Multilevel dynamics of moral identity conflict: professional and personal values in ethically-charged situations

ABSTRACT

Through an interdisciplinary literature review, this propositional paper explores the emergence and unfolding of professionals’ moral identity conflicts involving important but contrasting values. Building on the exemplary case of physicians’ professional-religious dilemmas in End-of-Life circumstances, we develop a multilevel model of professional-personal identity conflict dynamics in ethically-charged situations in which we integrate individual-level mechanisms with organizational-level boundary conditions, namely peer social support and ethical climate, in relation to psychological well-being. Our conceptual model contributes to the ethics, identity and human behavior literature by advancing suggestions of how professionals may prevent or/and resolve moral conflicts concerning also other identities and contexts.

KEYWORDS:

• Ethically-charged situations
• ethical climate and peer social support
• moral identity conflict
• professional-personal identity values
• psychological well-being

INTRODUCTION

How much do our values impact “who we are” at work? Finding an answer to this apparently simple question is, for most people, a rather challenging task. “Who we are” is usually explained in terms of identities (Alvesson et al., 2008). Individuals possess multiple identities that provide people with meanings and expectations (Brown, 2017) and reflect various social aspects of people’s lives (Ramarajan, 2014). Given the more complex and diverse nature of today’s society and workplaces (Horton et al., 2014), as well as the increasingly blurred distinction between work (e.g., professional) and non-work (i.e., personal) life domains (Ramarajan & Reid, 2013) accentuated even more by the COVID-19 pandemic (Hoff, 2021; Stetson & Dhaliwal, 2020), multiple identities can lead to individuals experiencing identity conflict (Ashforth et al., 2008). Defined as a tension between important but incompatible identities (Morgenroth et al., 2021; Petriglieri, 2011), identity conflict involves two or more discrepant identities as well as their values, since values are the constituting parts of such identities (Horton et al., 2014).

Identities and values are particularly core to professionals within a work context (Wright et al., 2017). Values such as commitment, fairness and altruism to society represent professionals’ key moral drivers that go beyond self-interest, power and privileges (Jeong & Han, 2013; Muzio et al., 2013). However, whilst providing strong theoretical bases for understanding identity conflict resolution strategies (Creed et al., 2010; Kreiner et al., 2006; Petriglieri, 2011; Ramarajan & Reid, 2013), identity research has posed less attention to the role of values in identity conflict dynamics (i.e., emergence and unfolding) at a more intrapsychic level. Yet, values and their associated imperatives guide individuals’ thoughts, feelings and behaviors (Alvesson et al., 2008; Islam, 2020; Jeong & Han, 2013). Hence, they can help professionals to perform their duties at the front line of organizations (Muzio et al., 2013; Wright et al., 2017) and, ultimately, to pursue the right course of actions (Shotter & Tsoukas, 2014). This is why all values are fundamentally of a moral nature (Frankena, 1973).

In contrast to identity research, virtue-based approaches in the ethical decision-making literature (Goodwin et al., 2014; Uhlmann & Zhu, 2014; Zhang et al., 2018) and medical ethics studies (Curlin et al., 2007; Genuis & Lipp, 2013; Karnik & Kanekar, 2016) have dedicated great attention to the role of moral values – belonging, for instance, to one’s religious identity – as triggers of ethical dilemmas. Since ethical dilemmas are defined as decision-making problems between two equally possible but incompatible moral imperatives upon which individuals must choose and act (Kälvemark et al., 2004; Kidder, 1995), the experience of ethical dilemmas can be associated with the experience of intrapsychic identity conflicts. We argue that this association can thus help to understand the role of values in influencing these micro-level conflicts, as the ones experienced between professional and personal identities.

Explaining how values may influence identity conflict is further hindered by the fact that people live and (inter)act in a specific context which, albeit with a strong potential of influencing individuals’ values, remains still vaguely defined (Johns, 2017). Consequently, even though organizational-management scholars have called for more consideration of contextual forces (Islam, 2020), studies in identity research have mostly neglected the role of “extra-individual” forces in affecting identity conflict (Alvesson et al., 2008, p. 18; Ashforth & Schinoff, 2016). Nonetheless, the collective values shared in, and forging, a specific context (e.g., values shared by professionals at their workplace) can provide essential cues regarding which personal values and behaviors should be prioritized in a specific instance (Martin et al., 2014; Salancik & Pfeffer, 1978; Treviño et al., 2008). Thus, context can be fundamental to help individuals to overcome the uncertainty of identity conflict dynamics.

Aiding identity research, ethical decision-making and medical ethics studies have offered diverse insights into how and what contextual forces could influence ethical dilemma dynamics. For instance, ethical decision-making research has suggested an interactionist model in which the context (e.g., organizational culture) influences ethical dilemmas and their effect on individuals’ ethical behavior (Treviño, 1986). Similarly, medical ethics studies have identified specific contextual factors (e.g., social support) that could influence moral conflict and decision making, especially when professional and personal (e.g., religious) values are involved in ethically-charged situations (Curlin et al., 2007; DuVal et al., 2004; Hurst et al., 2005; Karnik & Kanekar, 2016). Yet, despite their potential to offer a more complementary overview on identity conflict, the literature on identity, ethical decision making, and medical ethics has not been integrated to date to advance the handling of professional and personal identity conflict dynamics.

