HEC Forum

, Volume 24, Issue 1, pp 27–38 | Cite as

Moral Distress and the Contemporary Plight of Health Professionals

Article

Abstract

Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” encompasses not only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim.

Keywords

Health ethics Healthcare reform Moral distress Relational ethics 

References

  1. Austin, W. (2007). The ethics of everyday practice: Healthcare environments as moral communities. Advances in Nursing Science, 30(1), 81–88.Google Scholar
  2. Austin, W., Bergum, V., & Goldberg, L. (2003). Unable to answer the call of our patients: Mental health nurses’ experience of moral distress. Nursing Inquiry, 10(3), 177–183.CrossRefGoogle Scholar
  3. Austin, W., Kagan, L., Rankel, M., & Bergum, V. (2008). The balancing act: Psychiatrists’ experience of moral distress. Medicine, Health Care and Philosophy, 11, 89–97.CrossRefGoogle Scholar
  4. Austin, W., Kelecevic, J., Goble, E., & Mekechuk, J. (2009a). An overview of moral distress and the paediatric intensive care team. Nursing Ethics, 16(1), 57–68.CrossRefGoogle Scholar
  5. Austin, W., Rankel, M., Kagan, L., Bergum, V., & Lemermeyer, G. (2005). To stay or to go, to speak or stay silent, to act or not to act: Moral distress as experienced by psychologists. Ethics and Behavior, 15(3), 197–212.CrossRefGoogle Scholar
  6. Austin, W., Strang, V., Goble, E., Mitchell, A., Thompson, E., Lantz, H., et al. (2009b). Supporting relationships between family and the healthcare team in continuing care settings. Journal of Family Nursing, 15(3), 360–383.CrossRefGoogle Scholar
  7. Benedict, S., & Kuhla, J. (1999). Nurses’ participation in the euthanasia programs of Nazi Germany. Western Journal of Nursing Research, 21(2), 246–263.CrossRefGoogle Scholar
  8. Big shake–up for legal profession. (2005). BBC News. http://newsvote.bbc.co.uk/mpapps/pagetools/print/news.bbc.co.uk/2/hi/business/4350240.stm. Accessed 12 Oct 2011.
  9. Canadian Nurses Association. (2008). Code of ethics for registered nurses. http://www.cna-nurses.ca/CNA/documents/pdf/publications/Code_of_Ethics_2008_e.pdf. Accessed 6 Oct 2011.
  10. Chambliss, D. (1996). Beyond caring: Hospitals, nurses, and the social organization of ethics. Chicago: University of Chicago Press.Google Scholar
  11. Corley, M. C., Minick, P., Elswick, R. K., & Jacobs, M. (2005). Nurse moral distress and ethical work environment. Nursing Ethics, 12(4), 381–390.CrossRefGoogle Scholar
  12. Florence Nightingale’s disputed legacy: Angel of mercy or power-hungry meddler? (2007). The Guardian. http://victorianpeeper.blogspot.com/2007/09/florence-nightingales-disputed-legacy.html. Accessed 6 Oct 2011.
  13. Frank, A. (1995). The wounded storyteller: Body, illness, and ethics. Chicago: University of Chicago Press.Google Scholar
  14. Friedman, A. (2006). Strengthening professionalism: Ethical competence as a path towards the public good. Production values: Futures for professionalism. http://www.scribd.com/doc/469593/Production-Values. Accessed 6 Oct 2011.
  15. Goethe, J. W. (1797). Der Zauberlehrling (The sorcerer’s apprentice). http://german.about.com/library/blgzauberl.htm. Accessed 12 Oct 2011.
  16. Gordon, S. (2005). Nursing against the odds: How health care cost cutting, media stereotypes, and medical hubris undermine nurses and patient care. Ithaca, NY: Cornell University Press.Google Scholar
  17. Govier, T. (1997). Social trust and human communities. Montreal: McGill-Queen’s University Press.Google Scholar
