Online Program

Moral Distress among Public Health Professionals: Lessons from the West African Ebola Virus Disease Epidemic for Future Public Health Emergencies

Tuesday, November 3, 2015

Kata Chillag, PhD, Presidential Commission for the Study of Bioethical Issues, Washington, DC
The concept of “moral distress” refers to psychological consequences of situations in which a professional cannot act in accordance with his or her values due to institutional, professional, or other structural constraints. Local and expatriate public health professionals working in the current west African Ebola virus disease (EVD) epidemic are likely to face difficult and sometimes inextricable ethical issues in a context characterized by inadequate health resources, politicization, bureaucracy, community resistance, and desperation.  Many public health professionals view their career choice as a central reflection of their moral values, as an unassailable “good” in and of itself.  Substantial cognitive dissonance can occur when someone with this perspective encounters problems that he or she cannot “fix” at all or in a manner consistent with his or her values. This dissonance can have serious consequences for individuals and the public health project, analogous to the effects of moral distress described in clinical settings.  Public health professionals, particularly those who lack experience working in emergencies, unfamiliar sociocultural contexts, or in contexts of extreme poverty and inequality, often have few resources to address ethical issues, once identified.  The EVD epidemic is undoubtedly fertile ground for moral distress, in part because many professionals with limited experience in similar situations are participating in the public health response. This presentation outlines next steps after recognizing moral distress among public health professionals working in emergencies, focusing on the EVD epidemic and its lessons for “ethical preparedness.”  It will be important for public health institutions to take an active role in documenting and characterizing public health professionals’ different experiences with ethical issues and moral distress in the EVD epidemic, through both formal research and staff debriefing.  This information is important for two reasons: 1) it will likely reveal less visible ethical issues encountered by public health workers on the ground; and 2) it will inform development of training and other resources relevant for the long-term consequences of EVD epidemic-related moral distress as well as similar public health emergencies.     

Learning Areas:

Ethics, professional and legal requirements
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe what kinds of situations or issues might create moral distress for those working in public health emergency resonse. Formulate ways that public health institutions might prepare those working in global public health emergencies to grapple with ethical issues and moral distress.

Keyword(s): Ethics, Emergency Preparedness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health professional with expertise in public health ethics and policy. I conceptualized and authored this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.