By Ryan Pferdehirt, D.Bioethics, HEC-C

April 2022

Bioethics case study on moral distress of hospital workers.

Sandra is a 30-year-old nurse in a small rural hospital. Sandra became a nurse not only to help others, but to help her community. She made a commitment to herself and her community to provide the best medical care possible. The hospital is in her hometown, where just about everyone knows her. When she graduated from high school, she left for nursing school with every intention of returning.

Her passion is reflected in the way she connects with her patients, including Tiffany, a 21-year-old female-identifying patient recently hospitalized with severe upper respiratory distress caused by COVID. Tiffany has underlying health issues, namely, asthma and heart disease which could make for a severe disease progression. Tiffany is one among many patients hospitalized with COVID. Recently, the hospital has seen a surge in cases, which has caused a major strain on the hospital system. Beds are full and they are running out of some critical resources. Sandra knows the hospital recently received monoclonal antibodies and also knows that Tiffany would benefit greatly from this treatment, which is designated for patients with severe COVID infections.

Unfortunately, Sandra learns from the attending physician that the hospital is completely out of monoclonal antibodies, and they are having trouble sourcing them from other hospital systems in the area. Sandra is worried. She wants to provide the best care possible for Tiffany, and knows that monoclonal antibodies therapy would increase her chances of a better health outcome. However, Sandra and her team are unable to provide this treatment due to the shortage.

After the attending physician visits Tiffany to deliver the news, nurse Sandra checks in with Tiffany. “I know that Dr. Shah was just in to see you. How are you doing?” “Not so well,” responds a visibly worried Tiffany. “I’m having trouble with my breathing. And the doctor just said there’s none of that new medicine left that would help me fight the COVID. Isn’t there anything that can be done about that? I’m only 21 years old! This shouldn’t be happening to me!” Tiffany erupts into a coughing spell. Then pleads, “When do you think I can get the treatment? You’re from here. I know you care. Can you help?”

Unable to answer the question definitively, Sandra is left speechless. This is not the first patient with severe COVID for whom she’s provided nursing care. Apart from the incredibly high number of COVID hospitalizations recently, there has also been a disturbingly high number of COVID deaths, and it’s all been taking an emotional toll on hospital staff, including Sandra. The situation overwhelms her. There should be life-saving treatment for Tiffany and all those other patients, but the shortage of monoclonal antibodies is something that Sandra seems powerless to resolve. In the meantime, Tiffany and many others from this community may die while caregivers are forced to provide suboptimal care.

What should be done?