To bridge this gap, this article develops a multilevel, conceptual model of professional-personal identity conflict dynamics in ethically-charged situations by building on the extreme case of professional-religious identity conflict as experienced by physicians in End-of-Life (EoL) circumstances. This identity conflict is a useful, yet non-exhaustive, example of many other identity conflicts. For instance, physicians may experience identity conflicts between other nonprofessional identities (e.g., being a mother/father, a daughter/son) whose moral values may come into conflict with their professional duties. They could also experience conflicts between their identity as clinicians and as researchers, or between multiple areas of specialization. Hence, the professional-religious identity conflict presented here is an illustration for a variety of other identity conflicts. Additionally, since the medical ethics literature has built up a long tradition of studies on values and ethical dilemmas (Gillon, 2015), the complex medical context in which physicians operate (Shapiro et al., 2015) has made them a prototypical case that could function as a reference model for identity conflict dynamics (Eisenhardt, 1989; Pratt et al., 2006). Furthermore, we chose ethically-charged situations as our critical setting given their characteristics to evoke and sharpen individuals’ deep values, especially those of a moral nature, and their associated dynamics (Asgari et al., 2019; Borgstrom et al., 2010; Giubilini, 2016).

Due to our interest in the medical profession, we focused particularly on EoL circumstances as a specific case of ethically-charged situations since they are among the most common and frequent situations preceding death in Western countries (Rietjens et al., 2012). Not only more than 50% of European and American physicians experience ethical difficulties in these circumstances (Hurst et al., 2005, 2007), but also identify themselves as having a certain faith (Curlin et al., 2005; Miccinesi et al., 2005). Out of their experience, we extrapolate and frame a set of propositions regarding processes and mechanisms of professional and personal identity conflict of a moral nature. Indeed, we argue that the dynamics suggested in the five propositions below are applicable to various identities, professionals and organizational decision makers facing ethically-charged situations. Professional-religious identity conflict within physicians who face EoL circumstances is thus taken as an exemplary ethical phenomenon in which professional and personal identity dynamics of a moral nature can be unpacked and better understood.

The contributions of this article are therefore threefold. Firstly, we contribute to ethical decision-making and identity literature by showing how the strong juxtaposition between identity conflict and ethical dilemmas in ethically-charged situations can help to understand the role of values in identity conflict dynamics. More specifically, on the one hand, we extend identity research by concentrating our attention to moral values from virtue-based ethical approaches, which allows us to account for the multifaceted nature of identity contents (i.e., values, principles and imperatives) and conceptually unravel identity conflict processes and mechanisms at a deeper level. On the other hand, we also enhance the recent literature on virtue-based ethical approaches by suggesting identity-based micro processes as a means whereby ethical dilemmas and person-centered conflict dynamics can be further explained.

Secondly, in line with the interactionist model of ethical decision making (Treviño, 1986) and social information processing theory (SIPT; Salancik & Pfeffer, 1978), we extend identity approaches and their individual-level dynamics (Alvesson et al., 2008; Horton et al., 2014) by incorporating extra-individual forces as boundary conditions, namely peer social support and ethical work climate. Stimulated and supported by medical ethics insights, we thus offer a multilevel, conceptual bridge between intrapersonal and socio-ethical dynamics related to identity conflict, and we address important concerns regarding the role of context in identity conflict research (Ashforth & Schinoff, 2016; Islam, 2020; Johns, 2017). Hence, we unpack individual and contextual processes of how professional-personal identity conflicts emerge, unfold and influence psychological well-being in professionals facing ethically-charged situations.

Lastly, through our interdisciplinary literature review that blends ethical decision-making, identity, and medical ethics research, we overcome the reticence to cross academic boundaries by creating synergy among different research domains (Currie et al., 2012; Horton et al., 2014; Van Gils et al., 2017). The aim is to answer important calls to go beyond academic niches and their “myopic approaches” (Horton et al., 2014, p. 7), and offer a new model of identity conflict dynamics.

The structure of this article is as follows. Firstly, we focus on professional-personal identity conflict emergence in relation to moral values. Secondly, we explore the unfolding of identity conflict by considering both its individual and contextual dynamics, as well as its consequences on psychological well-being. After critically outlining five propositions, we lastly end the article by discussing practical and research implications for professionals.

IDENTITY CONFLICT EMERGENCE

Professional and personal identities

According to identity theories (Stryker & Burke, 2000; Stryker & Serpe, 1982; Tajfel & Turner, 1986), over the course of their lives, individuals take on multiple identities that reflect individuals’ affiliations with different social roles and groups (Brown, 2017). Hence, identities carry meanings and expectations about those proper attitudes and behaviors that allow individuals to thrive in their communities (Miscenko & Day, 2016) and are hierarchically arranged in terms of their salience and centrality to the context (Stryker & Burke, 2000). In management research, identities are often categorized in terms of being work-related (e.g., occupational, professional, or organizational identity) and non-work-related (i.e., personal) (Ramarajan & Reid, 2013). Since our interest is on professionals, we talk about professional-personal identity conflict dynamics. In particular, given the extreme context of EoL circumstances that we use as a reference model for identity conflict of a moral nature, we explore physicians’ medical and religious identities.

Professional (medical) identity

Professional identity represents a conscious awareness of who individuals are in their workplace (Miscenko & Day, 2016; Sliter & Boyd, 2014). Reinforcing specified attitudes, ethical principles and behavioral prescriptions (Aquino et al., 2009; Wright et al., 2017), professional identity crafts inherent values that outline what “being a physician,” “being an engineer,” “being a lawyer,” etc., means. In this article we focus on physicians because they are considered as “prototypical professionals” (Pratt et al., 2006, p. 236), whose core values constitute a well-established code of conduct that physicians abide by as members of their medical community (Borgstrom et al., 2010; Ysseldyk et al., 2010). Some of these values are embodied in the four principles of medical ethics, namely non-maleficence,¹ beneficence,² respect for patient autonomy³ and justice⁴ (Beauchamp & Childress, 2001; Gillon, 2015). Although changes in social meaning within the medical profession may have altered some of these values, physicians refer to them when making ethically-charged decisions in their clinical practices.

