The_political_language_of_moral_distress

In The political language of moral distress Part I, I proposed a social justice framework for understanding moral distress. Moral distress is defined as “the experience of being seriously compromised as a moral agent in practicing in accordance with accepted professional values and standards. It is a relational experience shaped by multiple contexts, including the socio-political and cultural context of the workplace environment” (Varcoe, Pauly, Webster & Storch, 2012, p. 59). In Part I, I argued that we must politicize the notion of moral distress by critically reflecting on its roots in wider intertwined social, cultural, political, and economic contexts. Rather than individualize moral distress as inadequacy or weakness, I suggested that we consider how systemic and structural injustice affects us as social workers and as citizens. This includes the role of injustice and structural violence in our mental health and substance use. In this piece, I explore my lived experience of moral distress and propose collective advocacy as a way to counter powerlessness and move beyond the individualization of ethical struggle to recognize moral distress as a collective issue.

*MSW, PhD.

Recibido. 7/8/2023

Aprobado por el Consejo Editorial: 14/2/2024

El lenguaje político de la angustia moral: Parte II

Norma Jean Profitt *

En la primera parte de El lenguaje político de la angustia moral propuse un marco de justicia social para comprender la angustia moral. La angustia moral se define como la experiencia de una persona cuando “se ve gravemente comprometida como agente moral al ejercer de conformidad con los valores y estándares profesionales aceptados. Es una experiencia relacional que se ve moldeada por múltiples contextos, incluidos los contextos sociopolíticos y culturales en el ámbito laboral” (Varcoe, Pauly, Webster y Storch, 2012, pág. 59). En la primera parte argumenté que debemos politizar la noción de angustia moral mediante una reflexión crítica sobre sus raíces en contextos sociales, culturales, políticos y económicos más amplios y entrelazados. En lugar de individualizar la angustia moral como deficiencia o debilidad, sugerí considerar las formas en que la injusticia sistémica y estructural nos afecta como personas profesionales en trabajo social y como ciudadanos. Esto incluye la función que desempeñan la injusticia y la violencia estructural en nuestra salud mental y el consumo de drogas. En este artículo exploro mi experiencia vital de angustia moral y propongo la lucha colectiva como una forma de contrarrestar la impotencia y superar la individualización de las obligaciones éticas para reconocer la angustia moral como un problema colectivo.

*MSW, PhD.

Enviado el:. 7/8/2023

Aprobado por el Consejo Editorial: 14/2/2024

As social workers who labour in systems, we are embedded in structures and processes designed to maintain the status quo, what Dorothy Smith (1996) so aptly terms “relations of ruling”. This embeddedness has been exacerbated by changes to the social work profession over the last two decades such as neoliberalism and the marketization of social welfare. Our sphere of action as social workers has shrunk alarmingly and we often have little power to address clients’ needs. Support for recognizing, let alone exploring, ethical struggles in the workplace appears to have evaporated under the practice of managerialism. Also, organizational discourse often employs middle-class language to frame moral distress as individual rather than systemic and structural.

In the situations of moral distress I have experienced, I have felt frustrated and powerless even when I have acted in good faith to resolve them within the web of relationships in the organization. Predominantly I have felt torn asunder by tentacles of violence that both pummel from a distance and directly buffet the workplace. Violence is pervasive in our Western colonialist capitalist society; it is normalized, legitimized, and socially tolerated as “the way it is”. Think of the everyday violence carried out here in Canada and globally. There is the violence of class and other “isms” perpetuated and legislated by our political and economic institutions, ensuring vast inequalities of income and wealth as well as inequities in access to health care.

The violence of the fossil fuel industry and the governments subsidizing it are destroying the Earth and all her living things. And then there is the violence of driving Indigenous Peoples from their Land and demolishing their “life-worlds” (Ghosh, 2021, p. 67) in the Amazon and elsewhere. We live daily with the violence of corporations toward labourers, citizens, and the natural world, i.e., mining projects in Canada and abroad on land or in the sea, or the recently reported corporate concentration of agribusiness controlling the production, distribution, and pricing of food across the globe. We often fail to connect the violence of the political economy to our experiences of moral distress in the workplace, instead drawing a line about causes at the walls of the organization.

