Emotional Effect of Clinical Ethics Work Often Goes Unrecognized
May 1, 2025
By Stacey Kusterbeck
During graduate school, Anna Goff, PhD, HEC-C, worked with senior clinical ethicists on cases including nonbeneficial treatment, quality of life, capacity and consent, and the role of surrogate decision-makers. “This represented a crash course on the realities of being a clinical ethicist. While I anticipated the intellectual demand of clinical ethics consultations, I was far less prepared for the emotional weight that sometimes accompanied the work,” says Goff, currently a clinical ethics fellow at Weill Cornell Medicine.
There is a great deal of focus, and a substantial body of literature, on the emotional well-being of nurses and physicians. In contrast, says Goff, “The impacts of clinical ethics work on ethicists are largely undiscussed within the field, at least in public forums such as academic writing or professional conferences.” Goff and colleagues interviewed 34 clinical ethicists in 2023 to learn the effect of their professional responsibilities and how coping mechanisms and organizational structures can help.1
Overall, clinical ethics work appeared to have a profound emotional effect on clinical ethicists. Participants described negative emotions, such as sadness, anger, frustration, helplessness, distress, and grief. Several participants talked about being exposed frequently to morally distressing cases and connected this with increased risk of burnout. These themes emerged from the interviews:
- Many participants spoke of cases that pushed them to their emotional limits. One participant described a consultation involving a patient who had attempted suicide shortly after that clinical ethicist had lost a loved one to suicide. “Creating a culture where clinical ethicists feel comfortable speaking up about their own struggles is important. Institutions must find ways to combat the isolation that so many of the participants in our study described,” says Goff.
- Having lack of clarity on their role significantly affects ethicists’ emotional experience. “There are several concerns that arise if ethicists have lack of clarity about their roles,” says Goff. Role-based differences could lead to significant variations in practice. This raises the question of whether (or to what extent) the clinical ethics field has a shared professional identity. “This is important as the field continues to professionalize and shift toward standardization. A lack of shared professional identity throws the validity of certification, for example, into question. It opens the door for potential role creep, such that clinical ethicists are being put in situations that they are not properly trained to navigate,” says Goff.
- Ethicists talked about the importance of having protected time off-service. Participants described a variety of systems, such as being limited to no more than two consecutive weeks on-call, having multiple ethicists on-call, and having a team-based approach for complex cases. “These are very concrete, actionable changes that appear to greatly benefit clinical ethicists. And the benefits are not limited to clinical ethicist well-being. Each of these structural features also has the potential to enhance the quality of ethics work,” says Goff.
- The concept of “moral distress” came up frequently. The researchers questioned whether moral distress was the best term for describing the experiences of clinical ethicists, given that ethicists do not provide medical care. “We proposed that, at least sometimes, clinical ethicists might instead be experiencing something we’ve termed ‘secondary moral distress,’ which draws on existing literature regarding ‘secondary traumatic stress,’” says Goff. Similar to the way that frontline workers sometimes display signs of trauma despite not being directly traumatized themselves, clinical ethicists appear to be demonstrating signs of moral distress despite not actually being the ones constrained from acting (insofar as they are not the ones providing or being unable to provide medical care). “We believe that this distinction is important as we begin thinking about how best to support clinical ethicists as they navigate the emotional challenges associated with their work,” says Goff.
- Ethicists used multiple personal and professional coping mechanisms if they experienced adverse emotions because of their work. “One of the major takeaways for individuals is that finding positive coping mechanisms is essential,” says Goff. One study participant stated, “The reality is that you cannot do healthcare ethics and not be negatively impacted. I think it’s unavoidable. It’s like being a farmer and working outside and avoiding sunburn. It’s just not going to happen. You’re going to get sunburned. When you’re a clinical ethicist, you’re going to be emotionally impacted by your work.” “This person seems to have it right. It’s not a matter of if clinical ethicists will be affected by their work, but rather when,” says Goff. “This is important to recognize, not just for individual clinical ethicists, but also for the collective profession.”
- Colleagues were a major source of support for many participants. “As such, it is imperative that clinical ethicists be aware and able to provide support for others on their hardest days,” says Goff. A crucial aspect of supporting clinical ethicists is ensuring that they are not practicing in isolation. “Where possible, having colleagues who also do and understand the work is hugely important. When that’s not feasible, supporting access to colleagues at other institutions also proved beneficial to many of our participants,” says Goff.
- Not all the emotions described by participants were negative. Clinical ethicists appear to experience a great amount of fulfillment, satisfaction, and appreciation in response to their work. “This is especially true in cases where they are able to help identify a solution, navigate a complicated situation, or provide support for stakeholders as they face a difficult ethical issue,” says Goff.
Stacey Kusterbeck is an award-winning contributing author for Relias. She has more than 20 years of medical journalism experience and greatly enjoys keeping on top of constant changes in the healthcare field.
Reference
1. Goff AD, Michie MM, Lambrix MA, Gerrek ML. The emotional impact of clinical ethics work on clinical ethicists: A qualitative study. AJOB Empir Bioeth. 2025; Mar 12:1-11. doi: 10.1080/23294515.2025.2474912. [Online ahead of print].
There is a great deal of focus on the emotional well-being of nurses and physicians, but the effects of clinical ethics work on ethicists are largely undiscussed. Anna Goff, PhD, HEC-C, colleagues interviewed 34 clinical ethicists in 2023 to learn the effect of their professional responsibilities and how coping mechanisms and organizational structures can help.
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