 1123
Abstract
In the current healthcare landscape, nurses frequently encounter various ethical dilemmas, necessitating situation-specific ethical judgments. It is crucial to thoroughly understand the factors that shape the hospital ethical climate and the elements that are influenced by this climate. This study aims to identify [...] Read more.
In the current healthcare landscape, nurses frequently encounter various ethical dilemmas, necessitating situation-specific ethical judgments. It is crucial to thoroughly understand the factors that shape the hospital ethical climate and the elements that are influenced by this climate. This study aims to identify the variables associated with the hospital ethical climate perceived by Korean nurses. A literature search was conducted using the core database, and the effect sizes of relevant variables were analyzed using a comprehensive meta-analysis. The overall effect size analysis incorporated 56 variables, and a meta-analysis was performed on 7 variables. This study found correlations between ethical sensitivity (ESr = 0.48), moral distress (ESr = −0.30), empathy (ESr = 0.27), ethical leadership (ESr = 0.72), job satisfaction (ESr = 0.64), and intention to leave (ESr = −0.34) with the hospital ethical climate. Both personal and organizational attributes were moderately related to the hospital ethical climate. Enhancing the hospital ethical climate could positively affect both individuals and the organization. The protocol for this study has been registered with PROSPERO (CRD42022379812). Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)
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10 pages, 254 KiB  
Essay
The Dilemma of Compulsory Vaccinations—Ethical and Legal Considerations
by Yael Sela, Keren Grinberg and Rachel Nissanholtz-Gannot
Healthcare 2023, 11(8), 1140; https://doi.org/10.3390/healthcare11081140 - 15 Apr 2023
Cited by 1 | Viewed by 2970
Abstract
The high childhood vaccination coverage in Israel leads to a low rate of morbidity from the diseases against which the vaccination in administered. However, during the COVID-19 pandemic, children’s immunization rates declined dramatically due to closures of schools and childcare services, lockdowns, and [...] Read more.
The high childhood vaccination coverage in Israel leads to a low rate of morbidity from the diseases against which the vaccination in administered. However, during the COVID-19 pandemic, children’s immunization rates declined dramatically due to closures of schools and childcare services, lockdowns, and guidelines for physical distancing. In addition, parents’ hesitancy, refusals, and delays in adhering to routine childhood immunizations seem to have increased during the pandemic. A decline in routine pediatric vaccine administration might indicate that the entire population faces increased risks for outbreaks of vaccine-preventable diseases. Throughout history, vaccines have raised questions about their safety, efficacy, and need among adults and parents who feared or hesitated to vaccinate their children. Objections derive from various ideological and religious reasons or concerns about the possible inherent dangers. Mistrust in the government and/or economic or political interests also raise concerns among parents. The importance of providing vaccines to maintain public health, as opposed to the autonomy of the individuals over their body and their children, raises ethical questions. In Israel, there is no legal obligation to get vaccinated. It is imperative to find a decisive solution to this situation without delay. Furthermore, where democratically one’s principles are sacred and where one’s autonomy over one’s body is also unquestionable, such a legal solution would not only be unacceptable but also rather impossible to enforce. It seems that some reasonable balance between the necessity to preserve public health and our democratic principles should apply. Full article
(This article belongs to the Special Issue Ethical Dilemmas and Moral Distress in Healthcare)
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