Moral Distress: A Growing Problem in the Health Professions? (Essays‪)‬

In the insightful and provocative book Final Exam, noted author and liver transplant surgeon Pauline Chen chronicles her medical education and some of the ethical dilemmas physicians face in practice. (1) She describes a hierarchal and often authoritative system of care, reflecting upon the frailties of care providers as well as patients. Though she does not explicitly use the term, Chen implicitly describes the impact of moral distress on health care quality, providers' ability to meet professional and ethical obligations, and subsequent provider satisfaction and retention. Moral distress, as defined by Andrew Jameton in 1984, is the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. (2) Others have noted the psychological and physical burdens resulting from moral distress. (3) Today, nurses and their colleagues face ethical issues that seem more complex and more frequent than when Jameton coined the term twenty-five years ago. Although moral distress was originally conceptualized to address ethical issues in nursing, all health care professionals tackle morally relevant questions pertaining to the "rightness" or "wrongness" of decisions, treatments, or procedures, while feeling powerless to change situations they perceive to be morally wrong. Providers frequently say things like, "It's not my job to speak out; no one will listen anyway," or, "This doesn't make any sense; why are we continuing to do this?," or "I want to tell the patient to run."