Abstract

Since Andrew Jameton introduced the concept of moral distress, it has become a central concept in nursing and clinical ethics. Yet, much of the existing literature presupposes, rather than examines, how healthcare professionals come to grasp what the right action is in the first place. This paper argues that this omission has contributed to conceptual ambiguity in moral distress research and, in turn, to difficulties in distinguishing moral distress from adjacent phenomena such as role conflict and occupational stress. To address this problem, the paper offers a philosophical reconstruction of moral distress by drawing on the work of John McDowell. Drawing on McDowell’s account of perception, second nature, the space of reasons, and Bildung, it clarifies the epistemological basis of moral sensitivity in healthcare practice. On this basis, the paper argues that moral distress should be understood not merely as psychological distress caused by being unable to do what one knows to be right, but as the normative aspect of the suffering experienced when a healthcare professional with moral sensitivity – understood as the cultivated capacity to perceive morally salient features of a situation as reasons – is prevented by some external constraint from responding to those reasons. This reconstruction further implies that, under certain conditions, those with greater moral sensitivity may be more likely to experience moral distress. The paper describes this as the paradox of moral distress. By reframing moral distress in these terms, the paper provides a new epistemological foundation for moral distress research and highlights its significance for nursing ethics, professional education, and organisational ethics in healthcare.