Table 3 Existing definitions of Moral Distress amongst Medical Students

Moral distress in the third year of medical school; a descriptive review of student case reflections

Lomis et al. 2009 [68]

Jameton’s definition.

Medical students’ experiences of moral distress: development of a web-based survey

Wiggleton et al. 2010 [69]

Jameton’s definition.

How Should Resident Physicians Respond to Patients’ Discomfort and Students’ Moral Distress When Learning Procedures in Academic Medical Settings?

Miller 2017 [70]

Jameton’s definition.

Moral distress in medical student reflective writing

Camp and Sadler 2019 [67]

Jameton’s definition.

Narrative, emotion and action: analysing ‘most memorable’ professionalism dilemmas

Rees et al. 2013 [71]

“Moral distress is when students feel unable to act in a manner consistent with their desire to do the ‘right’ thing.” (p. 93)

Antecedents and Consequences of Medical Students’ Moral Decision-Making during Professionalism Dilemmas

Monrouxe et al. 2017 [72]

“Moral distress, is emotional distress arising from the dissonance between one’s ethical/moral beliefs and one’s behaviour, which occurs when one’s actions are perceived as being limited by institutional constraints or unequal power relations. Moral distress can occur solely in the moment in which a person feels upset or uncomfortable (classified as mild distress) or continues for weeks or even months after an event (moderate distress). In extreme circumstances, distress is experienced many months or even years later (severe distress). Moral distress is different from other feelings.” (p. 568)

How Should Integrity Preservation and Professional Growth Be Balanced during Trainees’ Professionalization?

Weber and Gray 2017 [73]

Moral distress is “a negatively-valenced feeling state where one perceives a conflict between what one is expected to do and what morality requires.” (p. 545)

How Should Trainees Respond in Situations of Obstetric Violence?

Rubashkin and Minckas 2018 [74]

Moral distress is “the cognitive-emotional dissonance that arises when one feels compelled to act against one’s moral requirements.” (p. 240)

Joining the Club

Fuks 2018 [75]

The construct of moral distress is when “believes he or she knows the morally correct response to a situation but cannot act because of hierarchical or institutional constraints” (Lomis, Carpenter, and Miller 2009, p. 107).

Medical student reflections on geriatrics: Moral distress, empathy, ethics, and end of life

Camp 2018 [76]

Building on (Jameton, 1984)’s definition moral distress occurs when (1) A student described him- or herself doing or colluding with actions that the student believed were morally suspect or frankly immoral and (2) The student expressed that he or she was bothered by this to some degree. (p. 238)

Navigating Cognitive Dissonance: A Qualitative Content Analysis Exploring Medical Students’ Experiences of Moral Distress in the Emergency Department

Schrepel et al. 2019 [77]

Moral distress is defined as the negative feelings that arise when one knows the morally correct thing to do but they feel compelled to act in a way that contradicts with their values. (p. 332)

A systematic review of the causes, impact and response to moral distress among medical students

Glick 2019 [78]

Moral distress occurs when one is aware of the moral and ethical course of action yet is unable to perform it. (p. 1)

Medical students’ experiences of moral distress-a cross-sectional observational, web-based multicentre study

Dias 2020 [79]

Moral distress can be described as a psychological response to morally challenging situations, including moral conflict, dilemma, or uncertainty. Moral distress root causes can occur at patient, team or system levels.“ (p. 1)

Moral distress and burnout in caring for older adults during medical school training

Perni et al. 2020 [80]

1. Moral distress is a negative emotional state that results when a person feels inhibited from addressing a situation felt to be ethically problematic due to external constraints, including hierarchical or institutional constraints

2. We defined moral distress for respondents as “recognizing the situation to be ethically problematic and feeling inhibited from doing anything about it.” (p. 2)

Medical Students’ Experiences of Moral Distress in End-of-Life Care

Thurn and Anneser 2020 [81]

Moral distress occurs in situations in which a person recognizes a moral problem and has no doubts about the correct response but is constrained from acting on it or resolving it. (p. 116)

Ethikk First – extracurricular support for medical students and young physicians facing moral dilemmas in hospital routine

Kuhn et al. 2021 [82]

Such value conflicts cause moral stress, a term that was first introduced into the nursing sciences by the philosopher Andrew Jameton; however, it is now intensively being researched for various health professions. In a broad definition, it describes psychological reactions to moral challenges. (p. 2)