One of the more draining aspects of being a clinical ethicist is dealing with the emotions of patients, family members, as well as healthcare providers. Generally, by the time a clinical ethicist is called into a case, stress levels are running high, patience is low, and interpersonal communication is strained. Management of this emotional burden of clinical ethics is an underexamined aspect of the profession and academic literature. The emotional nature of doing clinical ethics consultation may be better addressed by (...) utilizing concepts and tools from clinical psychology. Management of countertransference, the natural emotional reaction by the therapist toward the patient, is a widely discussed topic in the psychotherapeutic literature. This concept can be adapted to the clinical ethics encounter by broadening it beyond the patient-therapist relationship to refer to the ethics consultant's emotional response toward the patient, the family, or other members the healthcare team. Further, it may aid the consultant because a recognition of the source and nature of these reactions can help maintain ‘critical distance’ and minimize bias in the same way that a psychologist maintains neutrality in psychotherapy. This paper will offer suggestions on how to manage these emotional responses and their burden in the clinical ethics encounter, drawing upon techniques and strategies recommended in the psychotherapeutic literature. Using these techniques may improve consultation outcomes and reduce the emotional burden on the clinical ethicist. (shrink)

BackgroundThe merits and drawbacks of moral relevance models of addiction have predominantly been discussed theoretically, without empirical evidence of these potential effects. This study develops and evaluates a novel survey measure for assessing moral evaluations of patient substance misuse (ME-PSM).MethodsThis measure was tested on 524 health professionals (i.e., physicians, nurses, and other health professionals) in California (n = 173), urban France (n = 102), and urban China (n = 249). Demographic factors associated with ME-PSM were investigated using analyses of variance (...) (ANOVAs) and t-tests, with results suggesting that ME-PSM is higher among younger health professionals, nurses (when compared with physicians and other health professionals), and Chinese health professionals (when compared with French and American health professionals).ResultsResults provide preliminary support for the psychometric quality of the survey measure introduced in this study, including the existence of a single latent structure and partial invariance of collected data across countries.ConclusionThe survey measure for ME-PSM which was developed and tested in the current study appears to hold potential utility for use as a measure of moral views of patient substance misuse. With development, this measure may be used to examine moral evaluations, both as factors of stigma and of other clinical factors associated with the treatment of patients with substance use disorders. (shrink)

This dissertation is a collection of four studies which collectively explore a hypothesized construct of ‘moral evaluation of patient behaviors’ (MEPB) as a driver of health professionals’ readiness to interact humanistically with their patients. In these studies, ‘humanistic interactions’ refer to the non-technical, intangible skills and factors of clinical competence; the factors specifically explored in these studies were compassion toward patients, self-efficacy for treating patients, and optimism toward patient treatment. For the purpose of specificity, all factors were examined as they (...) pertained to patients with substance use disorders. Survey data from a convenience sample of 524 health professionals (i.e. physicians, nurses, and other health professionals) from three culturally distinct areas of the world (i.e. California (n = 173), urban France (n = 102), and urban China (n = 249)) were analyzed using analyses of variance, Welch’s t-tests, confirmatory factor analyses, and structural equation models. Results indicate: 1.) Psychometric support for the survey tool that was created for the assessment of the hypothesized construct of MEPB among health professionals, and information on differences on this hypothesized construct by age group, occupation, and country of residence; 2.) Indication that this survey tool operates differently among health professionals in different countries, which supports the notion that people from differing cultures have differing notions about morality. 3.) In the California sample, results indicate that while moral judgements of patients’ behavior carries mixed associations with factors of health professionals’ readiness to interact humanistically with these patients, moral judgements of the self (or, moral self-image) have only positive associations with factors of this readiness for humanistic interaction. This finding supports the notion that having a healthy self-concept strengthens one’s ability to support others. 4.) In all three countries, moral evaluations were positively associated with optimism toward treating patients, and in urban China, they were additionally positively associated with compassion and with self-efficacy. Given weak measurement invariance (i.e. differences in the operation of the measurement of moral evaluations by country), more research is needed in this area. The current research provides a tool for examining research of just this nature, and most importantly suggests that morality does not need to be eliminated from perspectives of mental illness or addiction, but rather that more nuanced moral perspectives are needed. Future research may explore distinctions between moral appraisals and stigma, and associations between moral evaluations (both among health professionals and among patients) and clinical/health outcomes such as rates of relapse and recovery. (shrink)