Navigating Moral Distress in Shared Decision-Making: A Case Study on End-of-Life Choices

Kelsey Able – North Kansas City; Janice Wang – Kansas City University

Abstract: This presentation explores the ethical and emotional challenges healthcare teams face when patients with full decision-making capacity opt to delegate their end-of-life decisions to a surrogate. Through a case study of an elderly cancer patient, this session examines the discomfort and moral distress experienced by a treatment team navigating the intersection of patient autonomy, family dynamics, and professional responsibilities.

The patient, despite full cognitive capacity, chose to designate her daughter as the sole decision-maker for her care, as outlined in her advance directive. The treatment team struggled with how to address end-of-life decisions with the daughter in the patient’s presence, knowing the patient preferred not to participate. This case raises critical questions regarding respect for autonomy, the emotional toll on healthcare providers, and tensions between professional obligations and patient wishes.

The presentation will propose strategies for managing similar cases, focusing on best practices for reducing moral distress while respecting patient preferences. Additionally, cultural variations in decision-making, particularly among patients of Asian descent, where decisions may be made collectively by family members, will be explored to highlight their impact on healthcare dynamics.

This session will be presented by a diverse group, including a doctor, two student doctors (one of Asian descent, who will address cultural aspects), and a bioethics philosopher, offering multiple perspectives on managing ethical dilemmas and fostering effective communication in complex decision-making processes.

Keywords: Surrogate decision-making, Cultural impact on healthcare decision-making, Moral distress in healthcare