“One knows the right thing to do but institutional constraints make it nearly impossible to pursue the right course of action”
A Jameton, 1984
Research into Moral Distress in Social Work is slow to emerge and whilst there is still much to be explored it is a real and relevant aspect of the Social Workers daily role.
To exist it requires two elements;
- an event that highlights awareness that the practitioners moral agency is restricted, and
- the psychological and physiological suffering ‘distress’ that follows.
For Social Workers the inability to act in alignment with their ethical principles can cause significant stress. Distress occurs when the professional’s judgement of the morally appropriate action, cannot be carried out due to organisational or structural restraints.
Discussions on Moral Distress acknowledge two potential factors as ‘constraint’ on taking the morally ‘right’ action;
- Institutional constraints such as the organisations policies or culture, the wider socio-political structure of society and the laws within which they practice.
- Internal constraints such as insufficient knowledge, skills or a lack of moral courage.
Moral Residue can be described as the cumulative effect of unresolved Moral Distress. This can be seen as a separate concept. However in situations where the Social Worker continues to practice after the incident that caused the initial distress and sees the negative impact, often on a client, then this can cause strong, negative feelings such as guilt, frustration and anger.
There continues to be much debate in academic literature about the accepted definitions of Moral Distress. There is also not yet an agreed way of measuring or screening for it in Social Work. It does however provide a conceptualised framework for evaluating the restrictions on Social Workers choices and autonomy. The emerging awareness and research will enable us to explore the effects of Moral Distress and Moral Residue on our current Social Work practice.