Abstract
In the last three decades, considerable theoretical and empirical research has been undertaken on the topic of moral distress among health professionals. Understood as a psychological and emotional response to the experience of moral wrongdoing, there is evidence to suggest that—if unaddressed—it contributes to staff demoralization, desensitization and burnout and, ultimately, to lower standards of patient safety and quality of care. However, more recently, the concept of moral distress has been subjected to important criticisms. Specifically, some authors argue that the standard account of moral distress elucidated by Jameton (AWHONN’s Clin Issues Perinat Women’s Health 4(4):542–551, 1984) does not refer to a discrete phenomenon and/or that it is not sufficiently broad and that this makes measuring its prevalence among health professionals, and other groups of workers, difficult if not impossible. In this paper, we defend the standard account of moral distress. We understand it as a concept that draws attention to the social, political and contextual determinants of moral agency and brings the emotional landscape of the moral realm to the fore. Given the increasing pressure on health professionals worldwide to meet efficiency, financial and corporate targets and reported adverse effects of these for the quality and safety of patient care, we believe that further empirical research that deploys the standard account moral distress is timely and important.
Similar content being viewed by others
References
Aristotle. (1941). Nicomachean ethics. New York: Random House.
Austin, W. (2012). Moral distress and the contemporary plight of health professionals. HEC Forum, 24(1), 27–38.
Campbell, S. U., Ulrich, C. M., & Grady, C. (2016). A broader understanding of moral distress. American Journal of Bioethics, 16(12), 2–9.
Canadian Nurses Association (2017). Code of ethics for registered nurses of the Canadian Nurses Association. https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/code-of-ethics-2017-edition-secure-interactive.pdf?la=en. Accessed 8 Dec 2017.
Chen P. (2009). When doctors and nurses can’t do the right thing. New York Times, Feburary 5.
Corley, M. C. (1995). Moral distress of critical care nurses. American Journal of Critical Care, 4(4), 280–285.
Corley, M. C. (2002). Nurse moral distress: A proposed theory and research agenda. Nursing Ethics, 9(6), 636–650.
Corley, M. C., Minik, P., Elsewick, R. K., & Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12(4), 381–390.
de Hooge, I. E., Breugelmans, S. M., & Zeelenberg, M. (2008). Not so ugly after all: When shame acts as a commitment device. Journal of Personality and Social Psychology, 95(4), 933–943.
Dodek, P. M., Wong, H., Norena, M., Ayas, N., Reynolds, S. C., Keenan, S. P., et al. (2016). Moral distress in intensive care unit professionals is associated with profession, age, and years of experience. Journal of Critical Care, 31(1), 178–182.
Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330–342.
Epstein, E. G., Hurst, A. R., Mahanes, D., Marshall, M. F., & Hamric, A. B. (2016). Is broader better? American Journal of Bioethics, 16(12), 15–17.
Fourie, C. (2015). Moral distress and moral conflict in clinical ethics bioethics. Bioethics, 29(2), 91–97.
Greenspan, P. S. (1995). Practical guilt. Oxford: Oxford University Press.
Haidt, J. (2003). The moral emotions. In R. J. Davidson, R. K. Scherer, & H. H. Goldsmith (Eds.), Handbook of affective sciences (pp. 852–870). Oxford: Oxford University Press.
Hamric, A. (2012). Empirical research on moral distress: Issues, challenges, and opportunities. HEC Forum, 24(1), 39–49.
Hamric, A. B., Borchers, C. T., & Epstein, E. G. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. AJOB Primary Research, 3(2), 1–9.
Hanna, D. R. (2004). Moral distress: The state of the science. Research and Theory for Nursing Pratice: An International Journal, 18(1), 73–93.
Huffman, D. M., & Rittenmeyer, L. (2012). How professional nurses working in hospital environments experience moral distress: A systematic review. Critical Care Nursing Clinics of North America, 24(1), 91–100.
