Critical care clinicians commonly find themselves in situations that challenge their integrity as individuals and as professionals. In response to these situations, many clinicians experience moral distress.

When moral distress cannot be relieved and integrity cannot be restored, moral or ethical outrage may ensue. This column explores the contours of moral outrage, offers a definition of principled moral outrage, and suggests strategies for working more skillfully with the inevitable challenges to integrity that occur in the critical care environment.

Moral outrage has been described broadly as anger provoked by a real or perceived violation of an ethical standard such as fairness, respect, or beneficence.2,3  Pike4(p351) describes moral outrage as “characterized by energy-draining frustration, anger, disgust, and powerlessness.” The psychological processes that affect the intensity of moral outrage may be activated by threats to personal or professional role, identity, self-worth, or integrity; by beliefs or customs...

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