The experience of acute moral distress has become a pervasive and serious problem among health care clinicians. Clinical care, especially of patients with serious and life threatening illness, requires clinicians on the front lines to discern ethically justifiable courses of action in exceedingly complex circumstances, riddled with conflict and uncertainty. Although complex moral decision-making is an inescapable part of clinical practice, research confirms a significant increase in the sense of frustration and failure clinicians report in their attempts to fulfill moral obligations inherent in their professional roles and codes of ethics. The causes are many, including a rapidly expanding population of people who have chronic health conditions and are aging, the explosion of technology that pushes the boundaries of treatment, and the erosion of empathy and compassion in a relationally depleted health care system. Both the quality and safety of health care and the sustainability of the health care workforce demand that we attend to the crisis of moral distress in clinical care in ways that are realistic, practical, and effective.

Cynda Hylton Rushton, PhD, RN, FAAN

Johns Hopkins University