  18. Hatab, L. (1997). Ethics and finitude: Heideggerian contributions to moral philosophy. After postmodernism conference. http://www.focusing.org/apm_papers/hatab.html. Accessed 20 Oct 2011.
  19. MacDonald, C. (2002). Nurse autonomy as relational. Nursing Ethics. doi:10.1191/0969733002ne498o.
  20. McFarland-Icke, B. R. (1999). Nurses in Nazi Germany: Moral choice in history. Princeton, NJ: Princeton University Press.Google Scholar
  21. Newton–Wellesley RNs oppose Wal–Martization of nursing practice. (2006). Massachusetts Nurse: The Newsletter of the Massachusetts Nurses Association, 77(3), 1, 13. http://www.massnurses.org/files/file/News/newsletter/2006/April.pdf. Accessed 13 Oct 2011.
  22. Nightingale, F. (1898). Notes on nursing: What it is, and what it is not. New York: D. Appleton and Company. http://www.gutenberg.org/cache/epub/12439/pg12439.txt. Accessed 13 Oct 2011.
  23. Orbinski, J. (2008). An imperfect offering: Humanitarian action in the twenty-first century. Toronto, ON: Doubleday.Google Scholar
  24. Pauly, B., Varcoe, C., Storch, J., & Newton, L. (2009). Registered nurses’ perceptions of moral distress and ethical climate. Nursing Ethics, 16(5), 561–573.CrossRefGoogle Scholar
  25. Peter, E. H., Macfarlane, A. V., & O’Brien-Pallas, L. L. (2004). Analysis of the moral habitability of the nursing work environment. Journal of Advanced Nursing, 47(4), 356–364.CrossRefGoogle Scholar
  26. Rankin, J. M., & Campbell, M. L. (2006). Managing to nurse: Inside Canada’s health care reform. Toronto, ON: University of Toronto Press.Google Scholar
  27. Rittenmeyer, L., & Huffman, D. (2009). How professional nurses working in hospital environments experience moral distress: A systematic review. JBI Library of Systematic Reviews, 7(28), 1233–1290.Google Scholar
  28. Ritzer, G. (2004). The McDonaldization of society (5th ed.). Thousand Oaks, CA: Pine Forge Press.Google Scholar
  29. Rodney, P., Varcoe, C., Storch, J. L., McPherson, G., Mahoney, K., Brown, et al. (2002). Navigating towards a moral horizon: A multisite qualitative study of ethical practice in nursing. Canadian Journal of Nursing Research, 34(3), 75–102.Google Scholar
  30. Shannon, V., & French, S. (2005). The impact of the re-engineered world of health-care in Canada on nursing and patient outcomes. Nursing Inquiry, 12(3), 231–239.CrossRefGoogle Scholar
  31. Somerville, M. (2000). The ethical canary: Science, society and the human spirit. New York: Penguin Press.Google Scholar
  32. Storch, J., Rodney, P., Pauly, B., Brown, H., & Starzomski, R. (2002). Listening to nurses’ moral voices: Building a quality health care environment. Nursing Leadership, 15(4), 7–16.Google Scholar
  33. Taylor, C. (1989). Sources of the self: The making of the modern identity. Cambridge: Cambridge University Press.Google Scholar
  34. Thatcher, V. S., & McQueen, A. (1971). The new Webster encyclopedic dictionary of the English language. Chicago: Consolidated Book Publishers.Google Scholar
  35. Varcoe, C., & Rodney, P. (2009). Constrained agency: The social structure of nurses’ work. In B. S. Bolaria & H. Dickinson (Eds.), Health, illness, and health care in Canada (4th ed., pp. 122–151). Toronto, ON: Nelson Education.Google Scholar
  36. Wolgast, E. (1992). Ethics of an artificial person: Lost responsibility in professions and organizations. Stanford, CA: Stanford University Press.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Faculty of Nursing and the John Dossetor Health Ethics CentreUniversity of AlbertaEdmontonCanada

Personalised recommendations