Moral Distress in the Critical Care Setting

We read with interest the article “Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support” in the September issue of the American Journal of Critical Care.¹  We are nurses of varying degrees of background—including case management, critical care, and oncology. The focus on moral distress in the setting of mechanical circulatory support (MCS) is timely owing to the increased use of extracorporeal membrane oxygenation (ECMO), the high prevalence of moral distress, and nursing staff shortages in the critical care setting during the COVID pandemic.^2,3  The study also illustrates the potential for palliative care and ethics consultations as strategies to reduce moral distress. We would like to congratulate the authors on their contribution to the literature on moral distress and are interested in learning more about the research and seek clarification.

First, we note the low survey response rate (39%), which...