Center for Medical Ethics and Health Policy

Embedded Ethics Program in Medical Intensive Care Unit and Cardiovascular Intensive Care Unit to Alleviate Moral Distress


Project Description


The study assesses an intervention (an “Embedded Ethics Program”) developed to alleviate moral distress. We hypothesize that an embedded ethicist’s frequent presence in the units and participation in decision-making processes will mitigate moral distress, which we believe, arises due in part to uncertainty about clinical endpoints and patient or surrogate decision-makers goals. Through this project, we seek to identify factors or triggers underlying moral distress, develop and implement an intervention, and evaluate whether the intervention successfully identifies and subsequently reduces moral distress among hospital personnel.

Supported by: Houston Methodist Hospital and Houston Methodist Research Institute Multidisciplinary Research Grant Program


Project Personnel


Principal Investigator

  • Courtenay Bruce, M.A., J.D., Principal Investigator



Bruce CR, Miller SM, Zimmerman J. A Qualitative Study Exploring Moral Distress in the ICU Team: The Importance of Unit Functionality and Intrateam Dynamics. Critical Care Medicine 2014: [Epub ahead of print].

Weinzimmer S, Miller S, Zimmerman J, Isidro S, Hooker S, Bruce CR. Critical Care Nurses’ Moral Distress in End-of-Life Decision Making. Journal of Nursing Education and Practice 4(6), 2014: 6-12.

Bruce CR, Allen N, Fahy B, Gordon H, Suarez E, Bruckner B. Challenges in Deactivating a Total Artificial Heart for a Patient with Capacity. CHEST 145(3), 2014: 625-31.

Bruce CR, Weinzimmer S, Zimmerman JL. Moral Distress in the ICU. In J-L Vincent (Ed) Annual Update in Intensive Care and Emergency Medicine 2014. Springer International Publishing, Switzerland, 2014: 723-34.

Bruce CR, Zimmerman JL. “Like Firemen Going into a Fire”: Moral Distress in the Intensive Care Unit. ICU Management 14(2), 2014: 35-37.

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