Learning (and Teaching) How to Avoid Values Imposition and Reduce Moral Distress

The Core Competencies is definitive in stating that consultants must not “impose their own values” on patients and families. They maintain that such values imposition is a kind of “moral ‘hegemony’” in which the consultant “usurps the authority of the primary decision makers.” But while trained consultants are aware of this danger, there is another source of “moral hegemony” in bedside ethical conflicts that has no parallel professional safeguards: the values imposition of the healthcare providers who care for patients and interact with their families. A substantial empirical literature demonstrates that the care team’s values undergird their clinical recommendations and advocacy of particular goals of care. Providers’ values imposition is not only problematic for patients and families, but it has an unanticipated deleterious impact on the providers themselves: it creates the conditions for experiencing their own moral distress. Defined as a provider who knows the morally right course of action to take but is thwarted from taking it, moral distress has become a pervasive syndrome for healthcare providers. But American values pluralism – in which individuals hold profoundly different bioethical values – guarantees that nurses and physicians will frequently feel thwarted in their ability to achieve “the morally right course of action.” Values imposition and moral distress are closely related problems. In this workshop, I will present a method for learning how to avoid values imposition in HEC and then teaching colleagues the same approach. Understanding this method also has the potential to reduce providers’ experience of moral distress.