Aspects of Ethical Conflicts and their Implications for Work-Related Well-Being: A Cross-Sectional Study among Health and Social Care Professionals

Abstract

Moral distress is a pervasive phenomenon in health and social care organisations when employees feel unable to follow their ethical convictions, leading to impaired wellbeing and staff turnovers. While previous research has focused on identifying external root causes of moral distress, it has overlooked the subjective and multidimensional nature of ethical conflicts in explaining moral distress and its detrimental consequences for occupational well-being. We argue that ethical conflicts and moral distress are compounded, and it is important to investigate how employees themselves interpret situations that make them prone to moral distress. For this purpose, we surveyed 1,279 health and social care professionals who reported and assessed a recent ethical conflict from their work. Results showed that ethical conflicts involved three dimensions: ethical responsibilities to clients, ambiguous decision-making in organisations, and conflicting demands arising from relationships. Conflicting demands predicted general health, job satisfaction and turnover intentions, and ambiguous decision-making predicted general health and job satisfaction. Job autonomy, time pressure and organisational justice remained the most powerful predictors for indicators of work-related wellbeing. In resolving ethical conflicts and managing moral distress, organisational means are necessary. In particular, managers should be able to lead discussion about values with employees. In future, research should pay more attention to the social, dynamic and versatile nature of ethical conflicts in work organisations.