Moral Distress, Disempowerment, and Responsibility

Authors

DOI:

https://doi.org/10.5195/pom.2025.210

Keywords:

Moral distress, Responsibility, Disempowerment, Fittingness, Philosophy of emotion

Abstract

Since Andrew Jameton first introduced the concept of moral distress, a growing theoretical literature has attempted to identify its distinctive features. This theoretical work has overlooked a central feature of morally distressing situations: disempowerment. My aim is to correct this neglect by arguing for a new test for theories of moral distress. I call this the disempowerment requirement: a theory of moral distress ought to accommodate the disempowerment of morally distressing situations. I argue for the disempowerment requirement and illustrate how to apply it by showing that recent responsibility-based theories of moral distress fail to pass the test.

References

Anonymous. 2013. “What Power Do I Have? A Nursing Student’s Concerns Lead to a Passion for Ethics.” Narrative Inquiry in Bioethics 3, no. 2: 93–95. https://doi.org/10.1353/nib.2013.0042.

Batho, David, and Camilla Pitton. 2018. “What Is Moral Distress? Experiences and Responses.” University of Essex. https://powerlessness.essex.ac.uk/wp-content/uploads/2018/02/MoralDistressGreenPaper1.pdf.

Campbell, Stephen M., Connie M. Ulrich, and Christine Grady. 2016. “A Broader Understanding of Moral Distress.” American Journal of Bioethics 16, no. 12: 2–9. https://doi.org/10.1080/15265161.2016.1239782.

Choe, Kwisoon, Youngmi Kang, and Youngrye Park. 2015. “Moral Distress in Critical Care Nurses: A Phenomenological Study.” Journal of Advanced Nursing 71, no. 7: 1684–1693. https://doi.org/10.1111/jan.12638.

Corley, M.C., R.K. Elswick, M. Gorman, and T. Clor. 2001. “Development and Evaluation of a Moral Distress Scale.” Journal of Advanced Nursing 33, no. 2: 250–256. https://doi.org/10.1046/j.1365-2648.2001.01658.x.

D’Arms, Justin, and Daniel Jacobson. 2000a. “The Moralistic Fallacy: On the ‘Appropriateness’ of Emotions.” Philosophy and Phenomenological Research 61, no. 1: 65–90. https://doi.org/10.2307/2653403.

———. 2000b. “Sentiment and Value.” Ethics 110, no. 4: 722–748. https://doi.org/10.1086/233371.

Epstein, Elizabeth Gingell, and Ann Baile Hamric. 2009. “Moral Distress, Moral Residue, and the Crescendo Effect.” Journal of Clinical Ethics 20, no. 4: 330–342. https://doi.org/10.1086/JCE200920406.

Fachini, Janaína Sortica, Adriana Vilma Scrigni, and Rita de Cássia Gabrielli Souza Lima. 2017. “Moral Distress of Workers From a Pediatric ICU.” Revista Bioética 25, no. 1: 111–122. https://doi.org/10.1590/1983-80422017251172.

Fourie, Carine. 2015. “Moral Distress and Moral Conflict in Clinical Ethics.” Bioethics 29, no. 2: 91-97. https://doi.org/10.1111/bioe.12064.

Frankfurt, Harry. 1971. “Freedom of the Will and the Concept of a Person.” Journal of Philosophy 68, no. 1: 5–20. https://doi.org/10.2307/2024717.

Fumis, Renata Rego Lins, Gustavo Adolpho Junqueira Amarante, Andréia de Fátima Nascimento, and José Mauro Vieira Jr. 2017. “Moral Distress and Its Contribution to the Development of Burnout Syndrome Among Critical Care Providers.” Annals of Intensive Care 7, no. 1: 71. https://doi.org/10.1186/s13613-017-0293-2.

Gorin, Moti. 2016. “‘The Role of Responsibility in Moral Distress.” American Journal of Bioethics 16, no. 12: 10–11. https://doi.org/10.1080/15265161.2016.1239792.

Helft, Paul R., Patricia D. Bledsoe, Maureen Hancock, and Lucia D. Wocial. 2009. “Facilitated Ethics Conversations: A Novel Program for Managing Moral Distress in Bedside Nursing Staff.” JONA’s Healthcare Law, Ethics, and Regulation 11, no. 1: 27–33. https://doi.org/10.1097/NHL.0b013e31819a787e.

