Lawrence S. Bloomberg Faculty of Nursing Member, Joint Centre for Bioethics, University of Toronto, Suite 130-155 College St., Toronto, ON, M5T 1P8, Canada,
J Bioeth Inq. 2013 Oct;10(3):337-45. doi: 10.1007/s11673-013-9456-5. Epub 2013 Jun 11.
Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating "counterstories" of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life.
道德困境在护理和其他领域被广泛研究。然而，它通常没有得到太多的理论深度的应用。本文专注于使用女性主义伦理学对道德困境进行理论化，特别是玛格丽特·厄本·沃克和希尔德·林德曼的工作。我们结合实证研究结果，认为道德困境是护士对其道德身份、责任和关系所经历的约束的反应。我们建议卫生专业人员在道德困境中获得帮助，以说明和沟通他们的价值观和责任。我们还讨论了护士作为有知识和值得信赖的专业人员，创作他们工作的“反故事”以修复受损的道德身份的重要性，最后，我们建议努力将医疗保健的目标从不惜一切代价延长生命转移到减轻痛苦，以减少在生命末期积极护理的常见反应——道德困境。