Personal (religious) identity

Religious identity is a personal identity that reflects an individual’s affiliation with a distinctive religious group and its respective beliefs (Ysseldyk et al., 2010). Albeit in more privatized forms due to today’s more secularized society, religious identity is not set aside by individuals within their work contexts (Héliot et al., 2020). Indeed, religious identity is increasingly sought by employees to reach a deeper meaning within their workplaces (Tracey, 2012). When individuals embrace a religion, they accept its set of moral values, normative codes and imperatives that can help them attain a sense of stability and accomplishment, as well as to perform societal roles (Ysseldyk et al., 2010). Hence, religion depicts an institutionalized system of beliefs, norms and practices that provide individuals with ethical and moral principles to understand and navigate life (Tracey, 2012).

Some estimates report more than 4,200 religions in the world (Adherents.com, 2005). Hence, we adopt a broad perspective on religious identity to encompass a wide spectrum of those potential religious values, e.g., sanctity of life, compassion etc., which could trigger professional-religious identity conflict in ethically-charged circumstances. Indeed, since people put a subjective emphasis and importance on different religious values (Ysseldyk et al., 2010), the personal experience of the conflict itself can, consequently, change (Horton et al., 2014).

Ethical dilemmas and identity conflict

In both the ethical decision-making and medical ethics literature, the misalignment between different individuals’ values is often referred to as an ethical dilemma (Kälvemark et al., 2004). Ethical dilemmas are conflicts between two possible moral imperatives and suggest people’s difficulty in determining how they should act (Kidder, 1995). In particular, right/right dilemmas are “genuine dilemmas precisely because each side of the dilemma is firmly rooted in one of our basic core values” (Kidder, 1995, p. 18). Hence, right/right dilemmas are the most difficult ethical challenges for individuals because they represent pairs of values, principles and imperatives, both of which individuals tend to accept (Zhang et al., 2018). As such, ethical dilemmas unfold at the intrapersonal level and involve a trade-off between individuals’ competing values or principles.

Recent virtue-based ethical approaches from the decision-making literature have enforced a more person-centered perspective of ethical dilemmas, in which the unit of analysis for moral judgment are the people, rather than their acts (Goodwin et al., 2014; Uhlmann & Zhu, 2014). To exemplify, Uhlmann et al. (2015) suggested the case of a corporate executive who likes spending money on what others may considered to be frivolous perks, such as luxury cars or country club memberships. These perks are often perceived outrageous and condemnable by the public even though, concretely, they represent just a small proportion of the higher expenditures relative to top-level corporate salaries. And yet, individuals who request such perks are perceived to possess more negative moral qualities than those who do not. This is because even an act that may not be immoral per se, may still shed light on the goodness or badness, i.e., the moral character, of an individual (Uhlmann et al., 2015). Hence, the meaning behind individuals’ actions cannot be found in their immediate consequences, but in the virtues guiding those actions according to individuals’ moral standards and values (Jeong & Han, 2013; Shotter & Tsoukas, 2014). Consequently, individuals’ behavior reflects their choice of prioritizing one imperative over another and becomes a signal of individuals’ moral character and the identity that they deem more crucial in a specific circumstance (Goodwin et al., 2014; Uhlmann & Zhu, 2014; Zhang et al., 2018).

In line with the above, we argue that those discrepant imperatives causing ethical dilemmas can be viewed as values and principles of a moral nature belonging to different identities and initiating identity conflict. According to identity studies, identity conflict is defined as a discrepancy “between values, beliefs, norms and demands inherent in individual and group identities” (Horton et al., 2014, p. 6) and can lead individuals to experience doubts regarding which identity should be prioritized to make a decision and act accordingly. All values are fundamentally moral, since they propel us to act in what we think is the right way (Frankena, 1973). Hence, in ethically-charged situations, right/right ethical dilemma can be associated with identity conflicts. These situations may intensify the clash between moral imperatives and values that belong to individuals’ professional and personal identities (Borgstrom et al., 2010), thus triggering identity conflict. Such professional-personal identity conflict dynamics can create moral impasses (Genuis & Lipp, 2013), raise psychological and behavioral challenges (Petriglieri, 2011; Ramarajan & Reid, 2013) and, ultimately, have ripple effects that reverberate throughout the team and organizational structure (Horton et al., 2014). Through the exemplary case of physicians’ professional-religious identity conflict in ethically-charged situations, we explicate micro and macro identity dynamics to draw more generalizable propositions.

Physicians’ identity conflict in ethically-charged situations

Due to their responsibility toward people’s lives, physicians face ethical dilemmas at their workplace on a regular basis (Bernuzzi et al., 2021; DuVal et al., 2004; Shapiro et al., 2015) and these dilemmas are particularly exacerbated in EoL circumstances (Hurst et al., 2007). These circumstances precede almost half of deaths in Western countries (Rietjens et al., 2012) and are characterized by moral intensity (Jones, 1991). Moral intensity determines “the moral imperative in a situation” (Jones, 1991, p. 372) and influences individuals’ moral sensitivity, judgment and decision making toward an ethical choice (McGrath & Holewa, 2006; Valentine & Hollingworth, 2012). Hence, behavioral responses that unravel in EoL situations become informative of individuals’ moral characters, values and identities (Shotter & Tsoukas, 2014; Uhlmann & Zhu, 2014) and make identity conflict dynamics more transparent and observable (Eisenhardt, 1989).

