Anticipatory Moral Distress: A conceptual analysis
Thursday, October 12, 2023
8:15 AM – 9:30 AM ET
Location: Bristol (Third Floor)
Moral distress is a well-known concept covering a wide-array of distress-causing events. Subcategorization is warranted. One such secondary concept, we suggest is Anticipatory Moral Distress (AMD). AMD is distress that is foreseeable, persistent, and irresolvable in relation to upcoming patient encounters. Examples of sources of AMD include: experiences in healthcare related to COVID-19 triaging policies, legislative changes that undermine reproductive and trans health standards of care, and constrained care in carceral settings. In these settings, regulatory and systemic barriers constrain care in such a way, that providers may feel moral distress before they encounter any specific patient. AMD is therefore defined as circumstances in which: a provider feels distressed prior to encountering any specific patient, because they know they will be unable to provide a standard of care; this standard of care is something they consider morally required and is professionally recognized as a standard of care; and these constraints are without foreseeable change. We make clear the discreteness of this concept by distinguishing it from non-moral anticipatory distress and moral distress experienced spontaneously in patient encounters. While the original concept of moral distress technically includes AMD events most measurement and interventions address moral distress arising spontaneously in inpatient encounters. Chronic exposure to moral distress is tied to moral residue and burn-out and even PTSD. This has serious implications for patient care, providers’ mental health, and the sustainability and functioning of our health systems. Understanding this specific form of moral distress is important as it will require different responses.
Johnna Wellesley, MTS – PhD Student, Bioethics and Health Humanities, University of Texas Medical Branch; Jeffrey Farroni, PhD, JD – Associate Professor, Bioethics and Health Humanities, University of Texas Medical Branch