Moral Stress and Moral Distress: Confronting Challenges in Healthcare Systems under Pressure

Abstract

Stresses on healthcare systems and moral distress among clinicians are urgent, intertwined bioethical problems in contemporary healthcare. Yet conceptualizations of moral distress in bioethical inquiry often overlook a range of routine threats to professional integrity in healthcare work. Using examples from our research on frontline physicians working during the COVID-19 pandemic, this article clarifies conceptual distinctions between moral distress, moral injury, and moral stress and illustrates how these concepts operate together in healthcare work. Drawing from the philosophy of healthcare, we explain how moral stress results from the normal operations of overstressed systems; unlike moral distress and moral injury, it may not involve a sense of powerlessness concerning patient care. The analysis of moral stress directs attention beyond the individual, to stress-generating systemic factors. We conclude by reflecting on how and why this conceptual clarity matters for improving clinicians’ professional wellbeing, and offer preliminary pathways for intervention.

Keywords:

• Agency
• COVID-19
• moral distress
• moral stress
• professional integrity
• professional wellbeing

ACKNOWLEDGMENT

The authors are grateful to Sara Feinstein, Lily Goldberg, Laila Knio, and Bernie Ebri for assistance with qualitative coding, and to the members of the STEPPS expert advisory board for guidance and support throughout the study.

Additional information

Funding

This study was supported by grants from the Greenwall Foundation and the National Institute for Occupational Safety and Health (R21 OH012175).