Moral Disengagement in Medicine and Nursing: A Narrative Review

 Moral disengagement includes the cognitive mechanisms which are formed in the doer’s mind while performing unethical actions or deciding not to perform ethical actions, which influences the occurrence of unethical actions or not performing ethical behaviors. The Present study aims to narratively review the studies that have examined the role of this variable in medical and nursing settings.

 Through Google scholar and PubMed databases, besides using the search section of the websites of the journals related to medical and nursing ethics, the keywords moral disengagement, medical ethics and nursing ethics were searched; the articles which had studied moral disengagement in medicine and nursing until 2022 were reviewed.

Ethical Considerations: 

The results of the studies have been mentioned without bias, while observing trustworthiness in reporting the contents of the articles.

 Moral disengagement was found to be prevalent among the nurses and the physicians. Moral disengagement was accompanied by decreasing moral reasoning, behaviors and traits, as well as increasing unethical and unproductive behaviors among the physicians and the nurses. In addition, these mechanisms increased in the medical environments with higher levels of stress, more perceived injustice and higher power. On the other hand, they decreased in managerial conditions in the form of moral leadership. These mechanisms were more prevalent among the physicians and the nurses who had stress, unstable moods, negative emotions, as well as the desire for power.

 Considering the modifiability of moral disengagement through certain educational interventions, it is necessary to add some lessons or courses in order to introduce and reduce the mechanisms of moral disengagement in academic programs and the in-service courses of doctors and nurses In addition, considering the role of variables such as job stress, perceived injustice and having uncontrolled power, it can be possible to reduce the aforementioned variables and consequently, moral disengagement through applying certain management reforms such as applying ethical leadership.