Moral distress and healthcare resource cutbacks: Leaders' and professionals' experiences

BackgroundHealthcare resource cutbacks create organizational conditions that may constrain moral agency and contribute to moral distress, yet little is known about how leaders and healthcare professionals experience these ethical challenges.AimThe aim of this study was to explore how leaders and healthcare professionals experience moral distress associated with healthcare resource cutbacks. The research question was: How do leaders and healthcare professionals experience moral distress associated with healthcare resource cutbacks?Research designQualitative exploratory design. In-depth semi-structured interviews. Participants and research contextTwelve participants, six leaders and six health professionals. Among leaders, leadership experience ranged from 1 to 30 years. Among healthcare professionals, healthcare experience ranged from 7 to 41 years.Ethical considerationsThe study adhered to the Finnish National Board on Research Integrity (TENK) guidelines on good scientific practice. Ethical approval was obtained from an ethics committee at a university in Finland (verdict 11/2024) and research permissions were granted by the two healthcare organizations included in the study. Participants received written information about the study and provided informed consent before interviews.FindingsFive themes were generated: Organizational transformation as a source of moral constraint; Structural limitations create conflicts between professional values and organizational realities; Moral distress as emotional suffering and erosion of professional identity and well-being; Relational and organizational support as protection against moral distress; Professional commitment as both a source of resilience and vulnerability. ConclusionsMoral distress associated with healthcare resource cutbacks is an ethical and organizational phenomenon arising from tension between caring responsibility and restricted possibilities for ethical action experienced by both leaders and healthcare professionals. Ethically sustainable healthcare requires individual commitment and organizational structures that enable caring responsibility. Addressing moral distress requires attention to resource allocation, decision-making, leadership, and organizational conditions that strengthen moral agency and support care grounded in human dignity.