Jameton, A. (1984). Nursing practice: The ethical issues. Englewood Cliffs: Prentice Hall.
Jameton, A. (1993). Dilemmas of moral distress: Moral responsibility and nursing practice. AWHONN’s Clinical Issues in Perinatal and Women’s Health, 4(4), 542–551.
Johnstone, M. J., & Hutchinson, A. (2015). ‘Moral distress’—Time to abandon a flawed nursing construct? Nursing Ethics, 22(1), 5–14.
Lamiani, G., Borghi, L., & Argentero, P. (2015). When healthcare professionals cannot do the right thing: A systematic review of moral distress and its correlates. Journal of Health Psychology, 22(1), 51–67.
Lützén, K., Conqvist, A., & Magnusson, A. (2003). Moral stress: Synthesis of a concept. Nursing Ethics, 10(3), 312–322.
McCarthy, J., & Deady, R. (2008). Moral distress reconsidered. Nursing Ethics, 15(2), 254–262.
McCarthy, J., & Gastmans, C. (2015). Moral distress: A review of the argument-based nursing ethics literature. Nursing Ethics, 22(1), 131–152.
Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2017). What is ‘moral distress’? A narrative synthesis of the literature. Nursing Ethics, 24(1), 1–2. https://doi.org/10.1177/0969733017724354.
Morreim, H. (2015). Moral distress and prospects for closure. American Journal of Bioethics, 15(1), 38–40.
Oh, Y., & Gastmans, C. (2013). Moral distress experienced by nurses: A quantitative literature review. Nursing Ethics, 22(1), 15–31.
Parker-Pope, T. (2009). Medicine and moral distress. New York Times, February 5. http://well.blogs.nytimes.com/2009/02/05/medicine-and-moraldistress/?apage=3#comments. Accessed 23 May 2017.
Pauly, B., Varcoe, C., & Storch, J. (2012). Framing the issues: Moral distress in health care. HEC Forum, 24(1), 1–11.
Peter, E., & Liaschenko, J. (2013). Moral distress reexamined: A feminist interpretation of nurses’ identities, relationships, and responsibilites. Journal of Bioethical Inquiry, 10(3), 337–345.
Repenshek, M. (2009). Moral distress: Inability to act or discomfort with moral subjectivity? Nursing Ethics, 16(6), 734–742.
Rodney, P. (1988). Moral distress in critical care nursing. Canadian Critical Care Nursing Journal, 5(2), 9–11.
Shelton, W. N., & White, B. D. (2015). Realistic goals and expectations for clinical ethics consultations: We should not overstate what we can deliver. American Journal of Bioethics, 15(1), 54–56.
Smith, A. (1982). The theory of moral sentiments. In D. D. Raphael & A. L. Macfie (Eds.), Glasgow edition of the works and correspondence. Indianapolis: Liberty Press.
Spike, J. P. (2015). What ‘the straw man’ teaches us, or, finding wisdom between the horns of a false dilemma about ethics consultation methodology. American Journal of Bioethics, 15(1), 48–49.
Taylor, G. (1985). Pride, shame, and guilt: Emotions of self-assessment. Oxford: Clarendon Press.
Varcoe, C., Pauly, B., & Webster, G. (2012). Moral distress: Tensions as springboards for action. HEC Forum, 24(1), 51–62.
Webster, G., & Bayliss, F. (2000). Moral residue. In S. B. Rubin & L. Zoloth (Eds.), Margin of error: The ethics of mistakes in the practice of medicine. Hagerstown: University Publishing Group.
Wilkinson, J. (1987/88). Moral distress in nursing practice: Experience and effect. Nursing Forum, 23(1), 16–29.
Williams, B. (1993). Shame and necessity. Berkeley: University of California Press.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McCarthy, J., Monteverde, S. The Standard Account of Moral Distress and Why We Should Keep It. HEC Forum 30, 319–328 (2018). https://doi.org/10.1007/s10730-018-9349-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10730-018-9349-4