Table 1 The 12 clinical scenarios experienced by medical students during the major clinical year that may invoke moral distress

1

Following the family’s wishes to continue life support even though I felt it was not in the best interest of the elderly patient.

2

Administration of life-extending therapy to an elderly patient even though I felt it was futile or harmful.

3

Administration of tests or treatments that I felt would be unlikely to benefit an elderly patient (e.g. daily labs, cancer screening).

4

Performance of painful procedures on elderly patients by trainees in order to increase skill level.

5

Felt that an elderly patient’s capacity to make medical decisions was incorrectly assessed.

6

Use of physical or pharmacologic restraints for an elderly patient that I felt to be unwarranted.

7

Avoidance of communication with an elderly patient because communication was made more difficult by disability (e.g. cognitive impairment, difficulty hearing, difficulty seeing, speech impairment).

8

Lack of concern for the bodily privacy of an older patient.

9

Felt that the wishes of an elderly person regarding end-of-life care had not been asked in a timely or appropriate manner.

10

Felt that an elderly patient’s prognosis was not adequately communicated.

11

Felt that a hospitalized elderly patient did not have the financial resources or social support to adequately care for him or herself after discharge.

12

Witnessed ageist remarks or attitudes from the health care team about an elderly patient.