Since preserving patients’ dignity, self-determination and quality of life are physicians’ number one priorities (Bernuzzi et al., 2021; Hurst et al., 2005), physicians’ moral character is constantly revealed through their choices in clinical practices and EoL situations. These circumstances put physicians under enormous cognitive and emotional demands and challenge their quest to strike the optimal balance between medical and personal values (Borgstrom et al., 2010; McGrath & Holewa, 2006; Morgenroth et al., 2021). Indeed, since the application of physicians’ codified system of medical practices is not straightforward (Beaulieu et al., 2008; Wright et al., 2017), conflicts between duties toward their profession and duties toward their moral conscience may arise. Since moral conscience is often framed in terms of religious beliefs (Giubilini, 2016), these beliefs and their moral values cannot be ignored. When deeply-held, religious values provide frameworks for ethical decision making (Giubilini, 2016) they may affect the way ethical issues are personally experienced (Hurst et al., 2005). As a result, when values belonging to an individual’s religious identity are profoundly important but clash with values belonging to an individual’s professional identity, a state of professional-religious identity conflict may ensue.

Professional-religious clashes have been accentuated by advancements in medical technology which have changed the norms of natural death and empowered patients through treatment choice and preference (Karnik & Kanekar, 2016; Sulmasy, 2008). For instance, even in regions where abortion, physician-assisted suicide, euthanasia, or participation in death penalty are legalized, Catholic physicians may refuse to perform these actions since they are against their religious values and condemned by the Roman Catholic Church as well as the ethical directives of the Catholic Medical Association (Catechism of the Catholic Church 2270–2283). Nevertheless, such a choice might be against their professional obligation to fulfil their patients’ will, leading potentially to the emergence of identity conflict and ethical dilemmas. Even though the issue could be solved by offering the patient consultations with another physician, the clash between religious and professional values remains: it has just been circumvented. In this regard, medical ethics studies, albeit with controversies and debates (Savulescu, 2006), have generally acknowledged the critical role that professional and personal values (i.e., religious) may play in the dynamics of moral identity conflict.

Compared to medical ethics studies, identity conflict research has mostly overlooked the role of values in identity dynamics of a moral nature (Sliter & Boyd, 2014; Tracey, 2012). Indeed, even though identities are “value-soaked” (Ashforth & Schinoff, 2016, p. 122), the polyhedral nature of identities whilst exploring identity conflicts has been given little justice. Yet, values are the pillars of individuals’ self-definitions and actions (Schwartz, 1994) and are drawn upon by professionals and practitioners when making decisions and exercising judgment (Nonaka & Toyama, 2007). Going beyond a view of identities as “monolithic” constructs and building on the notion that all values are fundamentally moral (Frankena, 1973), we argue that identity conflict happens due to the contrasting values inherent in individuals’ multiple identities. These values are triggered by the strong moral intensity of ethically-charged situations which allows the emergence of less salient and central identities whose moral values are, nonetheless, crucial for the situational context. Hence, in ethically-charged circumstances, these moral values are evoked and questioned, leading professionals to experience conflicts and ethical dilemmas. The way individuals decide to address such ethical challenges – and thus act – will be indicative of the identity and associated values they prioritize.

Furthermore, the individual can perceive a sense of discomfort and distress when experiencing identity conflict (Bernuzzi et al., 2021; Borgstrom & Walter, 2015; Huhtala et al., 2020; Kreiner et al., 2006; Morgenroth et al., 2021). Hence, we propose that the degree of conflict that professionals experience may vary depending on the different levels of importance that they attach to those values involved in the identity conflict. In this sense, the perceived identity conflict is minimized when an individual clearly has values belonging to one activated identity that are more central and salient than those values belonging to the other identities. Identity conflict is instead maximized when both identity values are equally important. Assuming different degrees of severity in identity conflict would explain why identity conflict is sometimes experienced by people as “latent” – i.e., it goes unnoticed – or as “manifest” – i.e., it is recognized and prominent – (Horton et al., 2014, p. 12). This value-based approach to identity conflict can thus provide a wider spectrum of identity conflict dynamics that individuals face in their professional lives. Therefore, we suggest the following proposition.

Proposition 1: In ethically-charged situations individuals’ moral values are activated, so that professionals whose moral values belonging to their professional and personal identities are both salient and central, but incompatible, experience higher levels of professional-personal identity conflict compared to professionals whose moral values belonging to one identity are more compatible with the other identity.

IDENTITY CONFLICT UNFOLDING

Identity conflict and psychological well-being

Research on identity conflict has noted that when individuals acknowledge the conflict, they make an effort to reduce it “to sustain a complex and meaningful sense of self, essential to [their] well-being” (Horton et al., 2014, p. 9). Well-being is a broad concept reflecting the conditions that allow people to find meanings in their life, work, and self (Ryff & Singer, 2008). Given our interest in the role of values in moral identity conflict, psychological well-being represents a particular key outcome for individuals involved in ethically-charged situations and challenging social-cultural behaviors (Ryff & Singer, 2008).

Stemming from Aristotle’s Nichomacean Ethics and the notion of eudaimonia (i.e., happiness in accordance with virtue⁵), psychological well-being is strictly linked to those virtues and ethical values that can provide individuals with guidelines on how to live a balanced life (Hughes, 2001). Indeed, Aristotle considered virtues to be concerned with those choices and actions necessary to manage competing pulls of the self, and thus to function optimally (Hughes, 2001). Hence, psychological well-being refers to the fulfillment of individuals’ potential and meaningful lives in the face of existing, critical challenges (Chen et al., 2013). In this sense, the identity conflict triggered by the moral values constituting identities can also influence psychological well-being. Yet, research on identity conflict has mostly overlooked psychological well-being (Ryff & Singer, 2008) as an outcome, focusing more on burnout depression, stress, and anxiety (Bernuzzi et al., 2021; Brook et al., 2008; Karelaia & Guillén, 2014), as well as self-esteem and life satisfaction (Settles, 2004).

