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<p>Since Andrew Jameton introduced the term “moral distress” (MD) in 1984, the idea has gained enormous attention in the healthcare literature. We offer a critical, narrative review of the understandings of MD that have been proposed, with an eye towards their scope and corresponding ability to speak to the moral vulnerability inherent in human life. Jameton’s understanding of MD is narrow in the sense that it requires the presence of institutional constraints (e.g., hierarchies or hospital policies) that prevent a healthcare professional from doing what they take to be morally right. Other theorists have suggested that internal constraints (e.g., lack of moral courage) can engender MD as well, and still others have suggested that neither kind of constraint is necessary, as MD can arise from moral conflicts and moral uncertainty in addition to constraints. We criticize understandings of MD that emphasize institutional and/or internal constraints, as they exclude cases in which MD does not arise from any flaw or shortcoming and so for which there is no fix. However, we also criticize understandings of MD that look beyond constraints in general, as they lose sight of MD’s distinguishing feature as a moral experience, namely the anguished or panicked sense that one is constrained from doing what one takes to be morally required. We suggest that the corrective involves acknowledging a third kind of constraint: <i>human constraints</i>, or constraints that arise from the human condition rather than any kind of flaw or shortcoming.</p>

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Moral distress: sometimes, there is no fix

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月19日

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  • Cullin Brown,
  • Jan Helge Solbakk

摘要

Since Andrew Jameton introduced the term “moral distress” (MD) in 1984, the idea has gained enormous attention in the healthcare literature. We offer a critical, narrative review of the understandings of MD that have been proposed, with an eye towards their scope and corresponding ability to speak to the moral vulnerability inherent in human life. Jameton’s understanding of MD is narrow in the sense that it requires the presence of institutional constraints (e.g., hierarchies or hospital policies) that prevent a healthcare professional from doing what they take to be morally right. Other theorists have suggested that internal constraints (e.g., lack of moral courage) can engender MD as well, and still others have suggested that neither kind of constraint is necessary, as MD can arise from moral conflicts and moral uncertainty in addition to constraints. We criticize understandings of MD that emphasize institutional and/or internal constraints, as they exclude cases in which MD does not arise from any flaw or shortcoming and so for which there is no fix. However, we also criticize understandings of MD that look beyond constraints in general, as they lose sight of MD’s distinguishing feature as a moral experience, namely the anguished or panicked sense that one is constrained from doing what one takes to be morally required. We suggest that the corrective involves acknowledging a third kind of constraint: human constraints, or constraints that arise from the human condition rather than any kind of flaw or shortcoming.