Saskia Wilhelmy¹, Saskia Metan¹, Meike Gerber¹

¹ Institute of History of Medicine, Carl Gustav Carus School of Medicine, Dresden University of Technology

In acute medical situations, patients may find themselves in ethically complex decision-making situations in which they must decide, under time pressure, on measures that affect their continued existence, their quality of life or their death. In doing so, they must not only process medical information but also weigh up their own values and conceptions of dignity and suffering.

Although the patient’s refusal of life-sustaining measures is clearly regulated by law, case studies from clinical ethics counselling show that irreversible patient decisions made under time pressure can cause the treatment team to feel a sense of moral burden. This stems less from doubts about patients’ autonomy than from the healthcare professionals’ sense of responsibility. They see themselves as sharing responsibility for decision-making processes that take place under extreme time constraints, emotional strain and often medically unstable conditions. The question of whether decisions would have turned out differently under different time constraints may persist as lingering moral doubt.

For treatment teams, this creates a conflict between respect for the patient’s wishes and the professional impulse to preserve life and prevent irreversible consequences from occurring prematurely. Time pressure exacerbates this situation, as opportunities to clarify perspectives and resolve ambivalence are limited. Conversely, a delay can also be morally burdensome, for example when a measure is continued even though it has already been rejected. Here, treatment teams find themselves caught in an internal conflict between the desire for certainty in decision-making and the concern that a delay might infringe upon the patient’s self-determination.

Our paper addresses this tension between autonomous decision-making and time constraints and examines how decisions made under considerable time pressure contribute to a sense of moral distress within the treatment team. Complementing established concepts of ‘moral distress’, we argue that time constitutes a morally relevant dimension of clinical decision-making. Using ethical case consultations, we aim to examine the temporal asymmetry between patients and the treatment team and to derive implications for ethical counselling and clinical practice. In particular, the focus will be on the importance of spaces for ethical reflection in alleviating moral distress.