'Moral Distress and Moral Residue'

CAERS SUBSTACK ARTICLE #16

‘MORAL DISTRESS AND MORAL RESIDUE’

CAERS SUBSTACK ARTICLE #16

In previous articles I spoke about ethics and moralizing. As humans we are constantly being tempted by things that are aesthetically pleasing to us but that may not be ethically pleasing to others (or even ourselves). These temptations can make doing ‘the right thing’ more difficult, but certainly not impossible.

At other times, however, we want desperately to engage in the most morally upright action, yet we are not sure what that is, or even how to determine it. This desire for our actions to comply with our conscience can produce considerable inner turmoil. And this can be quite uncomfortable, so much so that we wish someone else would simply deal with the moral conundrum for us, or just tell us what to do in order to spare us what is referred to as ‘moral distress’.

This distress arises because ethics is hard. Almost always we find that there are competing moral principles and priorities. You may feel guilty for working at a company that has a bad reputation, for example, but you also have a family to support and your employment options are limited. You might disagree on moral grounds with some of the policies your political party espouses, yet you feel that they are better than the other parties whose policies you find even more disturbing.

In a complex and complicated world, moral distress is inevitable. Even more unnerving is that once you have sorted through your moral distress and have chosen the plan of action you think is most morally justifiable and carried it out, you might still feel a deep angst. Have you considered all of the factors and weighed them carefully and as objectively as possible? Did you even have all of the information necessary to make the best decision? These lingering questions that can continue to plague you constitute what is referred to as ‘moral residue’. Like moral distress, it too may be inevitable.

Is there a way out of this moral quagmire? Or are we doomed to suffer these discomforts without reprieve?

When we are in the middle of this distress or residue it may seem like there is no way out. It would be wise to realize that although ethics is hard, we must not be too hard on ourselves; be tough on the issues but soft on ourselves (and others who are sincerely struggling, too). Yes, it is important that we strive the best we can to always do ‘the right thing’, but that does not imply perfection. What may matter the most is that you allow yourself, even encourage yourself, to experience moral distress and residue, and let them sit with you and teach you. In truth, most harm done by humans to one another has not been done when people earnestly and actively struggle with moral quandaries, but when they avoid such challenges to begin with.

Sadly, most unethical acts are done when we simply ignore the need for ethical reflection because it is too difficult and too uncomfortable.

I suspect that a considerable number of people have experienced both moral distress and moral residue during the pandemic; I know that I have. In fact, for many these moral struggles have been far more troublesome than the virus itself.

Doing the right thing is not always easy or obvious; it takes work, wisdom, perseverance, and most of all courage. We might be disappointed when we or someone else seems to fail to use their moral compass with complete accuracy. But we tend to have a much stronger and more negative reaction when our moral compass is not consulted at all, or worse still, we do the opposite of what it suggests.

Perhaps more than any other experiences we share, moral distress and moral residue define what it means to be truly human. Despite the pain they can bring, the more we embrace them the better off our species will be.

J. Barry Engelhardt MD (retired) MHSc (bioethics)

CAERS Health Intake Facilitator