Ethics in Critical Care: Principled Moral Outrage: An Antidote to Moral Distress?
Cynda Hylton Rushton RN, PhD
Cynda Hylton Rushton RN, PhD; Department Editor

$3.95 		AACN Advanced Critical Care
March 2013 
Volume 24  Number 1
Pages 82 - 89
 
  PDF Version Available!

ABSTRACT
Critical care clinicians commonly find themselves in situations that challenge their integrity as individuals and as professionals. In response to these situations, many clinicians experience moral distress.Moral distress is the pain or anguish affecting the mind, body or relationships in response to a situation in which the person is aware of a moral problem, acknowledges moral responsibility, and makes a moral judgment about the correct action; yet, as a result of real or perceived constraints, participates in perceived moral wrongdoing.1(p421)When moral distress cannot be relieved and integrity cannot be restored, moral or ethical outrage may ensue. This column explores the contours of moral outrage, offers a definition of principled moral outrage, and suggests strategies for working more skillfully with the inevitable challenges to integrity that occur in the critical care environment.Moral outrage has been described broadly as anger provoked by a real or perceived violation of an ethical standard such as fairness, respect, or beneficence.2,3 Pike4(p351) describes moral outrage as "characterized by energy-draining frustration, anger, disgust, and powerlessness." The psychological processes that affect the intensity of moral outrage may be activated by threats to personal or professional role, identity, self-worth, or integrity; by beliefs or customs that are different from one's own; or challenges to the beliefs or values that are integral to personal or professional identity.5 In the context of critical care, nurses may, for example, perceive that their nursing identity is irrevocably tarnished when they participate in actions that result in unrelieved suffering or when their efforts to advocate for their patients fail, resulting in unjust treatment allocation. Such actions threaten nurses' ability to uphold the core values of the nursing profession to provide respectful, nondiscriminatory care to all persons and to avoid harm to their patients.6Moral outrage,

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