Rivlin, K., Bornstein, M., et al. (2024).
JAMA Network Open, 7(8), e2426248.
Abstract
Importance
Moral distress occurs when individuals feel powerless to do what they think is right, including when clinicians are prevented from providing health care they deem necessary. The loss of federal protections for abortion following the Dobbs v Jackson Women’s Health Organization Supreme Court decision may place clinicians providing abortion at risk of experiencing moral distress, as many could face new legal and civil penalties for providing care in line with professional standards and that they perceive as necessary.
Main Outcomes and Measures
Using descriptive statistics and unadjusted and adjusted negative binomial regression models, the association between self-reported moral distress on the Moral Distress Thermometer (MDT), a validated psychometric tool that scores moral distress from 0 (none) to 10 (worst possible), and state abortion policy was examined.
Conclusions and Relevance
In this purposive national survey study of clinicians providing abortion, moral distress was elevated among all clinicians and more than twice as high among those practicing in states that restrict abortion compared with those in states that protect abortion. The findings suggest that structural changes addressing bans on necessary health care, such as federal protections for abortion, are needed at institutional, state, and federal policy levels to combat widespread moral distress.
Here are some thoughts:
A national survey of 310 abortion clinicians found that those practicing in states with abortion restrictions experience more moral distress than those in states that protect abortion. This study found that clinicians in restrictive states reported moral distress scores that were more than double those in protective states. The study's authors suggest that structural changes at the state, federal, and institutional levels are needed to address this moral distress, such as federal protections for abortion.
Moral distress can occur when people feel powerless to do what they believe is right, such as when clinicians are prevented from providing care they consider necessary. High levels of moral distress can lead to burnout, errors in patient care, and clinician attrition. In restrictive states, these issues could worsen provider shortages and lead to poor patient outcomes.
However, some clinicians have found ways to cope with moral distress. For example, one participant said they felt more empowered to provide abortion care after the Dobbs decision, while another described feeling motivated by the support of their team.
