Moral distress is the psychological experience of knowing what the right thing to do is, but being unable to act (CMA, 2020, pg. 1). It is a common experience in healthcare, as patients lives and health outcomes are shaped by complex systems that are largely incomprehensible without insider knowledge. Nurses are in a unique position to experience moral distress due to the concept of “moral hazard” where the party making the decisions does not face the consequences (Morley, 2018, para 6). As the feet on the ground in healthcare, it is nurses who must bear witness to the outcomes of decisions made in government and management.
Nursing has the burden of a strong moral and ethical code that drives their decision making progress and forms the basis of their profession. Concepts like respect for life, fairness, client wellbeing, and client choice underpin how nurses structure their care and operate in their role (CNO, 2019, pg 1). While noble, it is when the healthcare system cannot operate optimally that these ethics and values become a source of psychological distress, like during public health emergencies, staffing crises, or simply unjust care.
An extreme example could be hospitals preparing to triage patients during the covid pandemic and refusing treatment to people who would not live enough healthy years to justify the resources. More commonly it could be a nurse prepping a patient for surgery who they do not believe will benefit from the treatment. It could also be allowing an infant who survived a medical abortion to die after they were accidentally born alive, or witnessing domestic violence and being unable to act. Every specialty in nursing has the potential to experience moral distress, because nurses witness intimate parts of people’s lives and often have the knowledge and tools to help but not the authority.
Climate change is expected to stretch the heathcare system to its limits through an increase in patients and a decrease in resources. We can expect surges in patients to become more common in conjunction with extreme weather events. The physical and human resources that healthcare relies on to operate will be disrupted due to natural disasters and global supply chain issues, leading to drug shortages, power outages,and poor staffing ratios. We know that surges in patients increases incidences of moral distress(CMA, 2020, pg. 1). As climate change intensifies, the nursing profession needs to be prepared for the psychological toll of working in a system in crisis.
Canadian Medical Association. (2020). Covid-19 and Moral Distress. RetrievedMarch 30th, 2022 from https://www.cma.ca/sites/default/files/pdf/Moral-Distress-E.pdf
College of Nurses of Ontario. (2019). Practice Standard: Ethics. Retrieved March 30th, 2022 from https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf
Morley G. (2018). What is “moral distress” in nursing? How, can and should we respond to it?. Journal of clinical nursing, 27(19-20), 3443–3445. https://doi.org/10.1111/jocn.14332
The Avery Spectacle 