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What We Know About Moral Distress

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Moral Distress in the Health Professions

Abstract

When theory and practice in healthcare ethics started to evolve in the late 1970s, there emerged a growing consensus about how ethical principles ought to guide healthcare delivery, yet the well-being of healthcare providers received relatively little attention. Introduction of the concept of moral distress began to highlight the relationship between the moral experience of healthcare providers and the delivery of quality health care to patients. The initial definition of moral distress captured the core elements of the experience, professional values, constraints on action, and the importance of the context of healthcare delivery and served as a starting point for discussion and research. However, there were also conceptual gaps with the definition that made it difficult to move forward with effective interventions to support the well-being of healthcare providers. Through research and scholarship, we are moving toward a more nuanced understanding of moral distress that will support effective interventions. We track the evolution of the definition that reflects a growing understanding of moral distress as an experience that is complex and relational, needs to move beyond a singular disciplinary perspective, occurs in the context of a reciprocal relationship between structure and agency, and is shaped by the broader sociopolitical and cultural contexts.

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Notes

  1. 1.

    It is worth noting that early healthcare ethics work was largely silent on access to resources for health, such as ethnicity, education, and income. Although equitable access to resources for health is receiving more attention in contemporary healthcare ethics work (e.g., [16]), much more work is needed. Indeed, Varcoe et al. [17] argue that “…the same socio-political values that tend to individualize and blame people for poor health without regard for social conditions in which health inequities proliferate, hold responsible, individualize and even blame healthcare providers for the problem of moral distress” (p. 52).

  2. 2.

    For example, in a piece in Narrative Inquiry in Bioethics, a healthcare provider, Cheryl Mack, explores her response to the moral uncertainty she experienced in a complex organ donation situation [38].

  3. 3.

    For further information on this critique, we refer the readers to McCarthy and Gastmans [39], Johnstone and Hutchinson [40], Hanna [19] and Repenshek [41].

  4. 4.

    For example, social psychologist Bandura’s writing about moral disengagement can help us to understand how healthcare providers may respond to moral distress [33].

  5. 5.

    We believe that Jameton’s understanding of action was more nuanced than his definition suggests and refer readers to his 1993 article Dilemmas of moral distress: Moral responsibility and moral practice for a more in-depth view of his perspective on action.

  6. 6.

    For an itemization of theoretically grounded and practical suggestions to develop moral resiliency in healthcare providers, we refer readers to the recent Rushton et al. [57] article, A collaborative state of the science initiative: Transforming moral distress into moral resiliency in nursing.

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Author information

Authors and Affiliations

  1. School of Nursing, Trinity Western University, Langley, BC, Canada

    Lynn Musto

  2. UBC School of Nursing, W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, BC, Canada

    Patricia Rodney

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  1. Lynn Musto
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Correspondence to Lynn Musto .

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Editors and Affiliations

  1. Lillian S. Brunner Endowed Chair, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA

    Connie M. Ulrich

  2. Department of Bioethics, National Institute of Health Clinical Center, Bethesda, Maryland, USA

    Christine Grady

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Musto, L., Rodney, P. (2018). What We Know About Moral Distress. In: Ulrich, C., Grady, C. (eds) Moral Distress in the Health Professions . Springer, Cham. https://doi.org/10.1007/978-3-319-64626-8_2

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  • DOI: https://doi.org/10.1007/978-3-319-64626-8_2

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