What is Moral Distress?
Ethically charged environments expose us to this unique risk
In the fast-paced and often ethically charged environments of healthcare, social work, the military, and other high-stress professions, individuals frequently face situations that challenge our core values and ethical standards. When we cannot act according to those values due to external constraints, we risk experiencing moral distress.
The Origins of Moral Distress
Moral distress was first described in 1984 by Andrew Jameton as where healthcare professionals feel torn between doing what they believe is right for their patients and the policies or limitations imposed by their work environment. For example, a nurse might want to provide more comprehensive care for a patient but be constrained by institutional rules, time pressures, or limited resources.
These internal conflicts between what one believes should happen and what is allowed to happen give rise to the emotional turmoil known as moral distress.
Understanding Moral Distress
Moral distress is not the same as general workplace stress.
It occurs specifically when someone knows the ethically appropriate action to take but cannot carry it out due to barriers or constraints. These barriers may be policies, procedures, or be related to internal and external sources. This emotional conflict can lead to feelings of frustration, guilt, and powerlessness, and over time, unresolved moral distress can contribute to burnout and job dissatisfaction.
While originally studied in healthcare, moral distress is now recognized in other fields, including law, social work, and education, where individuals must navigate conflicting values and practical limitations. According to researchers, moral distress often results from systemic issues that prevent professionals from aligning their actions with their ethical beliefs, such as understaffing, budget cuts, or inflexible policies.
Who is Affected by Moral Distress?
Professionals in high-stakes, high-empathy roles are especially susceptible to moral distress.
For instance, doctors, nurses, and social workers may feel overwhelmed by the conflict between providing optimal care and dealing with the constraints of an often inhumane healthcare system. Many physicians have reported experiencing moral distress due to their inability to advocate effectively for their patients under current system constraints. Similarly, teachers may experience moral distress when they see students who don’t have enough resources through the school or home to succeed. Teachers often feel constrained by standardized policies or administrative pressures focusing on district needs rather than students.
The Impact of Moral Distress
Over time, unresolved moral distress can have significant consequences on both mental health and job performance. It can lead to feelings of alienation, diminished compassion, and emotional exhaustion, making it more difficult to engage meaningfully in work. In extreme cases, persistent moral distress can lead to depression, anxiety, or even thoughts of leaving a profession entirely.
When we don’t address moral distress, it can lead to moral injury.
Addressing Moral Distress
To manage moral distress, professionals need both personal and organizational support. On an individual level, mindfulness, self-reflection, and peer support groups can be helpful in processing these feelings.
Organizationally, institutions need to recognize moral distress as a significant issue and work to address the systemic problems that contribute to it. Building a culture of ethical reflection and open dialogue is essential for reducing the prevalence and severity of moral distress.