Moral Distress and the Ethical Call to Self Care

Moral distress occurs when individuals know the ethically right course of action but are unable to act due to systemic, organizational, or contextual barriers^1,2. This experience can significantly impact well‑being, compassion, and long‑term sustainability in care roles. Importantly, moral distress is not a failure or weakness; it reflects strong professional values and moral awareness^1,2.

Self‑care must be reframed as an ethical and professional responsibility, not a luxury or indulgence. Every clinical act is an ethical act, and self‑care is both clinical and ethical work. Sustaining one’s ability to care for others requires preserving one’s own capacity to act with integrity¹.

Self‑Care vs. Self‑Soothing

Acts such as baths, comfort food, or alcohol may provide temporary relief (self‑soothing), but true self‑care is intentional, restorative, and protective, addressing the conditions that contribute to burnout and moral distress¹.

• Individual Self‑Care Practices^1,2
• Reflection and journaling^1,2
• Peer debriefing and ethical dialogue^1,2
• Clear boundary setting (e.g., declining extra shifts when depleted, prioritizing safety, seeking flexible or remote work options when possible)^1,2
• Asking consent before emotionally unloading on colleagues ^1,2
• Meaningful movement, hydration, nourishment, and sleep hygiene^1,2

Validated tools such as the Maslach Burnout Inventory (MBI), Copenhagen Burnout Inventory, and Professional Quality of Life Scale (ProQOL) can help individuals and organizations assess burnout and compassion fatigue³.

What We Should Advocate for as Employees

• Grief and bereavement policies that reflect the realities of care work¹
• Reciprocal employer–employee relationships (a salary alone is not sufficient support)¹
• Clear supports when workload expectations increase¹
• Organizational reflection on how staff worth and value are communicated¹
• Defined, respected boundaries around what is sustainable in the role¹

Self-care is not separate from ethical practice; it is essential to it^1,2,3.

Resources

1. Hines, M. (2026, March). Moral distress and the ethical call to self-care. Waterloo Wellington HPC Education Evening. Waterloo, ON; Bingemans Conference Centre.
2. Salari, N., Shohaimi, S., Khaledi-Paveh, B., Kazeminia, M., Bazrafshan, M. R., & Mohammadi, M. (2022). The severity of moral distress in nurses: a systematic review and meta-analysis. Philosophy, ethics, and humanities in medicine: PEHM, 17(1), 13. https://link.springer.com/article/10.1186/s13010-022-00126-0
3. Collins, M. H., & Cassill, C. K. (2022). Psychological wellness and self-care: an ethical and professional imperative. Ethics & Behavior, 32(7), 634–646. https://www.tandfonline.com/doi/full/10.1080/10508422.2021.1971526
4. College of Registered Nurses of Manitoba. (2025, April). Ethical decision making in nursing practice. College of Registered Nurses of Manitoba. https://www.crnm.mb.ca/wp-content/uploads/2025/04/2025.04.10-Ethical-Decision-Making.pdf

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