Published by Roberto Wenk.
Last updated date: July 16, 2025.
Moral distress is a state of anguish or exhaustion that arises after a decision—whether through action or inaction—conflicts with internal values or ethical principles.
• It involves reflecting on past actions or omissions.
• Decisions may be active or passive; for example, not acting is still a form of decision-making and can lead to moral distress.
• Distress may also stem from witnessing an event or behavior and perceiving that intervention or influence could have altered the outcome. Even if that perception is inaccurate, it may carry moral weight and lead to suffering.
Moral anxiety refers to the worry or fear associated with a decision that might have to be made in the future.
• This anxiety arises from anticipating a morally challenging situation and doubting whether action will align with ethical values, especially when circumstances may limit available options.
Moral tension is the internal conflict experienced in the present moment when facing competing options and uncertainty about which path to take.
• It reflects the struggle to evaluate alternatives and act in accordance with moral principles amid ambiguity or conflicting demands.
See reference for more information. Adapted from Bedzow I. A Framework for coping with moral challenges in the COVID-19 era. Internet. Center of advance Palliative Care. Accessed on July 15, 2025.