Medical ethics research, thanks to its attention to individuals’ values, has dedicated more interest in exploring psychological well-being in physicians, since it is considered as a paramount condition for an efficient healthcare system (Howard et al., 2018). This medical research has also highlighted that physicians’ psychological well-being is one of the lowest among professionals, making physicians twice as likely to report poor mental health compared to the rest of the population (Wallace & Lemaire, 2007). Conflicting values involving professional and personal (e.g., religious) identities have been recognized as strong sources of burnout, stress and emotional strain in the medical context (Curlin et al., 2007; Genuis & Lipp, 2013; Hurst et al., 2005; Kälvemark et al., 2004; Karnik & Kanekar, 2016). Hence, the recurrence of the experience of moral conflicts and dilemmas in ethically-charged situations, such as EoL, can endanger physicians’ mental health, including psychological well-being (Hayes et al., 2017; Huhtala et al., 2020; Simon & Durand-Bush, 2014).

Building on the theorizing of identity research as well as the empirical relationships established by the medical ethics literature, we argue – from a value-based perspective – that experiencing severe identity conflict lowers professionals’ psychological well-being since harmonizing competing identity values of a moral nature demands a huge effort which, in turn, depletes an already limited number of mental resources and amount of energy. Thus, we propose the following.

Proposition 2: The professional-personal identity conflict, experienced as incompatible moral values by professionals and triggered in ethically-charged situations, has a negative impact on professionals’ psychological well-being.

Identity conflict as an intrapersonal mechanism

Following from the above, when values belonging to one identity are considerably dominant in their importance over those belonging to other identities, professionals can experience a moderate or low level of identity conflict. Some minor tensions may pass unnoticed, producing “latent” conflicts (Horton et al., 2014) that do not impact psychological well-being. Conversely, if both co-activated identity values are salient and central to a professional, but are incongruent, the disagreement will generate a “manifest” identity conflict (Horton et al., 2014). Albeit in different degrees of severity, one’s psychological well-being will be negatively affected by the discomfort caused by the perceived conflict. Hence, identity conflict can be seen as the mechanism through which the interaction of multiple identities and their values can affect individuals’ well-being.

The medical ethics literature has shown that the moral values belonging to physicians’ professional and religious identities can be activated simultaneously due to their crucial but incompatible importance in EoL situations (Curlin et al., 2007; Giubilini, 2016). This conflict can, in turn, have a negative impact on physicians’ psychological health (e.g., burnout, stress and anxiety) (Curlin et al., 2007; Genuis & Lipp, 2013). These dynamics can be explained as the interaction between physicians’ professional and religious values that can lead to different degrees of professional-religious identity conflict (i.e., “latent” or “manifest”). This may subsequently affect physicians’ psychological well-being negatively. Whilst particularly evident among physicians in EoL and moral impasse circumstances, more generally, we argue that professional-personal identity conflict can be thought of as the result of the interaction between multiple important and incompatible moral values, as well as the mechanism underpinning the relationships between such identity values and individual-level psychological outcomes. Therefore, we advance the subsequent proposition:

Proposition 3: In ethically-charged situations, identity conflict, experienced by professionals as incompatible moral values, mediates the relationship between the interplay of professional and personal identity values, and psychological well-being.

Socio-ethical forces as contextual boundary conditions

Identity scholars have dedicated great attention to both the various strategies that individuals may adopt to solve identity conflict – ranging from integration and combination to compartmentalization and separation – (Creed et al., 2010; Kreiner et al., 2006; Petriglieri, 2011; Ramarajan & Reid, 2013) and the intra-individual boundary conditions that can ameliorate such a conflict (Rabinovich & Morton, 2016; Settles, 2004). However, they have mostly neglected potential extra-individual forces affecting identity conflict dynamics (Alvesson et al., 2008; Ashforth & Schinoff, 2016; Horton et al., 2014). On the contrary, ethical decision-making research has acknowledged that human actions do not happen in a vacuum and are influenced by situational variables (Islam, 2020; Johns, 2017; Treviño et al., 2008). More specifically, according to the interactionist model of ethical decision making, human behavior can be seen as the result of the interplay between the individual and the context (Treviño, 1986). When individuals experience identity conflict, forces from the surrounding context can help individuals to overcome it (Alvesson et al., 2008; Treviño et al., 2008). These forces may prompt people to put one of the two important identities temporarily on hold (Weaver, 2006) and “can often be decisive in determining the direction toward which our moral compass turns” (Aquino et al., 2009, p. 123).

These insights can be coupled with, and strengthened by, SIPT (Salancik & Pfeffer, 1978). Albeit overlooked in identity conflict research, SIPT posits that an individual’s social context “provides cues which individuals use to construct and interpret events […] and information about what a person’s attitudes and opinions should be” (Salancik & Pfeffer, 1978, p. 226). By inducing individuals to understand what is unfolding around them, social context allows individuals to become aware of which identity-relevant shared values are deemed socially acceptable by others within a work environment (Martin et al., 2014; Treviño et al., 2008). Through this awareness, individuals ultimately know how to overcome the insecurity attached to moral identity conflict, thus solving it. Hence, contextual forces can support individuals to make temporary peace with the personal struggles caused by conflicting moral values (Weaver, 2006) so that the final outcome is an amelioration of the negative influences of a conflict on psychological well-being.

