Feeling torn, tough choices, and troubled thoughts: The concept of moral distress

The notion of moral distress is meant to capture the psychological toll felt by practitioners who feel powerless to pursue the right course of action. Professionals' moral distress can result in long-lasting impressions that their work places them in situations where they are unable to live up to their professional obligations. As public health ethics continues to develop distinct approaches for public health practitioners, it is worth examining where moral distress might arise and what it tells us about current public health practices. In response to epidemics, such as the ongoing Ebola epidemic in West Africa, health workers might experience lingering moral distress, a possibility for which they have not been prepared. Local workers face an unprecedented crisis, with tragic consequences compounded by already stretched personal and professional resilience given internal conflicts and decimated social infrastructure. U.S. public health workers have encountered a lack of sufficient resources on-site and a highly politicized atmosphere at home. In this presentation, I describe how greater discussion of moral distress in public health can name an often unrecognized problem, as moral exhaustion, frustration or disillusionment can result from consistently feeling unable to act with professional integrity, given limited available options. Such recognition sets the stage for much-needed conversations about the underlying values of public health, and how to grapple with constraints on one's ability to live up to these ideals in an imperfect world.