In 2016, the story broke that Wells Fargo, a major bank in the United States, had been routinely defrauding customers by having its employees open customer accounts and activating financial products without customer’s clear consent or knowledge. It came to light through stories that this practice was pushed from the top down, with area presidents directing branch managers, who in turn pressured employees to meet sales goals at all costs. The fallout from these revelations included anecdotes from employees, who described physical and psychological symptoms of stress as a consequence not only of threats and intimidation from those higher on the food chain, but of routinely being forced into of lying, forgery, and other forms of deceptive behaviour.
Long hours, awful bosses and workplace bullying are widely observed as sources of potential psychological fallout, but we less often hear about the negative effects of working conditions that routinely contradict our sense of what is morally right. The Wells Fargo workers described above knew that they were being deceptive. Worse for some was the recognition that they were targeting vulnerable poor and elderly clients who were less likely to be able to afford the fees on the financial products they had been “sold.” Thus, part of the stress for employees came from knowing that their actions on the job were harmful to others.
The Origins and Nature of Moral Distress
One could argue that some Wells Fargo workers experienced the effects of moral distress. The concept of moral distress may be traced back to the 1984 book, Nursing Practice: The Ethical Issues, in which author Andrew Jameton stated “moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (p. 6). Distinct from moral dilemmas, where one does not know what to do, moral distress specifically describes cases where bureaucracies and authorities in workplaces prevent people from doing what they perceive to be right.
In health care, the case for moral distress is ready and obvious. In critical and acute care cases where physical suffering and the prospect of death loom large, it is not difficult to see where workers — in most cases nurses — would feel profound distress when feeling compelled to act against both intuitive and reasoned bases of morality. Oft-cited examples include being compelled to withhold pain medication, or to keep patients alive by artificial means when they are suffering and have no hope of recovery.
Imminent death and physical suffering: these topics evoke strong feelings, and invite immediate and intuitive understanding of moral distress that might be experienced by those who witness suffering and are unable to act to alleviate it. What, however, of moral distress when life is not on the line? Can it be applied to the likes of Wells Fargo workers, who were similarly compelled to act in ways that harmed the bank’s clients, and violated their own sense of right and wrong? Can it be applied to other workplace contexts where workers are constrained from behaving ethically? Moral distress might be considered for workers in factory farms, for example. Moral distress might describe teachers’ anxiety when they administer standardizes or other high-stakes tests to young children that generate test anxiety. A recent article by university professors proposed that moral distress might describe faculty’s experiences when they are required to respond punitively to plagiarism by international students who are not sufficiently prepared or fluent in English to study at Western institutions.
What’s interesting here is that by expanding the concept of moral distress to different workplace settings and the more mundane aspects of work, we may be able to add some new dimensions to our understanding of work-related stress and burnout. We may also be able to stimulate more dialogue in daily working life about ethics. In an era of slick PR campaigns, apparently effortless lying by CEOs, and a great deal of cynicism surrounding the trustworthiness of corporations, conversations about right and wrong in the workplace need to be brought back down to earth and in to a community of workers so that they are not shamed or isolated by being placed in compromising situations. Affronts to our moral sensibilities, over time, diminish our sense of self-worth and integrity — a cumulative effect that has been described as “moral residue” (Epstein & Hamric, 2009, p.3). These effects thrive in cultures of silence.
On the other hand, when ordinary people speak up and speak to colleagues about moral distress, it “outs” our desire to act with integrity. We can all be reassured that the world is not entirely full of those who exploit others and sleep very well at night. Some of us — hopefully most of us — care enough about doing the right thing that we become ill when we are consistently constrained from doing so, and this speaks to the resilience of moral feeling. This resilience is something in which we can all take some comfort.
 Mehrota, K. (2016, December 8. Wells Fargo ex-managers’ suit puts scandal blame higher up the chain. Bloomberg. Retrieved June 1, 2017 from https://www.bloomberg.com/news/articles/2016-12-08/wells-fargo-ex-managers-suit-puts-scandal-blame-higher-up-chain
 Jameton A (1984) Nursing practice: The ethical issues. Englewood Cliffs, NJ: Prentice Hall.
 See Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. Journal of Clinical Ethics, 20(4), 330–342. http://doi.org/10.1016/j.str.2010.08.012.Structure
 (cf. Porcher, J. (2011). The relationship between workers and animals in the pork industry: A shared suffering. Journal of Agricultural and Environmental Ethics, 24(1), 3–17, http://doi.org/10.1007/s10806-010-9232-z; Leder, D. (2012). Old McDonald’s had a farm: The metaphysics of factory farming. Journal of Animal Ethics, 2(1), 73–86); Vehviläinen, S., Löfström, E., & Nevgi, A. (2017). Dealing with plagiarism in the academic community: Emotional engagement and moral distress. Higher Education. http://doi.org/10.1007/s10734-017-0112-6