Balancing Systems and Humanity: Navigating Moral Distress and Ethical Practice in Paediatric End-of-Life Music Therapy
Tracks
Stream Three
| Saturday, October 18, 2025 |
| 10:30 AM - 10:50 AM |
| Terrace Room 1&2 |
Overview
Jack Thomas
Speaker
Jack Thomas
The Royal Children's Hospital
Balancing Systems and Humanity: Navigating Moral Distress and Ethical Practice in Paediatric End-of-Life Music Therapy
Abstract
As healthcare systems become increasingly outcome-driven, music therapists are challenged to uphold core values, such as creativity, presence, and person-centred care while navigating environments that prioritise efficiency, clinical efficacy, and measurable change [1]. This presentation explores how these tensions surfaced in a paediatric end-of-life context, where moral distress (MD) became a critical point of reflection and adaptation in practice.
MD occurs when clinicians recognise the ethically appropriate action but are unable to act due to systemic or interpersonal constraints [2, 3].
In this case, music therapy began with goals focused on neurodevelopmental support but evolved in response to the child’s transition toward palliative care. As therapeutic aims expanded to include legacy work, caregiver support, and dignity at the end of life, the therapist experienced growing discomfort when strengths-based interventions risked appearing misaligned with the clinical reality.
Rather than retreating from these tensions, the therapist engaged in reflective practice and interdisciplinary dialogue, including consultation with clinical bioethics, to reframe therapeutic intent. This process supported a more integrated, ethically responsive practice, allowing the therapist to remain meaningfully connected with the child and family through the final stages of life and at the moment of death.
This case invites broader reflection on how music therapists define and uphold professional identity in complex systems, and how we might adapt without compromising our values. It demonstrates the need to advocate for music therapy in ways that are both credible and compassionate, grounded in both evidence and ethical integrity. As we consider the future of music therapy in Australia, this work underscores the importance of flexibility, reflexivity, and emotional sustainability in ensuring our practice remains relevant, inclusive, and deeply human.
1. Bower et al. (2025). Nordic Journal of Music Therapy.
2. Morley et al. (2021). Bioethics.
3. Prentice et al. (2016). Archives of Disease in Childhood.
MD occurs when clinicians recognise the ethically appropriate action but are unable to act due to systemic or interpersonal constraints [2, 3].
In this case, music therapy began with goals focused on neurodevelopmental support but evolved in response to the child’s transition toward palliative care. As therapeutic aims expanded to include legacy work, caregiver support, and dignity at the end of life, the therapist experienced growing discomfort when strengths-based interventions risked appearing misaligned with the clinical reality.
Rather than retreating from these tensions, the therapist engaged in reflective practice and interdisciplinary dialogue, including consultation with clinical bioethics, to reframe therapeutic intent. This process supported a more integrated, ethically responsive practice, allowing the therapist to remain meaningfully connected with the child and family through the final stages of life and at the moment of death.
This case invites broader reflection on how music therapists define and uphold professional identity in complex systems, and how we might adapt without compromising our values. It demonstrates the need to advocate for music therapy in ways that are both credible and compassionate, grounded in both evidence and ethical integrity. As we consider the future of music therapy in Australia, this work underscores the importance of flexibility, reflexivity, and emotional sustainability in ensuring our practice remains relevant, inclusive, and deeply human.
1. Bower et al. (2025). Nordic Journal of Music Therapy.
2. Morley et al. (2021). Bioethics.
3. Prentice et al. (2016). Archives of Disease in Childhood.
Biography
Jack is a registered music therapist who has worked in a range of acute hospital, educational and community settings across Victoria and New South Wales over the past 9 years. Jack is currently part of the team at The Royal Children's Hospital, working on the Mental Health and Cardiac units.
