Abstract
Physicians often face the decision between following rigid hospital protocol and doing the right thing for the patient, creating moral distress and contributing to burnout. This letter describes a case in which an elderly patient with COVID-19 pneumonia and a DNI order developed worsening hypercapnia and required noninvasive ventilation. Despite clinical appropriateness, hospital policy prohibited BiPAP use in obtunded patients due to aspiration risk - even when the resident offered continuous bedside monitoring. This case highlights the ethical tension that arises when rigid hospital policies prevent physicians from making real-time exceptions in appropriate situations. Empowering physicians to make context-driven decisions promotes patient-centered care and may reduce moral distress and burnout.
DOI
10.22237/crp/1770638460
Creative Commons License
This work is licensed under a Attribution 4.0 International (CC-BY 4.0) License
Recommended Citation
DUDAR A. Letter To The Editor: When systems fail: the impact of protocol on physician moral distress. Clin Res Prac. Feb 24 2026;12(1):eP3607. https://doi.org/10.22237/crp/1770638460
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