Is moral fatigue making you tired?

June 25, 2020

Providence Health Team

[4 MIN READ]

Moral fatigue defines difficult situations -- where the right thing to do is unclear and fraught with “what-ifs.”
During the COVID-19 pandemic, seemingly everyday choices could have consequences that affect your health, the health of loved ones, and your community.
Providence psychologist Ezekiel Sanders shares 5 tips for handling the stress brought on by moral fatigue.

Suzanne Savell recalls the days when shopping for groceries was a simple, if mundane task. Before the coronavirus pandemic, the Portland resident didn’t give it a second thought to stop for one or two items after work. Now, even as restrictions ease, it still can require both planning and fast-thinking.

“I find going to the store exhausting. I’m putting it off more,” said Savell, a patient at Providence Medical Group Milwaukie. “When you’re walking through a store and you come around the corner where there’s another person, it’s a moment of indecision: ‘should I back away and wait, or proceed down the aisle?’”

That’s one of many calculations we all had to make since the globe was swept by the coronavirus (COVID-19). Deciding whether we really need to go to the post office, order takeout, ride public transit or walk in the park has implications that could affect others. We’re constantly weighing the cost of our actions and it takes a toll, leaving us emotionally exhausted and doubting our ability to make the right decision.

“People are having to make decisions that are now moral dilemmas, and it’s exhausting,” said Ezekiel Sanders, a licensed psychologist at Providence Medical Group.

This is what’s known as moral fatigue, a term that defines difficult situations where the “right thing to do” is unclear and fraught with “what-ifs.” It’s commonly used in reference to healthcare providers because the nature of their work requires constant decision-making that has potential consequences. Although you may not be making decisions for patients, during the pandemic, seemingly everyday choices could have consequences that affect your health, the health of loved ones, and your community.

Old routines, new rules

What we’re experiencing in our everyday lives is a new landscape, with very different rules of engagement. Before the pandemic, the decisions around picking up groceries might have been based on time, money and needs. Now it’s potentially all those things plus so much more. These seemingly no-win decisions are troubling and disorienting because the rules frequently change, and not everyone subscribes to the same ones.

“Often in these moral decisions there’s no clear answer,” said Sanders. “There’s always weighing of pros and cons, risks and benefits. What that often looks like in the pandemic is personal autonomy versus the greater good. As Americans, we’re generally more predisposed toward autonomy, so from that standpoint it becomes a bigger challenge. How do you let go of yourself for the greater good? Those daily decisions are challenging and can result in a high level of stress and fatigue.”

What are the health implications?

Sanders explained that every micro-decision we make as we navigate myriad uncertainties during the pandemic is like a tiny stressor. Alone, we probably wouldn’t notice one of these, but they add up over time and can sneak up to present themselves as avoidance behaviors, increased alcohol or drug use, irritability or impatience, and other behavior issues. The accumulation of stress from moral fatigue can also affect relationships and decision-making.

We witnessed the way people made unusual decisions in the early phase of the pandemic when people were hoarding toilet paper and flour. Sanders interprets this behavior as being driven by emotions (fear, anxiety, etc.) rather than logic. “It’s people’s attempt to minimize risk and feel as though they are prepared despite what could happen in the future,” he said.

How do you manage the stress?

It may feel difficult now, but we can learn to get through the challenges of this pandemic with practice and patience. Sanders recommends that you first bring awareness to how you’re feeling and whether you notice changes in your mood or behaviors as a manifestation of daily stressors. If you find yourself being impatient or irritable, for example, acknowledge it and try to understand why you might be feeling that way. Sanders also recommends that you:

Be compassionate with yourself. In other words, give yourself a break. We’re all navigating a gray area right now where there is uncertainty and no clear end in sight. This is not easy.

Talk with supportive family or friends about your decisions and how difficult it is to make them. Talking about these things can help you process feelings and normalize fears and doubts.

Slow down and allow yourself to process the question of going or not, wearing a mask, or not, etc. Anxiety can make it seem like every decision is urgent. Try not to let anxiety dictate how you make your decision.

Try not to second-guess yourself. Make a decision based on your values and then stick to it. Self-doubt can eat away at your sense of security and confidence.

Plan and understand your boundaries and limits. Think about what they are in advance, before you’re in the moment where you might have to make a decision that would require crossing a boundary you’ve set for yourself.

We can grow from this experience

Although it’s exhausting, there are positive outcomes associated with all the micro decisions we’re making these days. For example, by thinking through our actions in public places, we’re seeing how seemingly small actions can affect others. “There is a growing body of research around the theory of post-traumatic growth, defined as, ‘positive psychological change experienced as a result of adversity and other challenges in order to rise to a higher level of functioning,’' said Sanders. “I am not saying that the pandemic is a traumatic experience for everyone, but what I am saying is that there is evidence to suggest that we as humans can not only manage and handle difficult experiences, but we can actually (and often do) grow from them.”

Find a doctor

If you would like to talk with a behavioral health provider, make an appointment with a professional in your area. Use our provider directory to find the right Providence provider for you. Through Providence Express Care Virtual, you can also access a full range of healthcare services.