LAUSR

Moral distress occurs when one feels sure of the ethically correct thing to do, but external factors prevent pursuing that course. When unresolved, and especially if accumulated from different situations, moral distress can lead to psychological manifestations such as anxiety, frustration, anger and burnout in providers. In a consultation context, where multiple clinicians from different backgrounds in different professional roles are inevitably involved, the “truth” of a single event can be perceived in different, often conflicting ways, a phenomenon known as the Rashomon effect, named for the classic movie Rashomon. We present a case of moral distress triggered by caring for a patient with severe untreated depression and complicated psychosocial problems, who did not have a terminal illness, but wished a hastened death, and refused treatment for depression and nutrition. We explore the different perceived professional ethical responsibilities from the perspective of the primary treatment team and the psychiatric consult team, in order to better understand the role of the Rashomon effect in creating moral distress for the providers involved. We propose that better understanding of the role of the Rashomon effect and moral distress in the consultation context could lead to a reduction in, and potentially prevention of, moral distress experienced from ethically challenging cases.