Iatrogenic trainwrecks and moral injury

Area of Science:

• Medical Ethics
• Public Health
• Sociology of Medicine

Background:

• Opioids are potent pain medications with significant side effects, including death.
• The US faces a severe opioid epidemic, with widespread opioid prescription and administration in clinical settings.
• Clinical iatrogenesis refers to patient harm caused by medical treatment.

Purpose of the Study:

• To examine how clinicians experience iatrogenic harms from opioid administration as moral injury.
• To explore the systemic factors contributing to patient harm and clinician distress in opioid management.
• To extend the concept of iatrogenesis to include harm experienced by healthcare providers.

Main Methods:

• Analytic auto-ethnography utilizing over a decade of clinical practice in urban hospitals.
• Description of clinician-patient interactions involving opioid complications.
• Exploration of institutional and systemic influences on opioid care.

Main Results:

• Clinicians experience moral injury when opioid administration leads to patient harm, conflicting with their ethical obligations.
• Hierarchical medical decision-making systems disempower clinicians, hindering optimal patient care.
• Biomedical institutions and systems exacerbate harm for vulnerable patients receiving and addicted to opioids.
• Emotional distress and ambivalence are common among physicians making opioid-related decisions.

Conclusions:

• Iatrogenesis and moral injury are co-produced by systemic and cascading decision-making processes within healthcare.
• Moral injury offers a framework for understanding the harm experienced by clinicians in the context of opioid care.
• Addressing opioid-related harms requires systemic changes beyond individual clinical practice.