moral distress

The term was first used in clinical nursing literature in the 1980s and first formally described by Andrew Jameton in 1984.

moral distress (uncountable)

1. A form of emotional or psychological distress that occurs when a person knows the ethically appropriate action to take but is prevented from acting due to external constraints, such as policy restrictions or an insufficiently powerful role.
   • 1984, Andrew Jameton, Nursing Practice: The Ethical Issues, Prentice-Hall, page 6:

     Moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.

   • 2025 May 3, Dr. Jenny Shields, “DSM-5 doesn’t name it, but moral distress is everywhere in medicine”, in KevinMD‎^[1]:

     Unlike burnout, moral distress isn’t primarily exhaustion. Unlike trauma, it isn’t primarily fear. Instead, moral distress arises from an unspoken, collective agreement to pretend things are fine when they’re clearly not. It’s the quiet erosion of professional identity—the gradual realization that what you’re doing daily doesn’t align with why you chose this profession in the first place.

• Often contrasted with moral injury, which typically refers to trauma resulting from actions taken rather than inaction.

• moral injury
• burnout