However, what comprises a context is still relatively vague in identity research (Ashforth & Schinoff, 2016; Islam, 2020; Johns, 2017). Medical ethics and ethical decision-making studies are significantly helpful in this regard, since they have empirically investigated those contextual, extra-individual forces impacting physicians ’ decision making and ethical conflicts in clinical practice (Hurst et al., 2007; Woo et al., 2006). Among several factors, peer social support and ethical climate have emerged as paramount elements in ethically-charged situations, as they seem to be able to keep the potential escalation of ethical conflicts under control (Deshpande & Joseph, 2009; Haslam et al., 2005; Hurst et al., 2005; Ntontis et al., 2020; Pagliaro et al., 2018; Woo et al., 2006). Linking these socio-ethical, contextual factors to individual-level identity dynamics, we suggest that peer social support and ethical climate serve as positive contextual boundary conditions in the relationship between professional-personal identity conflict and psychological well-being in professionals.

Peer social support

Social support in the workplace constitutes an interactive and reciprocal process (Haslam et al., 2005) based on individuals’ perceptions of receiving and giving support when needed (Schwarzer & Knoll, 2007). Identity conflict and ethical dilemmas are moments of need, uncertainty, and discomfort (Horton et al., 2104; Huhtala et al., 2020; Treviño, 1986). People may overcome these moments by asking their colleagues or managers for advice regarding the more suitable course of actions to take. Management research has reported that workplace social support can influence individuals’ appraisal of stressful situations, preventing maladaptive outcomes (Chiaburu & Harrison, 2008; Haslam et al., 2005; Ntontis et al., 2020; Schwarzer & Knoll, 2007). Similarly, medical ethics studies have shown that even the most experienced physicians count on social support when facing challenging situations (Hurst et al., 2005). In particular, peer social support can guarantee expertise as well as a sense of “sibling-type” equality and respect. Peer social support is particularly sought to resolve ethical dilemmas and make decisions (Kälvemark et al., 2004), manage expectations and difficult conversations with patients and their families (Woo et al., 2006) and provide validation or fresh perspectives on a case (DuVal et al., 2004; Hurst et al., 2005).

Ethical climate

By answering the Socratic question “What should I do?,” ethical climate has been defined as individuals’ “shared perceptions of what correct attitudes and behaviors are, and how ethical situations should be handled in an organization” (Victor & Cullen, 1988, p. 51). Ethical climate encompasses substantial parts of an organizational context (Arnaud & Schminke, 2012) since it can help individuals in navigating ethically-charged situations (Deshpande & Joseph, 2009) and can influence moral decision making (Pagliaro et al., 2018; van Gils et al., 2017). Ethical climate is also very well established in the medical ethics literature and involves those practices that influence how ethical problems are discussed and tackled by physicians and nurses within healthcare organizations (Woo et al., 2006). In particular, ethical climate has been found to significantly lessen the intensity of moral distress caused by organizational constraints, misinformed and over-treated patients, and lack of time and resources (Asgari et al., 2019; Atabay et al., 2015).

In line with SIPT (Salancik & Pfeffer, 1978), we argue that both peer social support and ethical climate may provide physicians with cues to understand those values that are treasured and accepted by the peer community within the workplace and can guide their decisions toward appropriate behavior. Thereby, physicians experiencing identity conflicts receive clear directions that may help them to solve their inner discomfort (Salancik & Pfeffer, 1978).

Consequently, we propose, more generally, that when professionals perceive high levels of peer support and ethical climate, they will be able to prioritize the identity that they deem to be more appropriate and tackle identity conflict more promptly. In this way, they will limit any negative consequences of disharmonious values on their psychological well-being. This is because peer social support and ethical climate are fundamental sources of information and allow them to identify the “right” attitudinal and behavioral alternative when faced with critical decisions that have consequences for others (Salancik & Pfeffer, 1978). Hence, peer social support and ethical climate help professionals to funnel their contrasting values toward a specific path and decide how they should act in that circumstance. Hence, peer social support and ethical climate can work as boundary conditions and buffer the relationship between professional-personal identity conflict and psychological well-being, ultimately helping individuals to make peace with their inner conflicts. Therefore, we suggest the following propositions:

Proposition 4: In ethically-charged situations, peer social support positively moderates the relationship between professional-personal identity conflict and psychological well-being in professionals, so that the stronger the peer social support, the less negative the impact of the professional-personal identity conflict on psychological well-being.

Proposition 5: In ethically-charged situations, ethical climate positively moderates the relationship between professional-personal identity conflict and psychological well-being in professionals, so that the stronger the ethical climate, the less negative the impact of the professional-personal identity conflict on psychological well-being.

Before proceeding further, it is worth noting that there are times in which identity conflicts and ethical dilemmas might function as “signals” of a set of harmful acts that may take place at various scales and contexts in our society (e.g., in terms of clinical practice, institutional or environmental norms, and societal gaps in care). In these instances, the positive moderation of social support and ethical climate argued in this article in favor of physicians’ psychological well-being might not be actually advisable since an ethical value could be attributed to the experience of such professional distress. Such a distress could function as a “symptom” that problems and failures may be happening. Although discussing this circumstance was beyond the scope of this article, still, it is important to acknowledge this possible situation, since we believe it offers a different and yet complementary perspective to further advance this line of research.

DISCUSSION

Research implications

Through a combination of virtue-based ethical decision-making, identity and medical ethics research, we present a multilevel, conceptual model (Figure 1) that depicts identity conflict dynamics in professionals, with a key role for the moral values that constitute professional-personal identities in ethically-charged situations.

