Moral distress is a significant ethical concern for both individuals and organizations. Some describe it as “moral compromise,” or the undermining of an individual’s integrity following participation in and/or failure to stop an event that the individual considers to be a harmful or undignified practice. 

Moral distress can arise when members of a health care team disagree about what constitutes “acceptable standards of professional care.” For example, when members of a health care team are asked to provide care that is inconsistent with their understanding of acceptable professional care standards, or is contrary to their ethical framework for the situation, team members can experience moral distress or feel morally compromised.

Moral distress can also be caused by our own failings: we may decide to do or not to do something for various reasons, such as we don’t have enough time, we don't want to “rock the boat,” or we want to get along with our colleagues, even though we know our actions (or inactions) are “wrong.” The team may have reasons that influence our decision, but the decision to proceed (or not to proceed) is ours.

Awareness of the potential for moral distress is important. Health care teams can be helped in such situations by knowing what resources are available and how to access them. In particular, health care teams can benefit greatly from the input of professionals with expertise in ethics and palliative care. Thoughtful discussion and excellent communication is essential. Ideally, value conflicts may be pre-empted or addressed through ongoing dialogue with patients, their family members, and members of the health care team.

Staff may need to be rotated so they are not confronted with or spend limited time in situations where moral distress might arise. Professional regulatory bodies, such as those for nurses and medical practitioners, may be helpful in providing guidance about how to address clinical care situations in which a team member feels morally and professionally compromised. However, the onus is on facility management to take the lead in developing an approach to deal with moral distress when it arises.

To learn more, please view The Gallery video Moral distress in providing palliative care by Dr. Kevin Brazil.