Moral Distress Among Clinicians During Resource-Constrained Pandemic Care

Abstract

The COVID-19 pandemic exposed frontline clinicians to sustained resource scarcity, forcing rationing and
triage decisions that gave the long-standing concept of moral distress a new scale and urgency.
This review examines how moral distress has been defined and measured in pandemic contexts,
distinguishing acute, decision-specific triggers such as ventilator triage from chronic, exposure-based harms
that accumulate over prolonged periods of understaffing and unmet professional standards.
It surveys the ethical debates over crisis standards of care and triage committees, the empirical literature
linking moral distress to moral injury and burnout, and the legal and institutional responses -- liability shields
and formal crisis protocols -- that emerged during the pandemic.
We argue that these institutional responses, while necessary, addressed legal exposure more successfully
than the underlying moral burden, and that building genuine "moral community" within health institutions is a
more promising avenue for reducing harm than individual resilience training alone.
We conclude by identifying open questions about whether pandemic-era ethical infrastructure will persist
into ordinary practice and how well its lessons generalize to other forms of chronic resource scarcity.