These tentacles of violence encompass the often futile social work task of trying to marshal scarce or non-existent resources for clients, i.e., helping a client find decent and affordable housing or resolve an issue for which there are no cross-institutional policies. Frustration and anger are healthy responses to systemic and structural issues much larger than the individual client. At an organizational level, managers may be unable or unwilling to act or problem-solve to support staff facing moral distress. Violence flows out of a particular set of values and these values stifle the political choices of politicians and citizens, choke off life-giving public policies, and incapacitate hierarchical bureaucratic systems to disregard workers and clients (citizens). Thus, the moral distress generated by such violence cannot be resolved by individual advocacy, by moral courage, or by unrelenting rage because the situations that produce it have their roots in oppressive values, systems, and structures.

An alternative definition of moral distress may help us appreciate the range of emotional responses to moral compromise: “One or more negative self-directed emotions or attitudes that arise in response to one’s perceived involvement in a situation that one perceives to be morally undesirable” (Campbell, Ulrich & Grady, 2018, p. 67). I have certainly experienced the erosion of self-respect, purpose, and even of the life force itself. Feeling powerless, anguished, trapped, torn, isolated, ashamed, guilty, angry, and contaminated are common to the experience of moral distress and these feelings are usually cumulative. Moral distress can trigger trauma as well as contribute to burnout. We may turn to self-medicating to quell the tumult in our interior, whether to alcohol, drugs (prescription and non-prescription), gaming, or comfort eating, among the many efforts to self-soothe and deal with painful emotions. I contend that if there were nourishing and safe spaces to process ethical challenges in the workplace, our moral suffering would diminish significantly. We might also consider, morally, what concern and respect organizations owe us as employees.

Our moral integrity as professionals must be recognized and fostered by the culture of our workplaces, that is, by an ethical climate (Olson, 2018). The creation of moral spaces such as ethics rounds is one such avenue that can lessen moral distress (Pavlish, Robinson, Brown-Saltzman & Henriksen, 2018). Ethics rounds can promote a moral community in which to clarify values and obligations; learn from difficult situations; encourage creativity; engage in ethics education; strengthen communication; identify the systemic and structural roots of moral distress; and counter powerlessness. Through reflection on, and critical analysis of, our practice, we can gain clarity over time about how we understand and enact our moral agency as well as internal and external constraints on agency. The “systemic dimension” of moral distress can be collectively tackled through action emerging from ethics rounds (Grady et al., 2018, p. 169). Nancy Berlinger suggests collective advocacy by teams in order to funnel the issues to people in the hierarchy with more power to push for change and hold systems accountable (Grady et al., 2018). Such action is integral to social justice practice.

One of our moral strengths as social workers is to do our best for clients and simultaneously, to be ethical for ourselves. In order to do our best, the scaffolding has to be in place to fulfill our professional commitments. The violence of the political economy saturates social work. What produces moral suffering in us as social workers is always already affecting clients. Carrying this burden in isolation is untenable. Moral distress must be collectivized and critically analyzed, turning the gaze from individual workers to systems and the structural violence endemic to our “modern” and “civilized” world.

References

Campbell, S. M., Ulrich, C. M., & Grady, C. (2018). A broader understanding of moral distress. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 59-77). Switzerland: Springer International Publishing AG.

Ghosh, A. (2021). The nutmeg’s curse: Parables for a planet in crisis. Chicago: University of Chicago Press.

Grady, C., Berlinger, N., Caplan, A., Davis, S., Hamric, A. B., Ketefian, S., Truog, R., & Ulrich, C. M. (2018). Reflections on moral distress and moral success. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 159-171). Switzerland: Springer International Publishing AG.

Olson, L. L. (2018). Building compassionate work environments: The concept of and measurement of ethical climate. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 95-101). Switzerland: Springer International Publishing AG.

Pavlish, C. L., Robinson, E. M., Brown-Saltzman, K., & Henriksen, J. (2018). Moral distress research agenda. In C. M. Ulrich & C. Grady (Eds.), Moral distress in the health professions (pp. 103-125). Switzerland: Springer International Publishing AG.

Smith, D. E. (1996). The relations of ruling: A feminist inquiry. Studies in Cultures, Organizations and Societies, 2(2), 171-190.

Varcoe, C., Pauly, B., Webster, G., & Storch, J. (2012). Moral distress: Tensions as springboards for action. HEC Forum, 24, 51-62.