Jameton, Andrew. 1984. Nursing Practice: The Ethical Issues. Saddle River, NJ: Prentice-Hall.

Kälvemark, Sofia, Anna T. Höglund, Mats G. Hansson, Peter Westerholm, and Bengt Arnetz. 2004. “Living with Conflicts: Ethical Dilemmas and Moral Distress in the Health Care System.” Social Science & Medicine 58, no. 6: 1075–1084. https://doi.org/10.1016/s0277-9536(03)00279-x.

Mack, Cheryl. 2013. “When Moral Uncertainty Becomes Moral Distress.” Narrative Inquiry in Bioethics 3, no. 2: 106–109. https://doi.org/10.1353/nib.2013.0037.

Maiden, Jeanne, Jane M. Georges, and Cynthia D. Connelly. 2011. “Moral Distress, Compassion Fatigue, and Perceptions About Medication Errors in Certified Critical Care Nurses.” Dimensions of Critical Care Nursing 30, no. 6: 339–345. https://doi.org/10.1097/dcc.0b013e31822fab2a.

Morley, Georgina, Jonathan Ives, and Caroline Bradbury-Jones. 2019. “Moral Distress and Austerity: An Avoidable Ethical Challenge in Healthcare.” Health Care Analysis 27, no. 3: 185–201. https://doi.org/10.1007/s10728-019-00376-8.

Papazoglou, Konstantinos, and Brian Chopko. 2017. “The Role of Moral Suffering in Police Compassion Fatigue and PTSD.” Frontiers in Psychology 15, no. 8, article 01999. https://doi.org/10.3389/fpsyg.2017.01999.

Rushton, Cynda Hylton, and Renee Boss. 2013. “The Many Faces of Moral Distress Among Clinicians.” Narrative Inquiry in Bioethics 3, no. 2: 89–93. https://doi.org/10.1353/nib.2013.0039.

Shoemaker, David. 2011. “Attributability, Answerability, and Accountability.” Ethics 121, no. 3: 602–632. https://doi.org/10.1086/659003.

Smith, Angela M. 2005. “Responsibility for Attitudes: Activity and Passivity in Mental Life.” Ethics 115, no. 2: 236–271. https://doi.org/10.1086/426957.

Tessman, Lisa. 2020. “Moral Distress in Health Care: When Is It Fitting?” Medicine Health Care and Philosophy 23, no. 2: 165–177. https://doi.org/10.1007/s11019-020-09942-7.

Tigard, Daniel W. 2018. “Rethinking Moral Distress: Conceptual Demands for a Troubling Phenomenon Affecting Health Care Professionals.” Medicine, Health Care, and Philosophy 21, no. 4: 479–488. https://doi.org/10.1007/s11019-017-9819-5.

———. 2019. “The Positive Value of Moral Distress.” Bioethics 33, no. 5: 601–608. https://doi.org/10.1111/bioe.12564.

Weber, Elijah. 2016. “Moral Distress, Workplace Health, and Intrinsic Harm.” Bioethics 30, no. 4: 244–250. https://doi.org/10.1111/bioe.12181.

Williams, Bernard. 1993. Moral Luck: Philosophical Papers 1973–1980. Cambridge: Cambridge University Press.

Wojtowicz, Jake. 2022. “The Purity of Agent-Regret.” Philosophy 97, no. 1: 71–90. https://doi.org/10.1017/S0031819121000309.

Young, Amanda, Katherine Froggatt, and Sarah G. Brearley. 2017. “‘Powerlessness’ or ‘Doing the Right Thing’—Moral Distress Among Nursing Home Staff Caring for Residents at the End of Life: An Interpretive Descriptive Study.” Palliative Medicine 31, no. 9: 853–860. https://doi.org/10.1177/0269216316682894.

Zhao, Michael. 2020. “Guilt Without Perceived Wrongdoing.” Philosophy and Public Affairs 48, no. 3: 285–314. https://doi.org/10.1111/papa.12171.

Downloads

Published

2025-04-15

How to Cite

Bennett, M. (2025). Moral Distress, Disempowerment, and Responsibility. Philosophy of Medicine, 6(1). https://doi.org/10.5195/pom.2025.210

Issue

Section

Original Research Articles (other)