Moral Suffering in Nursing and Medicine: An Erosion of Professional Identity and the Virtue of Integrity Open Access

Abstract

Nursing and medicine are not only technical professions but inherently moral ones, grounded in a shared moral purpose of prioritizing patient well-being. Clinicians are expected to uphold both clinical competence and moral character, often under conditions that challenge their ability to do so. Moral suffering is a term used to describe the moral anguish that arises when clinicians are unable to act in alignment with their deeply held moral and professional values. It encompasses experiences of moral distress and moral injury, which are increasingly understood within the discourse as existing along a continuum of severity. While first explored in nursing through the concept of moral distress, moral suffering is increasingly recognized as affecting physicians as well, particularly in relation to systemic and institutional pressures. Persistent constraints—such as resource limitations, administrative demands, and conflicting institutional values—create conditions that obstruct ethical clinical practice. These barriers not only prevent clinicians from fulfilling their moral purpose but also contribute to the erosion of professional identity and moral integrity. As a result, moral suffering has become a significant concern, deeply impacting clinician well-being and the quality of patient care. This thesis approaches moral suffering through the lens of virtue ethics, framing it as not only a reaction to external constraints but also a gradual deterioration of moral character. Integrity is identified as the central, unifying virtue essential to ethical practice in both nursing and medicine. Yet, despite being expected by healthcare institutions, integrity is often compromised by the very systems within which clinicians work. Addressing moral suffering requires more than resilience training or ethical guidelines; it demands institutional accountability and environments that support the cultivation and protection of clinicians’ moral character. There is an ethical urgency to support nurses and physicians not only as healthcare professionals but as moral agents striving to act with integrity in the face of adversity.

Table of Contents

Introduction................................................................................................................................... 1

Chapter 1: Defining Moral Suffering and its Symptoms in Nursing and Medicine............ ......................5

1.1      Introduction...................................................................................................................... ....5

1.2      The Moral Suffering Discourse in Nursing................................................................... .............5

1.3      Symptoms of Moral Suffering in Nursing................................................................................ 14

1.4      The Moral Suffering Discourse in Medicine............................................................................ .19

1.5      Symptoms of Moral Suffering in Medicine................................................................. ..............23

1.6     An Analysis of the Moral Suffering Discourse in Nursing and Medicine...................................... 25

1.7      Conclusion........................................................................................................................... 28

Chapter 2: Moral Suffering and Constraints Present in Nursing and Medicine..................................... 30

2.1     Introduction.......................................................................................................................... 30

2.2     Constraints in Nursing.................................................................................................... ........30

2.2.1  Individual-Level Constraints................................................................................................... 31

2.2.2 Work Environment Constraints............................................................................................... 34

2.2.3 Institutional and Systemic Constraints.................................................................................... 37

2.3     Constraints in Medicine.......................................................................................................... 39

2.3.1  The Constraint of Divergence of Purpose................................................................................. 40

2.3.2 The Constraint of Compulsive Bureaucracy...............................................................................43

2.4     An Analysis of Constraints in Nursing and Medicine................................................................. 45

2.5     Conclusion............................................................................................................................ 47

Chapter 3: Interventions to Alleviate Moral Suffering in Nursing and Medicine.................................. 48

3.1     Introduction......................................................................................................................... 48

3.2     The Discourse on Moral Suffering Interventions in Nursing...................................................... 48

3.3     Implemented Moral Suffering Interventions for Nurses............................................................ 53

3.4     The Discourse on Moral Suffering Interventions in Medicine.................................................... 59

3.5     Implemented Moral Suffering Interventions for Physicians...................................................... 66 

3.6     Comparing Moral Suffering Interventions in Nursing and Medicine.......................................... 68

           Table 1. Moral Suffering Interventions in Nursing and Medicine............................................... 72

3.7     Conclusion........................................................................................................................... 73

Chapter 4: Examining Moral Suffering through the Lens of Virtue Ethics........................................... 74

4.1     Introduction......................................................................................................................... 74

4.2     The Role of Virtue in Nursing and Medicine............................................................................ 74

4.3     Moral Suffering and the Erosion of Professional Identity and Integrity...................................... 81

4.4     Conclusion........................................................................................................................... 86

Conclusion................................................................................................................................... .88

Bibliography.................................................................................................................................. 91

About this Master's Thesis

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School	Laney Graduate School
Department	Bioethics
Degree	M.A.
Submission	Master's Thesis
Language	English
Research Field	Ethics Health Sciences, Medical Ethics
Keyword	Virtue Ethics Moral Integrity Moral Injury Healthcare Moral Suffering Professional Identity Moral Distress
Committee Chair / Thesis Advisor	Bedzow, Ira, Emory University
Committee Members	Crane, Jonathan, Emory University Mabel, Hilary, Emory University

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