The experience of ‘moral distress’ is an increasing focal point of contemporary medical and bioethics literature, yet it has received little attention in discussions intersecting with ethical theory. This is unfortunate, as it seems that the peculiar phenomenon may well help us to better understand a number of issues bearing both practical and theoretical significance. In this article, I provide a robust psychological profile of moral distress in order to shed a newfound light upon the longstanding problem of ‘dirty hands’. (...) I argue that moral distress offers evidence of the existence of dirty hands situations. By examining moral distress and its relationship to cases of dirty hands, it appears that few of us are completely immune to susceptibility to these sorts of troubling experiences. With this concern in mind, I provide various recommendations to help alleviate our morally distressing personal and professional lives. (shrink)

Recent medical and bioethics literature shows a growing concern for practitioners’ emotional experience and the ethical environment in the workplace. Moral distress, in particular, is often said to result from the difficult decisions made and the troubling situations regularly encountered in health care contexts. It has been identified as a leading cause of professional dissatisfaction and burnout, which, in turn, contribute to inadequate attention and increased pain for patients. Given the natural desire to avoid these negative effects, it seems to (...) most authors that systematic efforts should be made to drastically reduce moral distress, if not altogether eliminate it from the lives of vulnerable practitioners. Such efforts, however, may be problematic, as moral distress is not adequately understood, nor is there agreement among the leading accounts regarding how to conceptualize the experience. With this article I make clear what a robust account of moral distress should be able to explain and how the most common notions in the existing literature leave significant explanatory gaps. I present several cases of interest and, with careful reflection upon their distinguishing features, I establish important desiderata for an explanatorily satisfying account. With these fundamental demands left unsatisfied by the leading accounts, we see the persisting need for a conception of moral distress that can capture and delimit the range of cases of interest. (shrink)

This chapter introduces the Special Issue and offers an overview of the corpus of work on the topic since the publication of Michael Walzer’s seminal article, ‘Political Action: The Problem of Dirty Hands’.