Responding to Moral Distress During Clinical Ethics Consultation: A Taxonomy for Advanced Clinical Ethics Practices

The evolution of the concept of moral distress has implications for how clinical ethicists respond to it. Originally defined as occurring when an individual knows the right thing to do but is institutionally constrained, the implication was that to eradicate moral distress, institutional change was necessary. However, through subsequent measurement and exploration of moral distress, the concept has expanded to include scenarios in which reasonable value disagreements occur. This expanded conceptualization of moral distress firmly places the responsibility for responding to moral distress within the realm of clinical ethics consultation. We draw on a sub-categorized framework of moral distress to guide a taxonomy of responses that clinical ethicists can utilize to address moral distress when it presents in situations prompting ethics consultation. We argue that responding to moral distress during consultation should be considered an advanced consultation skill.