I’m to speak about “moral distress” again next week at an ethics workshop for managers in health care.  It’s the third or fourth time doing this talk, and I still feel ill-equipped for the task.

I understand the concepts, and I understand the research; it’s the solutions that perplex me.

“Moral distress” is a term that was coined a generation ago by a professor of nursing to describe the experience of feeling incapable of doing what one believes one ought to do

because of some barrier, such as the opposition of someone more powerful in the situation, or the unresponsiveness of the organization within which one works. 

It’s not a phenomenon unique to nurses, of course.  If you’re a person with a conscience, you’ve probably experienced it yourself.  Not surprisingly, it’s experienced acutely in the workplace by professionals since to be a professional is to stand for a certain set of values and see oneself as bound by ethical responsibilities.  Again not surprisingly, it’s reportedly experienced acutely by people lower in the pecking order in complex organizations—by medical residents in their internships and staff nurses, less than by doctors. 

But the experience is not confined to the young and front-line staff only.  Research shows that 15-25% of nurses in critical care areas (places like neonatal intensive care units) have left their positions or the profession because of moral distress.  I wouldn’t be surprised to find similar numbers in the ministry or in social work (though that would itself be an interesting research question).

So what’s the ethical manager to do about it?  (That’s the primary question that next week’s workshop wants to hear about.) 

My wife was present the first time I did the talk.  Afterwards she was easy on my sensitive ego, but said that I needed to be clearer in my bottom line, which is that the ethical manager needs to be as resourceful as the issue is complex.

One of the “strategies” I mention might be called the Stoic response.  In brief, it’s to counsel those in moral distress that “ought implies can” and so if they really could not have done anything different in the circumstances then they should not burden themselves with guilt.  In Christian circles, this is known as part of the “Serenity Prayer”: “Lord, give me the serenity to accept the things I cannot change.”  In some Wesleyan circles, it’s known as being holy even though things go wrong—on the grounds that holiness has to do with the agent’s intentions and motivations, not with results.

But I have to admit that I find this a less-than-wholly satisfying answer.  I find something admirable in people who carry a feeling of personal guilt and personal compromise when they have not been able to do their best, even when the impediments have been outside their control. In some ways I don’t want them to feel that way, and I am troubled when these sensitive souls exit their professions, but on the other hand I think there’s something ethically shallow about people who blithely say “Well, I did what I could.    

What do you think?