AMA J Ethics. 2017 Jun 1;19(6):608-616. doi: 10.1001/journalofethics.2017.19.6.msoc1-1706.

Culture and Moral Distress: What's the Connection and Why Does It Matter?

Berlinger N1, Berlinger A2.

Author information

1

Research scholar at the Hastings Center in Garrison, New York, and the first author of the second edition of the Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life (Oxford University Press, 2013) and the author of Are Workarounds Ethical?: Managing Moral Problems in Health Care Systems (Oxford University Press, 2016), and After Harm: Medical Error and the Ethics of Forgiveness (Johns Hopkins University Press, 2005).

2

Nurse working in chronic disease care in Madison, Wisconsin.

Abstract

Culture is learned behavior shared among members of a group and from generation to generation within that group. In health care work, references to "culture" may also function as code for ethical uncertainty or moral distress concerning patients, families, or populations. This paper analyzes how culture can be a factor in patient-care situations that produce moral distress. It discusses three common, problematic situations in which assumptions about culture may mask more complex problems concerning family dynamics, structural barriers to health care access, or implicit bias. We offer sets of practical recommendations to encourage learning, critical thinking, and professional reflection among students, clinicians, and clinical educators.