MDS-R | Center on Trauma & Children

Moral Distress Scale - Revised

Hamric, A., Borchers, C., & Epstein, E. (2012). Development and testing of an instrument to measure moral distress in healthcare professionals. American Journal of Bioethics Primary Research, 3(2), 1–9.

Lamiani, G., Setti, I., Barlascini, L., Vegni, E., & Argentero, P. (2017). Measuring Moral Distress Among Critical Care Clinicians: Validation and Psychometric Properties of the Italian Moral Distress Scale-Revised*. Critical Care Medicine, 45(3), 430-437

Please read each item below and indicate the level of disturbance you are experiencing related to that item.

MDS-R

Questions	1	2	3	4 Great extent
1. Provide less than optimal care because of pressures from administrators or insurers to reduce costs . *	1	2	3	4 Great extent
2. Witness healthcare providers giving “false hope” to the patient or family.	1	2	3	4 Great extent
3. Follow the family’s wishes to continue life support even though I believe it is not in the best interest of the patient.	1	2	3	4 Great extent
4. Initiate extensive life-saving actions when I think they only prolong death.	1	2	3	4 Great extent
5. Follow the family’s request not to discuss death with a dying patient who asks about dying.	1	2	3	4 Great extent
6. Feel pressure from others to order/facilitate what I consider to be unnecessary tests and treatments.	1	2	3	4 Great extent
7. Continue to participate in care for a hopelessly ill person who is being sustained on a ventilator when no one will make a decision to withdraw support.	1	2	3	4 Great extent
8. Avoid taking action when I learn that a physician or nurse colleague has made a medical error and does not report it.	1	2	3	4 Great extent
9. Assist another healthcare provider who in my opinion is providing incompetent care.	1	2	3	4 Great extent
10. Be required to care for patients I don’t feel qualified to care for.	1	2	3	4 Great extent
11. Watch/ Let medical student perform painful procedures on patients solely to increase their skill.	1	2	3	4 Great extent
12. Provide care that does not relieve the patient’s suffering because of fears that increasing the dose of pain medication will cause death.	1	2	3	4 Great extent
13. Request or follow directives not to discuss the patient’s prognosis with the parent or family.	1	2	3	4 Great extent
14. Increase or administer the dose of sedatives/opiates for an unconscious patient that I believe could hasten the patient’s death.	1	2	3	4 Great extent
15. Take no action about an observed ethical issue because the involved staff member or someone in a position of authority requested that I do nothing.	1	2	3	4 Great extent
16. Follow the family’s wishes of the patient’s care when I do not agree with them but do so because of fears of a lawsuit.	1	2	3	4 Great extent
17. Work with nurses or other healthcare providers who are not as competent as the patient care requires.	1	2	3	4 Great extent
18. Witness diminished patient care quality because of poor team communication.	1	2	3	4 Great extent
19. Ignore situations in which patients have not been given adequate information to insure informed consent.	1	2	3	4 Great extent
20. Watch patient care suffer because of a lack of provider continuity.	1	2	3	4 Great extent
21. Work with levels of nurse or other care provider staffing that I consider unsafe.	1	2	3	4 Great extent

Important Information
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