Marcel and Josephine Patterson Memorial Lecture in the Medical Humanities
Perceptions of Vulnerability and Moral
Distress in Neurological Care
Georgina Morley, PhD, MSc, RN (UK)
Nurse Ethicist, Assistant Staff
Director, Nursing Ethics Program
Lerner College of Medicine
Lauren R. Sankary, JD, MA
Center for Bioethics
Thursday, October 21, 2021
12:00 p.m.—1:00 p.m.
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Using case studies, we explore ethical complexities commonly arising in neurological care that compound moral distress. First, we analyze obstacles to shared decision-making for patients at the margins of decision-making capacity or whose capacity
fluctuates over the course of their clinical care, and the moral distress that can arise when there are incapacitated refusals of care. Second, we explore situations in which cognitive impairments present a possible contraindication to life-prolonging
interventions. We identify compounding factors likely to exacerbate moral distress in neurological care, including epistemic injustices, communication barriers, and the perceived vulnerability of patients with neurological conditions. explore connections
between sources of vulnerability identified in Kenneth Kipnis’ bioethical taxonomy of vulnerability and heightened moral distress amongst healthcare professionals. We conclude with recommendations to mitigate moral distress that may arise in
caring for cognitively vulnerable patient populations.