Figure 1. A multilevel dynamic model of professional-personal identity conflict in ethically-charged situations.

Understanding identity conflict emergence, processes and influences has several research implications. Firstly, we showed the strong juxtaposition between identity conflict and right/right ethical dilemmas and thus extended identity approaches by incorporating insights on moral values from virtue-based ethical approaches (Goodwin et al., 2014; Jeong & Han, 2013; Uhlmann & Zhu, 2014; Zhang et al., 2018). Supported also by medical ethics studies, this incorporation allowed us to conceptually unravel at a somewhat deeper level identity conflict processes able to include identity contents, such as values, beliefs and principles. The focus on these contents enabled us to also consider the moral intensity of ethically-charged situations as a trigger of such multifaceted contents and to depict identity conflict as the interaction of important but dissonant professional-personal moral values as well as the mechanism explaining their effects on psychological well-being. At the same time, in line with very recent work that links macro-level identification processes with ethical climate and moral decision making (Van Gils et al., 2017), we enrich recent virtue-based ethical approaches. Indeed, we suggested identity-based processes of identity conflict as means whereby ethical dilemmas and person-centered dynamics can be understood better in their emergent phase at the micro, individual level.

Secondly, in line with the interactionist model of ethical decision making (Treviño, 1986) and SIPT (Salancik & Pfeffer, 1978), our work extended individual-level identity approaches (Alvesson et al., 2008; Horton et al., 2014; Islam, 2020) by integrating extra-individual, contextual forces as boundary conditions able to influence the relationship between identity conflict and psychological well-being. Spurred by medical ethics insights, we filled a current gap in the literature concerning the role of context in identity conflict dynamics (Alvesson et al., 2008; Horton et al., 2014). We have thus unified and laid the bases conceptually for further theorizing on intrapersonal and socio-ethical dynamics related to how professional and personal identity conflicts emerge, unfold and influence professionals’ psychological well-being in complex, ethically-charged contexts.

Lastly, we have overcome a general reticence to cross academic boundaries by merging ethical decision-making, identity and medical ethics research. Hence, we have enhanced the synergy among different but “connectable” research domains (Currie et al., 2012; Horton et al., 2014) and addressed the need for more comprehensive perspectives on the dynamics of identity conflict in general (Ashforth et al., 2008; Horton et al., 2014; Ramarajan, 2014).

Practical implications

Our study can also have multiple practical implications. Firstly, it could help professionals to become more aware of themselves and the values they hold deeply. Hence, the model can aid them to develop prevention skills to promptly recognize challenging moral values that may lead to professional and personal identity conflict in ethically-charged situations, thus safeguarding their psychological well-being. According to the job demand-resources model, cognitive and emotional demands related to ethical conflicts may lead to job strain or to a deterioration of positive outcomes such as health and job satisfaction (Bakker & Demerouti, 2007). Thus, knowing how to manage these moral job demands related to clashing professional-personal values may help professionals to prevent conflicts, reduce stress, save energy and improve their psychological well-being. Managers and leaders in different types of organizations should therefore consider how they can contribute to a climate in which such dilemmas are recognized and treated seriously, for instance, by promoting counseling and training schemes to stimulate the development of self-awareness and psychological safety (Héliot et al., 2020; Hurst et al., 2005).

Secondly, unraveling the contextual dynamics of professional-personal identity conflict could have a positive impact on individuals’ behavioral outcomes. For instance, the positive impact of peer social support and ethical climate on the relationship between identity conflict of a moral nature and psychological well-being could prompt greater levels of unanimity and cohesion within teams in organizations, through the incorporation of shared values, attitudes and behaviors. This could then favor higher commitment, collaboration and cooperation between professionals, including extra-role behaviors that do not detract from psychological well-being (Demirtas & Akdogan, 2015; Haslam et al., 2005; Salas et al., 2015). As a result, the overall quality and efficiency of the team and organizational structure could be boosted and enhanced (Horton et al., 2014; Körner et al., 2015; Sulmasy, 2008). This holds particularly true when considering that teamwork practices are pivotal in todays’ organizational settings (Dellafiore et al., 2019; McGrath & Holewa, 2006; Schmutz et al., 2019). Consequently, organizations should promote opportunities for teambuilding, as well as a strong and unified ethical climate (Karnik & Kanekar, 2016).

Lastly, practical implications may also concern medical and business school curricula, as well as students’ professional identity formation (Beaulieu et al., 2008). Managing ethically-charged situations and professional-personal ethical dilemmas represents challenging issues frequently neglected not only in clinical training and medical ethics education (DuVal et al., 2004; Hurst et al., 2005), but also within management courses and organizations (Héliot et al., 2020). Raising students’ awareness of the professional-personal identity conflict that they may encounter in their career could be an initial step toward mastering skills to prevent and tackle them effectively (Shapiro et al., 2015).

LIMITATIONS AND FUTURE RESEARCH

The basic model elaborated herein answered some calls regarding the role of values and personal (e.g., religious) identity in organizational settings (Tracey, 2012), identity dynamics, and contextual boundary conditions (Alvesson et al., 2008). However, albeit beyond the scope of this study, other interesting factors could have been included. For instance, emotions in identity conflict dynamics could have been considered. Emotions can influence identity construction, determine identity processes (Ashforth & Schinoff, 2016; Cascón‐Pereira & Hallier, 2012; Croft et al., 2015), as well as affect moral judgment and decision-making (Caza et al., 2018; Shotter & Tsoukas, 2014; Wright et al., 2017). Future studies may wish to explore these more spontaneous components of human nature, such as emotional intelligence, to further enrich the model and our understanding of identity dynamics.

