Clinician Moral Distress: Toward an Ethics of Agent‐Regret

Abstract

Moral distress names a widely discussed and concerning clinician experience. Yet the precise nature of the distress and the appropriate practical response to it remain unclear. Clinicians speak of their moral distress in terms of guilt, regret, anger, or other distressing emotions, and they often invoke them interchangeably. But these emotions are distinct, and they are not all equally fitting in the same circumstances. This indicates a problematic ambiguity in the moral distress concept that obscures its distinctiveness, its relevant circumstances, and how individual clinicians and the medical community should practically respond to it. We argue that, in a range of situations that are said to be morally distressing, the characteristic emotion can be well‐understood in terms of what Bernard Williams calls “agent‐regret.” We show what can thereby be gained in terms of a less ambiguous concept and a more adequate ethical response to this distinctive and complex clinician experience.

Moral Distress and Pediatric Palliative Care

“…In a recent Hastings Center Report, Kim et al promoted understanding the term "agent regret" as a factor of moral distress [26]. Agent regret encompasses the idea that clinicians who encounter feelings of moral distress should not feel guilt.…”

“…Agent regret encompasses the idea that clinicians who encounter feelings of moral distress should not feel guilt. Feeling guilt insinuates that there was a certain failure to meet expectations and can amplify feelings of powerlessness in an institutional or clinical capacity [26]. Agent-regret characterizes there being a "desire to make amends", even if it is simply an acknowledgment of processing feelings of moral distress [26].…”

“…Feeling guilt insinuates that there was a certain failure to meet expectations and can amplify feelings of powerlessness in an institutional or clinical capacity [26]. Agent-regret characterizes there being a "desire to make amends", even if it is simply an acknowledgment of processing feelings of moral distress [26]. However, novice clinicians and trainees may be hesitant or unaware of how to do so appropriately.…”