Rethinking moral distress: conceptual demands for a troubling phenomenon affecting health care professionals

Abstract

Recent medical and bioethics literature shows a growing concern for practitioners' emotional experience and the ethical environment in the workplace. Moral distress, in particular, is often said to result from the difficult decisions made and the troubling situations regularly encountered in health care contexts. It has been identified as a leading cause of professional dissatisfaction and burnout, which, in turn, contribute to inadequate attention and increased pain for patients. Given the natural desire to avoid these negative effects, it seems to most authors that systematic efforts should be made to drastically reduce moral distress, if not altogether eliminate it from the lives of vulnerable practitioners. Such efforts, however, may be problematic, as moral distress is not adequately understood, nor is there agreement among the leading accounts regarding how to conceptualize the experience. With this article I make clear what a robust account of moral distress should be able to explain and how the most common notions in the existing literature leave significant explanatory gaps. I present several cases of interest and, with careful reflection upon their distinguishing features, I establish important desiderata for an explanatorily satisfying account. With these fundamental demands left unsatisfied by the leading accounts, we see the persisting need for a conception of moral distress that can capture and delimit the range of cases of interest.

Moral Distress and Austerity: An Avoidable Ethical Challenge in Healthcare

“…Even with infinite resources, clinicians would still need to ask whether it is ethically permissible to provide or continue LST and balance this with quality of life considerations. As some scholars have suggested, MD in these situations could be considered a natural response to morally troubling situations [23, 45, 69], and no amount of resources could mitigate the nature of these decisions. This is not to say we should ignore the MD that occurs due to unavoidable ethical challenges but rather that avoidable and unavoidable ethical challenges require different responses.…”

What is “moral distress” in nursing? How, can and should we respond to it?

“…Arguably, only once the conceptual fog has cleared can healthcare professionals, researchers and policy‐makers can begin to gain further clarity regarding what, if anything, can be done to mitigate MD? Indeed, it has been suggested that MD is simply a natural response to morally troubling experiences that should be welcomed and that getting rid of MD is not only impossible but undesirable (personal communication with Tigard; hinted at in Tigard () and Howe ()). MD may be a natural consequence of the messiness of moral life but when one experiences MD everyday due to their occupation, which seems to be the case for nurses and other healthcare professionals, then it may instead be regarded as an occupational hazard that employers have a responsibility to address.…”

Is there a relationship between moral competencies and the formation of professional identity among nursing students?

“…However, recent studies have shown that the degree of moral competence development in all students is not equal and satisfactory (13,14). Moral behavior is the capacity to distinguish between right and wrong and to act accordingly (15). Nurses needs to reach to high levels of moral competence because most of the procedures and decisions in their daily practice have moral dimensions.…”