Although in our propositions we extended religious identity to personal identity, in our theorizing about religious identity we accounted for those religions whose values could lead physicians to experience the conflict in ethically-charged circumstances. We did not consider, for instance, religions such as Unitarianism, which is not against controversial and legally bounded actions (e.g., physician assisted suicide), since they would not cause identity conflict. Hence, considering circumstances in which multiple identity values would not clash, and perhaps even reinforce each other, would open numerous doors for future research aiming to explore a rather under-developed area in identity literature, namely identity enhancement (Ramarajan et al., 2017). Similarly, it is possible that emerging ethical dilemmas may reveal other professional-personal identity conflicts that have been hitherto un-examined. For instance, physicians who identify as anti-racist grappling with how to collaborate with law-enforcement agencies; physicians who are guided by the principle of patient autonomy grappling with system-wide adoption of artificial intelligence and/or machine learning for medical decision making; physicians whose personal-religious identities reinforce their professional commitment to justice may grapple with the unequal distribution to care at global, regional and local levels. Therefore, future research may wish to explore alternative and so-far neglected professional-personal identity conflicts.

Another interesting future-research route could be to explore the (in)direct effects of individual-level identity conflict on group- or organizational-level variables, such as team or organizational performance. Studies on identity and identity conflict have encouraged multilevel research given the ability of identity theories to bridge different levels of analysis (Brown, 2017; Horton et al., 2014). Hence, the model could be improved with higher-level criterion variables to extend the perspective of this article beyond the individual level of psychological well-being. In this regard, since the model and its matching propositions, albeit supported by some preexisting literature, have not been empirically based, we also call for future research to quantitatively test them.

In this article, we discuss the case of physicians’ professional-religious identity conflict in EoL situations, as an extreme, prototypical example of professionals facing ethically-charged circumstances. Future studies could look into other professions and circumstances to enhance our understanding of identity conflict dynamics more generally. For instance, an alternative professional context for this dynamic model of identity conflict is the legal setting. Consider the case of a lawyer who is asked to defend a renowned criminal accused of being a pedophile. This lawyer may perceive a conflict between the different moral values belonging to, for instance, his/her professional and parental identity (i.e., being a father or a mother). The identity conflict experience and the consequences on the lawyer’s psychological well-being would vary depending on the centrality and salience of each identity. If both (or more) identity values are important but contrasting to the lawyer, then a conflict will arise with potentially strong negative consequences on the lawyer’s psychological well-being. Contextual influences, such as other lawyers’ support and the firm/organization ethical climate the lawyer works for, could ameliorate the perception of the conflict, thus mitigating the negative consequences on psychological well-being.

Hence, we expect that the processes described and elaborated in our model can be “de-contextualised” and applied to other professionals (e.g., engineers, architects, accountants, etc.), other conflicting identities, and other organizational contexts. Indeed, Nielsen (2016) underlined that moral agency issues are part of the work of professionals and practitioners since they constantly need to choose between different principles and rules at work. By interacting with the environment and listening carefully to it, all professionals and reflective practitioners can face ethical concerns through processes of experiential learning (De Graaf, 2019; Huhtala et al., 2020). Consequently, appreciating and becoming aware of identity conflict dynamics could aid professionals to reflect upon their own moral values inherent in their professional and personal identities in different circumstances and lead to positive outcomes for all parties concerned.

CONCLUSION

Professionals in complex, ever-changing organizations can easily encounter identity conflict and ethical dilemmas as they deal with moral and existential uncertainties attached to them. In this article, we propose a multilevel, conceptual model of identity conflict dynamics by incorporating intra-personal processes – from identity approaches – with contextual, extra-individual forces – from virtue-based ethical decision-making research and medical ethics studies. Such integration enabled the examination of individual-level mechanisms and organizational-level, socio-ethical conditions under which professional-personal identity conflict emerges, develops and influences psychological well-being in professionals facing difficult ethically-charged situations.

Illuminated by the critical case of physicians’ professional-religious identity conflict in EoL circumstances, we believe that similar identity conflict dynamics can also occur in a multitude of other professional situations and organizational contexts, as well as concern other kinds of conflicting identities and clashing values. By extrapolating the processes and the mechanisms underpinning deeply held, disharmonious identity values, this model is thus useful for other circumstances of identity conflict in ethically-charged situations and offers general suggestions for practice-relevant empirical research on identity conflict dynamics.

AUTHOR CONTRIBUTION

All the authors developed and contributed equally to this manuscript.

ACKNOWLEDGMENTS

We would like to thank Celeste Wilderom for her constructive and helpful comments on earlier versions of this manuscript; Beverly Shrand, Hannah Collis and Emily Kitson for their fruitful suggestions and advice on how to improve the flow of this article.

DISCLOSURE STATEMENT

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Notes

¹ Non-maleficence is usually exemplified by the phrase “first, do not harm” (Beauchamp & Childress, 2001).

² Beneficence states that the best interest of the patient should always be a physician’s first priority (Beauchamp & Childress, 2001).

³ Respect for patient autonomy posits that the patient has the right to refuse or choose treatment (Beauchamp & Childress, 2001).

⁴ Justice concerns the fair and equal distribution of scarce health resources and treatments (Beauchamp & Childress, 2001).

⁵ Eudaimonia is sometimes translated as “aretē” (i.e., “virtue” or “excellence”) and “phronesis” (i.e., “practical or ethical wisdom”) (Ryff & Singer, 2008).