Moral Distress, Workplace Health, and Intrinsic Harm

Abstract

Moral distress is now being recognized as a frequent experience for many health care providers, and there's good evidence that it has a negative impact on the health care work environment. However, contemporary discussions of moral distress have several problems. First, they tend to rely on inadequate characterizations of moral distress. As a result, subsequent investigations regarding the frequency and consequences of moral distress often proceed without a clear understanding of the phenomenon being discussed, and thereby risk substantially misrepresenting the nature, frequency, and possible consequences of moral distress. These discussions also minimize the intrinsically harmful aspects of moral distress. This is a serious omission. Moral distress doesn't just have a negative impact on the health care work environment; it also directly harms the one who experiences it. In this paper, I claim that these problems can be addressed by first clarifying our understanding of moral distress, and then identifying what makes moral distress intrinsically harmful. I begin by identifying three common mistakes that characterizations of moral distress tend to make, and explaining why these mistakes are problematic. Next, I offer an account of moral distress that avoids these mistakes. Then, I defend the claim that moral distress is intrinsically harmful to the subject who experiences it. I conclude by explaining how acknowledging this aspect of moral distress should reshape our discussions about how best to deal with this phenomenon.

Ethical Issues Perceived by Clinical Ethicists

“…Are clinical ethicists ignoring their own personal feelings and values when fulfilling their work related activities? Or did these ethicists in this study under-report their experiences of moral distress due to defining moral distress too narrowly (Weber, 2016)?…”

“…This constraining factor could include perceived limitations posed by another person or organization, as well as legal requirements. When moral distress is experienced, there will be a negative impact upon not only the person experiencing the moral distress but also the person's work milieu (Weber, 2016). Besides negative feelings, other attributes of moral distress are feelings of "powerlessness, conflicting loyalties and uncertainty" (Russell, 2012, p. 19).…”

“…Besides negative feelings, other attributes of moral distress are feelings of "powerlessness, conflicting loyalties and uncertainty" (Russell, 2012, p. 19). The experience of moral distress is not limited to healthcare professionals (Weber, 2016).…”

“…The person might experience emotional, spiritual, and/or physical responses (Weber, 2016); altered relationships, job satisfaction and/or role performance (Russell, 2012). Epstein and Hamric (2009) believe that after experiencing moral distress and its related consequences, the person will continue to experience the enduring feelings of moral residue.…”

How Should Integrity Preservation and Professional Growth Be Balanced during Trainees' Professionalization?

“…Let's begin with the concept of moral distress itself. For brevity's sake, we will utilize a definition of moral distress that one of us (EW) has argued for elsewhere, which we believe captures the phenomenon better than most alternatives: moral distress is "a negatively-valenced feeling state where one perceives a conflict between what one is expected to do and what morality requires" [2]. This description captures, we believe, what's happening in Reema's case rather well.…”