Re-defining moral distress: A systematic review and critical re-appraisal of the argument-based bioethics literature

Sanderson, C; Sheahan, L; Kochovska, S; Luckett, T; Parker, D; Butow, P; Agar, M

Re-defining moral distress: A systematic review and critical re-appraisal of the argument-based bioethics literature

Sanderson, C

Sheahan, L Kochovska, S

Luckett, T

Parker, D

Butow, P Agar, M

Permalink

Publication Type:: Journal Article
Citation:: Clinical Ethics, 2019, 14 (4), pp. 195 - 210
Issue Date:: 2019-12-01

Closed Access

	Filename	Description	Size
	MD SR.pdf	Published Version	521.22 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Sanderson, C https://orcid.org/0000-0001-5423-5778	en_US
dc.contributor.author	Sheahan, L	en_US
dc.contributor.author	Kochovska, S https://orcid.org/0000-0002-3531-0389	en_US
dc.contributor.author	Luckett, T https://orcid.org/0000-0001-6121-5409	en_US
dc.contributor.author	Parker, D https://orcid.org/0000-0003-2552-8613	en_US
dc.contributor.author	Butow, P	en_US
dc.contributor.author	Agar, M https://orcid.org/0000-0002-6756-6119	en_US
dc.date.accessioned	2020-03-25T00:52:09Z
dc.date.available	2020-03-25T00:52:09Z
dc.date.issued	2019-12-01	en_US
dc.identifier.citation	Clinical Ethics, 2019, 14 (4), pp. 195 - 210	en_US
dc.identifier.issn	1477-7509	en_US
dc.identifier.uri	http://hdl.handle.net/10453/139516
dc.description.abstract	© The Author(s) 2019. The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. We found that moral distress is most frequently framed around individual experiences of distress in relation to local practices and constraints, and understood in terms of power relations and workplace hierarchies. This understanding is directly derived from, and often still seen as specific to, nursing. Frequently the perspective of the morally distressed individual is privileged. Understandings of moral distress have evolved towards an ‘occupational health approach’, with the assumption that moral distress should be measured and prevented. Counter-perspectives were identified, highlighting conceptual problems. Based on our review, we propose a redefinition of moral distress: ‘Ethical unease or disquiet resulting from a situation where a clinician believes they have contributed to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values’. This definition is specific enough for research use, anchored in clinicians’ professional responsibilities and concerns about harms to patients, framed relationally rather than hierarchically, and amenable to multiple perspectives on any given morally distressing situation.	en_US
dc.relation.ispartof	Clinical Ethics	en_US
dc.relation.isbasedon	10.1177/1477750919886088	en_US
dc.rights	info:eu-repo/semantics/closedAccess
dc.title	Re-defining moral distress: A systematic review and critical re-appraisal of the argument-based bioethics literature	en_US
dc.type	Journal Article
utslib.citation.volume	4	en_US
utslib.citation.volume	14	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Students
utslib.copyright.status	closed_access	*
pubs.issue	4	en_US
pubs.publication-status	Published	en_US
pubs.volume	14	en_US

Abstract:

© The Author(s) 2019. The concept of moral distress comes from nursing ethics, and was initially defined as ‘…when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action’. There is a large body of literature associated with moral distress, yet multiple definitions now exist, significantly limiting its usefulness. We undertook a systematic review of the argument-based bioethics literature on this topic as the basis for a critical appraisal, identifying 55 papers for analysis. We found that moral distress is most frequently framed around individual experiences of distress in relation to local practices and constraints, and understood in terms of power relations and workplace hierarchies. This understanding is directly derived from, and often still seen as specific to, nursing. Frequently the perspective of the morally distressed individual is privileged. Understandings of moral distress have evolved towards an ‘occupational health approach’, with the assumption that moral distress should be measured and prevented. Counter-perspectives were identified, highlighting conceptual problems. Based on our review, we propose a redefinition of moral distress: ‘Ethical unease or disquiet resulting from a situation where a clinician believes they have contributed to avoidable patient or community harm through their involvement in an action, inaction or decision that conflicts with their own values’. This definition is specific enough for research use, anchored in clinicians’ professional responsibilities and concerns about harms to patients, framed relationally rather than hierarchically, and amenable to multiple perspectives on any given morally distressing situation.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/139516