Understanding the ethical injury of moral distress in clinicians

Licensed clinical psychologist and health care ethicist Jenny Shields discusses her article, "DSM-5 doesn’t name it, but moral distress is everywhere in medicine." Jenny illuminates the pervasive issue of moral distress among clinicians, defining it as the psychological toll exacted when they know the ethically appropriate action but are systematically prevented from taking it by institutional constraints such as hospital policies or insurer mandates. She carefully distinguishes moral distress from burnout or trauma, characterizing it as a chronic erosion of professional identity that occurs when daily work consistently conflicts with the core values that drew clinicians to their profession. Examples cited include understaffing in the face of rising executive compensation and adherence to insurer-driven care plans over sound medical judgment. Jenny describes the accumulation of "moral residue"—a lasting emotional injury—and a form of institutional gaslighting where systemic issues are presented as improvements, causing clinicians to doubt their own perceptions. She argues that by not naming moral distress, diagnostic manuals like the DSM-5 contribute to medicalizing symptoms like burnout, thereby avoiding the underlying ethical fractures in a health care system primarily designed around revenue and efficiency, which consistently deprioritizes ethics. The article calls for a shift away from focusing on individual clinician resilience towards demanding fundamental systemic changes to address this profound ethical crisis.

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