Luppo Kuillman

Facilitating and motivating factors for reporting reprehensible conduct 85 4 INTRODUCTION In recent decades, healthcare professionals have increasingly been encountering moral dilemmas in their daily work. This development seems to be associated with changes in patient behavior, as well as with factors related to stress. The role of the patient has transformed into that of a partner within the framework of shared decision-making (Stiggelbout et al., 2012). As patients become more involved in the decision-making process, conflicts are more likely to arise between their ideas and the professional opinions, norms, or values of healthcare providers. Moreover, continuous changes in the healthcare environment have generated stress factors that are more commonly experienced by all healthcare professionals, regardless of their specialization (Pauly, Varcoe, & Storch, 2012). These stress factors include: (a) staffing problems; (b) the effects of increasing efficiency demands; (c) disturbances due to increasing hierarchical power; and (d) decreased control over one’s own professional conduct (Burston & Tuckett, 2013a; Sporrong, Höglund, & Arnetz, 2006). In amoral dilemma, the aforementioned factors canmake it difficult to choose the right course of ethical conduct. For example, upon witnessing a moral offense, “the right thing” is to report it. In addition to a high capacity for moral reasoning (Liyanarachchi & Newdick, 2009), individuals need resources in order to utilize this capacity. The availability of such resources can be problematic under conditions of high work stress. In addition, it is more difficult to reach substantiated moral judgments in contexts involving conflicting interests between professionals and patients (Campbell, Ulrich, & Grady, 2016). The influence of the aforementioned stressors on the ethical decision- making process is known to cause “moral distress”: a psychological disequilibrium occurring when the proper course of action is known, but circumstances prevent taking such action (Elpern, Covert, & Kleinpell, 2005). The increasing transformation of healthcare delivery into a moral enterprise is making it more likely that the numerous dilemmas arising in the daily work of healthcare providers will complicate the process of making ethical decisions, ultimately evoking a succession of moments of moral distress. It has been described that moral distress can have deleterious outcomes, with both intrapersonal and interpersonal consequences, while also affecting the working environment. Moral distress can inflict feelings of powerlessness regarding decision-making processes concerning treatment, thereby leading to “indecisive behavior” (Burston & Tuckett, 2013b). Such indecision could also occur with regard to reporting reprehensible conduct of others.