Missing the mental health mark: the hidden toll of moral distress in healthcare
Acting against your values can have a lasting impact.
During the pandemic, healthcare workers were confronted with impossible choices. Making decisions that are misaligned with our values is not only stressful in the moment, but acting against your values can have a lasting impact.
Niklas Juth is professor of clinical medical ethics
Unlike burnout or trauma-related stress, moral distress stems from value conflicts. A recent publication in the European Journal of Psychotraumatology reports on a survey of 6,500+ Swedish healthcare workers and their experiences of moral distress and lasting moral discomfort, or what ethicists refer to as moral residue, during the height of the pandemic.
Moral distress and moral residue can both be linked to burnout, traumatic stress and general psychological stress. If you feel proud and fulfilled at work, you tend to experience less moral residue, even though they still experience distress in the moment of making a difficult decision. Spending a lot of time in COVID-19 care, being in direct contact with patients, being younger and (in some cases) being female are predictors for experiencing moral distress and lasting moral discomfort.
Moral distress and residue are different from other work-or-trauma-related stress, which means that more general mental health interventions may fail if the distress is due to value conflicts. According to the authors, specific attention and targeted support is needed.
“Our results show that the current focus on treating burnout and PTSD might not be enough, but healthcare workers also need help processing moral conflicts, whether that be through ethical rounds or value-based discussions. Without this, the lasting toll might lead to cynicism, disengagement and even leaving the profession,” says Niklas Juth, professor of clinical medical ethics at Uppsala University’s Centre for Research Ethics & Bioethics and one of the authors.
How can we counter the negative effects of moral distress and moral residue? According to Niklas Juth and colleagues, healthcare systems that foster professional fulfilment and compassion satisfaction, manifesting in a sense of pride and reward in helping others, will be better equipped to prevent negative mental health effects. In short, a healthy work environment, where ethical dilemmas are acknowledged and addressed responsibly creates better conditions both for staff well-being and for the quality of care.
By Anna Holm Bodin & Josepine Fernow
Gustavsson ME, Juth N, von Schreeb J & Arnberg FK. Moral distress, moral residue, and associations with psychological distress: a cross-sectional study. European Journal of Phychotraumatology. 2025, VOL. 16, NO. 1, 2512677. DOI: 10.1080/20008066.2025.2512677