Ebola is causing moral distress among African healthcare workers.

No one is talking about what must be profound moral distress among local African healthcare workers. Moral distress can result from not acting in accordance with what you believe to be ethically correct in professional practice, and it can lead to serious health related outcomes such as emotional suffering and physical ailments. The phenomenon was first described by the philosopher Andrew Jameton 30 years ago. It is common to hear clinicians say, “I didn’t do right in that situation.” Moral distress is increasingly common among healthcare clinicians both nationally and internationally and can occur when doctors and nurses feel powerless to voice their concerns, do not agree with treatment procedures, or lack the equipment or resources necessary to advocate for patients. It can manifest as a sense of dread and a feeling of a loss of professional integrity. Many of us in healthcare can easily remember specific cases that led to feelings of moral distress. Perhaps we were questioning the continued use of aggressive measures requested by family members against the advice of the medical team. Or perhaps we were struck by a parent’s emotional insistence to keep his or her critically ill child alive at all costs. Or perhaps we were in the middle of a contentious family conflict that could not be resolved. For example, some evidence reports that 27% of European and Israeli intensive care clinicians cite inappropriateness of care in at least one patient care situation; in a similar way, higher moral distress in US physicians and nurses is associated with pressure to continue “unwarranted aggressive treatment.” 5 However, for African healthcare workers this distress often centres on an inability to meet an overwhelming demand for basic patient care needs with limited supplies and other resources. Emotional work