'Telling them "that's what it says in the guidance" didn't feel good enough': moral distress during the pandemic in UK public health professionals.

BACKGROUND: The study aimed to identify the causes of moral distress in public health professionals associated with the COVID-19 pandemic, and the potential ways of avoiding or mitigating the distress. METHODS: The survey was distributed to all members of the UK Faculty of Public Health between 14 December 2021 and 23 February 2022. Conventional qualitative content analysis was conducted to explore the situations in which moral distress arises, the moral judgments that led to distress and the proposed ways to address moral distress. RESULTS: A total of 629 responses were received from respondents broadly representative of the public health professional workforce. The main situations causing moral distress were national policy, guidance and law; public health advice; and workplace environments. Moral distress was precipitated by judgments about having caused injury, being unable to do good, dishonest communications and unjust prioritization. The need to improve guidance, communication and preparedness was recognized, though there was disagreement over how to achieve this. There were consistent calls for more subsidiarity, moral development and support and freedom to voice concerns. CONCLUSIONS: The causes of moral distress in public health are distinct from other healthcare professions. Important proposals for addressing moral distress associated with the COVID-19 pandemic have been voiced by public health professionals themselves.

Moral distress and injury in the public health professional workforce during the COVID-19 pandemic.

BACKGROUND: There is growing concern about moral distress and injury associated with the COVID-19 pandemic in healthcare professions. This study aimed to quantify the nature, frequency, severity and duration of the problem in the public health professional workforce. METHODS: Between 14 December 2021 and 23 February 2022, Faculty of Public Health (FPH) members were surveyed about their experiences of moral distress before and during the pandemic. RESULTS: In total, 629 FPH members responded, of which, 405 (64%; 95% confidence interval [95%CI] = 61-68%) reported one or more experience of moral distress associated with their own action (or inaction), and 163 (26%; 95%CI = 23-29%) reported experiencing moral distress associated with a colleague's or organization's action (or inaction) since the start of the pandemic. The majority reported moral distress being more frequent during the pandemic and that the effects endured for over a week. In total, 56 respondents (9% of total sample, 14% of those with moral distress), reported moral injury severe enough to require time off work and/or therapeutic help. CONCLUSIONS: Moral distress and injury are significant problems in the UK public health professional workforce, exacerbated by the COVID-19 pandemic. There is urgent need to understand the causes and potential options for its prevention, amelioration and care.

When Does Catholic Social Teaching Imply a Duty to be Vaccinated for the Common Good?

In 2017, Carson and Flood outlined a general duty to be vaccinated, arguing from Catholic social teaching on justice, love, solidarity and the common good. This necessarily relied on assumptions about the typical nature of vaccination, assumptions which do not always hold true in concrete situations. I identify twelve criteria that, where they hold, strengthen the particular duty to be vaccinated, and, if not met, weaken or reverse it. These pertain to the biological agent which vaccination aims to protect against, the vaccine and its supply, the costs and benefits of vaccination to the individual and society, and the alternative courses of action. The two-way relationship between the moral duty to be vaccinated and vaccine mandates is discussed. Individuals and policy-makers need to know these criteria - and be provided the necessary information to evaluate vaccination against them - in order to make a truly rational judgement.