Resisting Moral Residue

Alina Bennett, Sheena M Eagan Chamberlin

Pastoral Psychology
Pastoral Psychology

Abstract
This paper surveys contemporary scholarly conceptions of moral residue in order to demonstrate the fruitful inconsistencies contained in these various notions. Due to the fact that moral dilemmas are commonplace in the practice of medicine, patients and practitioners are uniquely situated to experience moral residue. The authors investigate two medical sites as case studies that demonstrate how a more capacious notion of moral residue can be useful for explaining ethical complexities: euthanasia on the battlefield and care of minors who are members of the Jehovah’s Witness faith community. These case studies will be of particular interest to chaplains, pastoral theologians, and other relevant practitioners and intellectuals. Fruitfully cast against the illuminations of interdisciplinary scholars including Donald Capps, Lorraine Hardingham, and others, these cases are used as instructive discursive devices, shedding greater light on ideas put forth within the literature on this engaging and complex topic.


Bennett A, Chamberlin SME. Resisting Moral Residue. Pastoral Psychol. 2013;62(2):151-162.

Moral Distress, Moral Residue, and the Crescendo Effect

Elizabeth Gingell Epstein, Ann Baile Hamric

Journal of Clinical Ethics
Journal of Clinical Ethics

Extract
It is doubtful that moral distress can ever be eradicated from healthcare settings. As increasing evidence accumulates to support the damaging effects associated with this phenomenon over time, however, interventions to decrease moral distress and moral residue become more urgently -needed. The crescendo effect model focuses attention on moral distress and moral residue and the relationships between them. . . . Both providers and healthcare systems need to acknowledge the repetitive nature of morally distressing events, such as prolonged aggressive treatment at the EOL, that occur in clinical settings. The crescendo effect highlights the crushing blow to professional integrity that nurses, physicians, and other disciplines have to manage on a daily basis in settings where moral distress goes unrecognized and unaddressed. It is not appropriate to expect highly skilled, dedicated, and caring healthcare professionals to be repeatedly exposed to morally distressing situations when they have little power to change the system and little acknowledgment of these experiences as personally damaging or career compromising. As evidence for the crescendo effect and its consequences accumulates, healthcare professionals, insurers, patients, and healthcare systems must not assume that damaged moral integrity is an acceptable, natural consequence that must be borne by healthcare providers.


Epstein EG, Hamric AB. Moral Distress, Moral Residue, and the Crescendo Effect. J. Clin. Ethics. 2009 Winter;20(4):330-342