Moral distress amongst oncology health-care workers as a consequence of constraints upon routine care during the COVID-19 pandemic: do health-care institutions have a moral obligation to acknowledge and address?

Dr Sarah Heynemann1,2

1Chris O’Brien Lifehouse, Camperdown, Australia, 2Monash University, Clayton, Australia

In January 2020, the World Health Organisation designated the COVID-19 pandemic a ‘public health emergency of international concern’ and noted the protection of health-care workers to be paramount. The pandemic has been described as giving rise to the worst possible work conditions for health-care workers. Whilst much attention has been given to adequate resourcing of health-care workers with personal protective equipment, less attention has been given to the protection of health-care workers from non-physical harms.

‘Moral distress’ describes the phenomenon in which health-care workers are confronted with an ethically challenging scenario, feel convicted to act in a particular fashion, but are prevented in doing so due to external or institutional constraints, and experience distress as a consequence.

The pandemic entails a ‘perfect storm’ for the risk of multiple episodes of moral distress amongst health-care workers, and potentially even lasting injury to moral integrity, in particular for those working in cancer care. As such, if moral distress may be considered a predictable, occupationally associated harm, to what extent do health-care institutions, as employers, have a moral obligation to address this as a component of providing a safe working environment? Precedents for the protection of workers from non-physical workplace harms exist (eg bullying and harassment).

This abstract will argue that health-care institutions have a moral obligation to acknowledge and seek to mitigate the risk of moral distress amongst their health-care worker employees as a consequence of changes to routine practice invoked on public health grounds during the pandemic.


Dr Sarah Heynemann currently works at Chris O’Brien Lifehouse, Sydney as a medical oncology fellow where she is undertaking a lung cancer fellowship. This work was undertaken whilst completing a Master of Bioethics through Monash University.

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