Understanding ethical climate, moral distress, and burnout: a novel tool and a conceptual framework

The pace of technological advancements in the intensive care unit (ICU) challenges clinicians' ability to manage ethical and decision-making challenges near the end of life. Modern medicine has advanced to the point where we can support multiple organ systems simultaneously and sustain life when the benefits of treatments to overall survival and quality of life are not always clear. Physiological and technological limits no longer always tell us when to stop, and clinicians and families are now forced to take over the role that was once played by nature to make decisions as to whether and when life-sustaining therapies should be withdrawn or withheld.

Unfortunately, we often do not do a very good job of making these tough decisions even when patients can participate in the discussion. To add to that challenge, patients often lack decision-making capacity during their ICU stay. Clinicians and families struggle to balance the inherently imperfect practice...

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