Abstract
Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life.
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References
Baier, A. 1986. Trust and antitrust. Ethics 96(2): 231–260.
Brazil, K., S. Kassalainen, J. Ploeg, and D. Marshall. 2010. Moral distress experienced by health care professionals who provide home-based palliative care. Social Science & Medicine 71(9): 1687–1691.
Cohen, R.L. 2011. Time, space and touch at work: Body work and labour process (re)organisation. Sociology of Health & Illness 33(2): 189–205.
DesAutels, P. 2004. Moral mindfulness. In Moral psychology: Feminist ethics and social theory, ed. P. DesAutels and M.U. Walker, 69–81. Lanham: Rowman and Littlefield Publishers Inc.
Frenk, J., L. Chen, A.B. Zulfiquar, et al. 2010. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet 376(9756): 1923–1957.
Gilligan, C. 1982. In a different voice: Psychological theory and women’s development. Cambridge: Harvard University Press.
Gordon, S., and S. Nelson. 2005. An end to angels. The American Journal of Nursing 105(5): 62–69.
Hamric, D.M., and L.J. Blackhall. 2007. Nurse–physician perspectives on the care of dying patients in intensive care units: Collaboration, moral distress, and ethical climate. Critical Care Medicine 35(2): 422–429.
Held, V. 1993. Feminist morality: Transforming culture, society, and politics. Chicago: University of Chicago Press.
Huffman, D.M., and L. Rittenmeyer. 2012. How professional nurses working in hospital environments experience moral distress: A systematic review. Critical Care Nursing Clinics of North America 24(1): 91–100.
International Council of Nurses. 2006. The ICN code of ethics for nurses. Geneva: International Council of Nurses.
Jameton, A. 1984. Nursing practice: The ethical issues. Englewood Cliffs: Prentice-Hall.
Kälvemark, S., A.T. Höglund, M.G. Hansson, P. Westerholm, and B. Arnetz. 2004. Living with conflicts-ethical dilemmas and moral distress in the health care system. Social Science & Medicine 58(6): 1075–1084.
Kelly, B. 1998. Preserving moral integrity: A follow-up study with new graduate nurses. Journal of Advanced Nursing 28(5): 1134–1145.
Liaschenko, J., and A. Fisher. 1999. Theorizing the knowledge that nurses use in the conduct of their work. Scholarly Inquiry for Nursing Practice: An International Journal 13(1): 29–41.
Liaschenko, J., and E. Peter. 2006. Feminist ethics: A way of doing ethics. In Essentials of teaching and learning in nursing ethics: Content and methods, ed. A. Davis, V. Tschudin, and L. de Raeve, 181–190. London: Elsevier.
Lindemann, H. 2006. An invitation to feminist ethics. New York: McGraw-Hill.
Lunardi, V.L., D.B.E. Luiz, M.S. Bulhosa, et al. 2009. Moral distress and the ethical dimension in nursing work. Brazilian Journal of Nursing 62(4): 599–603.
Lützén, K., and B.E. Kvist. 2012. Moral distress: A comparative analysis of theoretical understandings and inter-related concepts. HEC Forum 24(1): 13–21.
McCarthy, J., and R. Deady. 2008. Moral distress reconsidered. Nursing Ethics 15(2): 254–262.
Nelson, H.L. 2001. Identity and free agency. In Feminists doing ethics, ed. P. DesAutels and J. Waugh, 45–61. Lanham: Rowman and Littlefield Publishers, Inc.
Pauly, B.M., C. Varcoe, and J. Storch. 2012. Framing the issues: Moral distress in health care. HEC Forum 24(1): 1–11.
Peter, E. 2011. Fostering social justice: The possibility of a socially connected model of moral agency. Canadian Journal of Nursing Research 43(2): 11–17.
Peter, E., and J. Liaschenko. 2004. Perils of proximity: A spatiotemporal analysis of moral distress and moral ambiguity. Nursing Inquiry 11(4): 218–225.
Piers, R.D., E. Azouley, B. Ricou, et al. 2011. Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. Journal of the American Medical Association 306(24): 2694–2703.
Sherwin, S. 2011. Looking backwards, looking forward: Hopes for bioethics’ next twenty-five years. Bioethics 25(2): 75–82.
Tronto, J. 1994. Moral boundaries: A political argument for an ethic of care. New York: Routledge.
van Heijst, A. 2009. Professional loving care and the bearable heaviness of being. In Naturalized bioethics: Toward responsible knowing and practice, ed. H. Lindemann, M. Verkerk, and M.U. Walker, 199–217. New York: Cambridge University Press.
Varcoe, C., B. Pauly, G. Webster, and J. Storch. 2012a. Moral distress: Tensions as springboards for action. HEC Forum 24(1): 51–62.
Varcoe, C., B. Pauly, J. Storch, L. Newton, and K. Makaroff. 2012b. Nurses’ perceptions of and responses to morally distressing situations. Nursing Ethics 19(4): 488–500.
Verkerk, M., and H. Lindemann. 2009. Naturalized bioethics in practice. In Naturalized bioethics: Toward responsible knowing and practice, ed. H. Lindemann, M. Verkerk, and M.U. Walker, 238–265. New York: Cambridge University Press.
Walker, M.U. 1998. Moral understandings: A feminist study in ethics. New York: Routledge.
Walker, M.U. 2006. Moral repair: Reconstructing moral relations after wrongdoing. New York: Cambridge University Press.
Walker, M.U. 2009. Introduction: Groningen naturalism in bioethics. In Naturalized bioethics: Toward responsible knowing and practice, ed. H. Lindemann, M. Verkerk, and M.U. Walker, 1–20. New York: Cambridge University Press.
Wilkinson, J.M. 1987. Moral distress in nursing practice: Experience and effect. Nursing Forum 23(1): 16–29.
Young, I.M. 2006. Responsibility and global justice: A social connection model. Social Philosophy and Policy 23(1): 102–128.
Young, I.M. 2011. Responsibility for justice. New York: Oxford University Press.
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Peter, E., Liaschenko, J. Moral Distress Reexamined: A Feminist Interpretation of Nurses’ Identities, Relationships, and Responsibilites. Bioethical Inquiry 10, 337–345 (2013). https://doi.org/10.1007/s11673-013-9456-5
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DOI: https://doi.org/10.1007/s11673-013-9456-5