Jameton Andrew
Professor emeritus at the College of Public Health at the University of Nebraska Medical Center in Omaha, and the affiliate faculty of the Center for Bioethics at the University of Minnesota, and has been working as a philosopher in health care.
AMA J Ethics. 2017 Jun 1;19(6):617-628. doi: 10.1001/journalofethics.2017.19.6.mhst1-1706.
The concept of moral distress was defined in 1984 as (a) the psychological distress of (b) being in a situation in which one is constrained from acting (c) on what one knows to be right. A substantial literature on the subject has developed, primarily in nursing ethics. The aforementioned elements of distress are applied here to areas of clinical and organizational significance: (a) distress from causing intimate pain during care of the dying, (b) constraints stemming from proximate and background challenges of health care organizations, and (c) changing perspectives on therapeutic technologies derived from global environmental perspectives. Although moral distress may be increasing in clinical settings, nursing advocates are developing positive ways to cope with it that can help clinicians in general.
道德困扰的概念于1984年被定义为：（a）心理困扰，（b）处于一种被限制无法按照自己认为正确的方式行事的情境中，（c）这种限制来自于对自身认知正确之事的阻碍。关于这个主题已经形成了大量文献，主要集中在护理伦理学领域。上述困扰因素在此被应用于具有临床和组织意义的领域：（a）在临终护理过程中造成亲密痛苦所带来的困扰，（b）医疗保健组织的直接和背景挑战所导致的限制，以及（c）从全球环境视角衍生出的对治疗技术的不断变化的观点。尽管道德困扰在临床环境中可能正在增加，但护理倡导者正在开发积极的应对方法，这些方法总体上可以帮助临床医生。
