Living in an exhausted, morally distressed nation
We are overwhelmed by the constant barrage of toxic messages and distressful events that shape our sense of who we are as a society and negatively affect our physical and mental health.
This is not us.
This is not the America we thought we were. As nurses, we’re sensitive to negative shifts in compassion and empathy. Almost two years of multiple, relentless attacks on America’s core values have left us morally distressed.
It is not like us to set a weekly quota of arresting 2,000 of our law-abiding neighbors seeking asylum in the United States. It’s not like us to propose spending $20 million in taxpayer dollars on a device that will allow immigration agents to deliver painful electric shocks to any human being. It’s not like us to put those without criminal records in jails and provide them with less than adequate medical care that has now resulted in the deaths of at least 50 innocent human beings.
Values out of whack
As a nation, our actions are out of alignment with our values.
We are overwhelmed by the constant barrage of toxic messages and distressful events that shape our sense of who we are as a society and negatively affect our physical and mental health. We have seen, and some have personally experienced, the horrific public health impact of the resurgence of preventable diseases and deaths from measles, a disease that had been eradicated from the U.S.
As nurses, we have seen how words are used to evoke false beliefs. We have never seen a “vat” of solution injected into any person — let alone an infant, as President Donald Trump recently claimed about the childhood vaccination regimen. We have witnessed the fear and confusion of parents related to the mixed messages coming from non-pediatricians about the value of childhood vaccinations. Why change the vaccination schedule without evidence?
We see reductions and disinvestments in essential research funding that will hurt Americans waiting for scientific breakthroughs. Discouraging the next generation of investigators threatens our standing as a global leader in research innovation.
We experience ourselves the rising costs of life’s necessities, such as food, housing, and healthcare. And we endure public coarseness and disgraceful conduct among those elected to represent us, increasingly characterized by contempt and by labeling those with whom they disagree as “radicals,” “socialists,” “fascists,” or worse.
These developments are not mutually exclusive, and they represent a troubling sign for a country where trust in the values of public institutions and in government leaders and workers is being eroded by outright lies and a lack of mutual respect. In 2025, only 17% of Americans trusted the government to do “what is right.”
Moral distress occurs when one’s values are constrained because of institutional, social, political, or other barriers.
Moral distress occurs when one’s values are constrained because of institutional, social, political, or other barriers.
The concept is often applied to healthcare workers, such as nurses. For example, moral distress has been widely documented when nurses are unable to deliver a treatment they know is best because of restraints imposed by the healthcare system in which they work.
Repeated experiences of moral distress often lead to a sense of disillusionment, disengagement, moral outrage, burnout, and apathy. When this moral distress and resulting harm is experienced by a broad swath of the general population, we call this civic moral distress.
So what can we do?
We know respectful dialogue instead of derision advances collaborative agendas and builds solid coalitions. We know public health is key to the prevention of disease. We know respect for the dignity of our fellow humans has nothing to do with their age, race, gender, political ideology, or immigration status. We know a lack of basic healthcare leads to emergency room visits and higher costs. We know the average citizen is not being heard by those who represent them to address the broader societal and moral problems at home and feels powerless to change any of it.
Don’t be disillusioned
There are no easy antidotes to civic moral distress. Experts coalesce around key principles, grounded in a foundation of trust, that could move us from a morally distressed nation to one characterized by moral strength and integrity.
For everyone: Be kind, be truthful, perform one random act of kindness every day, care for your neighbors. For newspapers: Publish one issue a week that focuses on local community issues. For all government officials: Don’t break everything just because you can; stay in your lane and do not make healthcare recommendations out of your area of expertise.
For all Americans: Do not be disillusioned.
Advancing this agenda will require significant moral courage. Failing to do so will further erode our society, our humanity. And although civic moral distress is our current reality, it need not be our future.
Connie M. Ulrich is a registered nurse and professor of nursing and of medical ethics and health policy at the University of Pennsylvania School of Nursing. She is a Hastings Center Fellow. Mary D. Naylor is a registered nurse and professor of gerontology and nursing at Penn’s School of Nursing. Martha A.Q. Curley is a registered nurse and professor of pediatric nursing at Penn’s School of Nursing.
Inquirer Opinion Newsletter
