1 School of Nursing and Medicine, Berman Institute of Bioethics, Johns Hopkins University , Baltimore, Maryland.
J Palliat Med. 2013 Sep;16(9):1074-9. doi: 10.1089/jpm.2012.0490. Epub 2013 Jun 18.
Palliative care clinicians confront suffering as they care for people living with life-limiting conditions. When the degree of suffering becomes unjustified, moral distress can ensue. Promising work from neuroscience and social psychology has yet to be applied to clinical practice.
Our objective was to expand a social psychology model focusing on empathy and compassion in response to suffering to include an ethical dimension and to examine how the interrelationships of its proposed components can assist clinicians in understanding their responses to morally distressing situations.
In the clinical context, responses to distressing events are thought to include four dimensions: empathy (emotional attunement), perspective taking (cognitive attunement), memory (personal experience), and moral sensitivity (ethical attunement). These dynamically intertwined dimensions create the preconditions for how clinicians respond to a triggering event instigated by an ethical conflict or dilemma. We postulate that if the four dimensions are highly aligned, the intensity and valence of emotional arousal will influence ethical appraisal and discernment by engaging a robust view of the ethical issues, conflicts, and possible solutions and cultivating compassionate action and resilience. In contrast, if they are not, ethical appraisal and discernment will be deficient, creating emotional disregulation and potentially leading to personal and moral distress, self-focused behaviors, unregulated moral outrage, burnout, and secondary stress.
The adaptation and expansion of a conceptual framework offers a promising approach to designing interventions that help clinicians mitigate the detrimental consequences of unregulated moral distress and to build the resilience necessary to sustain themselves in clinical service.
姑息治疗临床医生在照顾患有生命有限疾病的患者时会面临痛苦。当痛苦程度变得不合理时，可能会出现道德困境。神经科学和社会心理学的有前景的工作尚未应用于临床实践。
我们的目的是扩展一个关注同理心和同情心以应对痛苦的社会心理学模型，纳入伦理维度，并研究其提出的组成部分的相互关系如何帮助临床医生理解他们对道德困境的反应。
在临床环境中，对困扰事件的反应被认为包括四个维度：同理心（情绪共鸣）、换位思考（认知共鸣）、记忆（个人经历）和道德敏感性（伦理共鸣）。这些动态交织的维度为临床医生如何应对由伦理冲突或困境引发的触发事件创造了前提条件。我们假设，如果这四个维度高度一致，情感唤醒的强度和极性将通过参与对伦理问题、冲突和可能解决方案的全面看法，并培养富有同情心的行动和适应力，影响伦理评估和辨别。相比之下，如果它们不一致，伦理评估和辨别将不足，导致情感失调，并可能导致个人和道德困境、自我关注行为、无调节的道德愤怒、倦怠和二次压力。
概念框架的适应和扩展为设计干预措施提供了一个有前途的方法，这些干预措施可以帮助临床医生减轻不受调节的道德困境的不利后果，并建立在临床服务中维持自己所需的适应力。
