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International Perspectives on Moral Distress

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Moral Distress in the Health Professions

Abstract

This chapter focuses on clinicians’ perspectives on moral distress within a European, Asian, and African context. The authors speak to their unique positions within their home countries and how moral distress is perceived, empirically measured, and sometimes accepted as part of everyday clinical practice when there are limited resources and decisions must be made. The need for ethics education to mitigate the moral distress that often ensues remains a consistent theme in both the developed and developing world, along with interprofessional dialogue, leadership and collegiality, and mutual respect.

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Notes

  1. 1.

    The only year that nurses did not top the list was in 2001 when firefighters were included in response to their work after September 11 attack. Ninety percent of Americans rated firefighters as “high” or “very high” for honesty and integrity. Nurses came in close second at 84% [91

  2. 2.

    For the sake of space and to reduce repetition, we will use she as a reference for the person; however, readers should note that this is not an act of discrimination against any gender.

  3. 3.

    Full disclosure to patients is a recent phenomenon in American medicine. Sisk, Frankel, Kodish, and Isaacson (2016) trace key developments for the past two centuries in American medicine that led to the shift in medical practice—from benevolent paternalism where physicians withheld unpleasant or bad news from their patients due to concerns for patients’ well-being to the current practice of transparency and full disclosure. The authors note that even today, physicians struggle to find “the best way to share difficult information without causing undue harm to their patients” (p. 74) [95]

  4. 4.

    The multicultural framework referred here is the official Chinese, Malay, Indian, and Others (CMIO) categorization that Singapore uses in all its official communications and government publications. Within the nursing community, it will be seen that the category of Others has expanded. For example, we now have significant proportion of nurses from the Philippines, China, India, Malaysia, and Myanmar (SNB, 2015). Singapore Nursing Board (2015). Annual report. Singapore: SNB. Retrieved from http://www.healthprofessionals.gov.sg/content/dam/hprof/snb/docs/publications/SNB%20Annual%20Report%202015_%2030%20Aug%202016.pdf.

  5. 5.

    Singapore became independent in 1965 and except for the indigenous population, Singapore is a land of immigrants whose ancestors came from China, India, Middle East, and Indonesia (Chan, 2013). Immigration continues even today as the country’s total fertility rate (TFR) is low—it was 1.2 in 2016 (Singapore Statistics, 2017). Department of Statistics (2017). Births and deaths. Singapore: Government of Singapore. Retrieved from http://www.singstat.gov.sg/statistics/latest-data#.

  6. 6.

    We note that the term used here suggest that the West is a homogenous and monolithic. We acknowledge that this is not the case and that even in a “Western” society, there are multiple realities and complexities. The homogeneity we are referring to is the dominant and influential Judeo Christian culture that influences the various institutions and thinking.

  7. 7.

    I will speak in the first person.

  8. 8.

    Times have changed and some of these practices are no longer practiced by the women (descendants of the earlier immigrants and newcomers of Uttar Pradesh [U.P]) in Singapore. However, for women of my mother’s generation, many of whom immigrated from India, these social and cultural mores were strictly adhered to within our U.P. community in Singapore. Widowhood was not merely a physical separation of a woman from her partner but each symbolic action reinforced her declined social standing. These include observing certain food prohibitions to removing the vermillion tikka on her forehead to removing her colored bangles to wearing a white sari to unable to attend certain auspicious functions. Repeatedly, my mother was reminded of what she had been when my father was alive to what she is now when my father died of cancer.

  9. 9.

    I was raised in the Hindu tradition.

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Authors and Affiliations

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

    Connie M. Ulrich

  2. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Connie M. Ulrich

  3. Cancer Centre, Ghent University Hospital, Ghent, Belgium

    An Lievrouw

  4. Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium

    Bo Van den Bulcke & Dominique Benoit

  5. Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium

    Ruth Piers

  6. Bioethics, University of Bristol, Centre for Ethics in Medicine, Bristol, UK

    Georgina Morley

  7. Critical Care Nurse, Barts Heart Centre, Barts Health NHS Trust, London, UK

    Georgina Morley

  8. Department of Bioethics and Health Professionalism, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

    Renatha Joseph & Baraka Morris

  9. Nursing Department of Management, Muhimbili University of Health and Allied Sciences,, Dar es Salaam, Tanzania

    Baraka Morris

  10. School of Health Sciences (Nursing), Nanyang Polytechnic, Singapore, Singapore

    Subadhra D. Rai

  11. Nursing Service, Tan Tock Seng Hospital, Singapore, Singapore

    Margaret Mei Ling Soon

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Correspondence to Connie M. Ulrich .

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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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Ulrich, C.M. et al. (2018). International Perspectives on 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_8

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  • DOI: https://doi.org/10.1007/978-3-319-64626-8_8

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