Moral Distress and Conscientious Objection: A Theoretical Distinction or a Clinical Difference?

Abstract: This paper addresses the relationship of moral distress and conscientious objection in clinical ethics. These concepts name different moral phenomena. However, there is a theoretical overlap between moral distress and conscientious objection that can affect clinical practice, since moral distress and conscientious objection often receive different administrative responses.
Clinicians may have complex moral objections to providing standard and legal forms of care, such as enabling VSED or MAiD, or termination of a pregnancy. “Moral distress” is one way of framing those moral objections, naming the experience of being pressured to provide care that does not meet one’s moral values. “Conscientious objection” has a more political valence, suggesting that pressuring a clinician to do treatments they have moral objections to is unfair, or unjustifiably harmful to their integrity.
Mark Wicclair and some other conscience rights theorists have argued that there are important differences between moral distress and conscientious objection—envisioning only minimal overlap between these experiences. I argue that the distinction between “moral distress” and “conscientious objection” fails conceptually, but also practically. The distinction presupposes deliberative practices and resources that are often not available (especially in rural and under-resourced settings).
The paper closes with suggestions for differentiating moral distress and conscientious objection in practice, and for navigating cases where both “moral distress” and “conscientious objection” may be applicable to a clinician’s moral objections.

Keywords: Conscientious objection, Moral distress, Integrity