Showing moral courage and maintaining ethical practice

Fairness and the commitment to confronting injustice and inequality are central to most professional codes of ethics. Professional values uphold ethical standards that validate justifiable actions, forming the foundation of health and social care practices and guiding professional identity. Codes of practice set clear standards for good practice, while policies, procedures and legislation also guide our work.

Reflective pause:

How has encountering ethical challenges and witnessing injustices in your professional role impacted your sense of moral integrity and commitment to advocating for change?

Health and social care work can evoke feelings of dissonance or moral injury, where ethical dilemmas challenge our personal or professional values. Moral injury refers to the distress resulting from actions (or inactions) that violate a person’s moral or ethical code. For example:

• A social care practitioner’s commitment to alleviating distress may be compromised when working with someone with dementia. For example, planned respite visits, while essential for caregivers to have a break, may cause upset for the individual receiving care. 

• A social worker may encounter bureaucratic barriers in their system that prevent them from providing sufficient support and resources to marginalised communities. Despite advocating for change, they might feel powerless and frustrated, experiencing moral injury as they witness ongoing harm and injustice. 

• A paramedic working in an understaffed ambulance service may experience moral injury when they are required to respond to multiple emergency calls and are unable to provide the level of care they believe their patients require.

Moral injury has become more prevalent in health and social care, especially during the COVID-19 pandemic, due to difficult decisions or actions many have been obliged to take (Williamson et al., 2020). It is crucial for your professional identity to recognise situations where you may be at risk of moral injury and seek supportive people to discuss your feelings before they impact your wellbeing.

Organisations must address moral injury among employees, especially in professions like health and social care, where ethical dilemmas are common. Promoting an ethical culture, establishing ethical guidelines, providing training and support and encouraging open communication are essential. Leaders should be accessible and proactive in addressing ethical concerns.

Practitioners also bear responsibility for developing moral resilience, which is the ability to navigate ethical challenges and uphold integrity during adversity. There are several ways to enhance your moral resilience:

• Reflect on values: Clarify your personal and professional values and how they guide your actions in challenging situations.

• Build self-awareness: Develop self-awareness to recognise your moral compass, emotions, triggers and biases. This awareness enhances your ability respond effectively to ethical dilemmas. 

• Seek training: Keep updated about ethical principles, professional standards and relevant laws and regulations. Continuous learning provides the knowledge and skills required to make ethical decisions.

• Practice ethical decision-making: Establish a systematic approach to ethical decision-making. Weigh the consequences of various actions, evaluate alternatives and, wherever possible, prioritise actions aligned with your values and principles.

• Build supportive relationships: When facing moral challenges, week out support and guidance from colleagues, mentors, and supervisors.

• Engage in moral dialogue: Encourage open discussions about ethical dilemmas with peers and colleagues to clarify values, perspectives, and potential solutions.

• Develop coping strategies: Practicing mindfulness, self-care and stress-reduction techniques can help manage stress and uncertainty in ethically challenging situations.

• Seek supervision: When facing complex ethical dilemmas, obtain guidance, perspective and support by consulting with supervisors, ethics committees, or trusted advisors. 

• Learn from experience: Reflect on past experiences to learn from both successes and challenges. Analyse how you navigated ethical dilemmas, identifying areas for growth.

• Advocate for ethical practice: Speak up against unethical behaviour and advocate for policies and practices that uphold ethical standards.