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Measuring and Minimizing Moral Distress

By Paul Basilio, December 8, 2025

Veterinary medicine is rife with ethical dilemmas, and equine practice often presents unique challenges that can increase the risks for career dissatisfaction and professional burnout due to moral distress. At a time when veterinarians are increasingly leaving practice due to long hours, compassion fatigue, and other factors, recognizing the causes of moral distress and understanding the tools to minimize its impact are critical to the future of the field.

Moral distress is generally defined as a mental state that occurs when a person is faced with an ethical dilemma, makes a judgment about the best course of action, and is forced to act in a way they believe is morally wrong. The term was first introduced in human medicine in the 1980s in reference to nurses facing institutional constraints.

For Barb Crabbe, DVM, MA Bioethics, moral distress presented itself early in her career when an older horse’s owners elected euthanasia because the horse had lice. Dr. Crabbe tried to explain that the condition was easily treatable, but the owners refused and insisted that the patient be euthanized.

“I did it, and I felt deep down at the time that I probably wasn’t doing the best thing for my patient,” she said. “That horse’s story has haunted me for my entire career.”

During a presentation at the 71st Annual AAEP Convention in Denver, Colo., Dr. Crabbe discussed how to recognize moral distress and what can be done to minimize its hold on veterinarians.

The Ideal vs The Real 

To illustrate one of the multiple ways in which moral distress can pop up in equine practice, Dr. Crabbe first described an ideal, morally unambiguous scenario in which a practitioner is called to examine an 8-year-old horse with colic that requires surgery. After the veterinarian recommends referral to a surgical hospital, the owner says, ‘The trailer’s hooked up, we’re ready to go, and I’ll call the insurance company on the way.’

“But that’s not what always happens,” explained Dr. Crabbe, a member of the AAEP’s Professional Conduct and Ethics Committee and the AVMA’s Council on Veterinary Services.

Instead, several other scenarios are more likely. Perhaps the owner loves their horse, but they simply can’t afford to pay the bill, so they request that the horse be euthanized.

“We don’t love that response, but you understand it, and you euthanize the horse,” she said. “We accept that as part of our job, but for many of us it can cause a small level of moral distress every time it happens, even if we don’t realize it.”

Or the owner is misinformed based on information they got from a friend or the internet, and refuses surgery and euthanasia, and wants the horse managed with pain medications and fluids. “In this situation, we might be tempted to refuse to provide treatments, but we may feel compelled to continue because we don’t want to abandon our patient,” Dr. Crabbe said.

Sometimes, an owner may request immediate euthanasia for the horse with colic because they don’t want to spend any more money on it. This situation is one of the most striking examples of moral distress because the veterinarian appears to place a higher value on the patient’s life than the owner does. Euthanizing the horse feels wrong, but abandoning the horse and refusing to euthanize it also feels morally wrong.

“You’re forced to euthanize the patient, and you’re likely to experience moral distress,” Dr. Crabbe said.

For younger veterinarians who may feel they lack the agency to push back or voice their concerns, such situations can be an enormous source of moral distress, which can dramatically increase their risk of leaving the profession.

Measuring Distress

Unrecognized and unaddressed moral distress builds over time. For every moral dilemma that causes distress, lingering feelings or moral residue can accrue even after the problematic situation has passed. Each time that happens, a new baseline of moral distress is created.

In human medicine, several measurement tools have been published to identify or measure moral distress, but it wasn’t until recently that Australian researchers published a pilot moral distress scale specifically for veterinarians. The Measure of Moral Distress for Veterinary Clinicians (MMD-VC) scale is based on the Measure of Moral Distress for Healthcare Professionals (MMD-HP) scale used in human medicine.

The authors divided the moral challenges faced by veterinarians into 3 primary areas:

• Team conflicts (ie, “I disagree with my colleague. How do I handle that?
• Client conflicts (ie, “My client wants to euthanize a perfectly healthy horse for convenience.”
• Personal threats (ie, “If I don’t do this, I’m going to lose my job.”

While the scale was published in 2025, it is a promising step toward drawing more attention to moral distress and minimizing its potential impact on veterinarians that the profession cannot afford to lose.