Truth, Lies, and Moral Injury
| Thursday, May 21, 2026 |
| 4:57 PM - 4:58 PM |
Speaker
Dr. Mandy El Ali
Senior Lecturer
Australian Catholic Unversity
Truth, Lies, and Moral Injury
Abstract Document
Aim
To explore the relationship between paediatric nurses’ commitment to veracity in clinical practice and the moral injury that arises when they are compelled to act against their moral code.
Method
An interpretative phenomenological approach was implemented when interviewing Australian paediatric nurses about their experiences and attitudes with truth-telling to seriously ill children, specifically when asked to uphold a non-disclosure directive and, in some instances, lie directly to children. Twenty-six participants were interviewed, and they shared numerous personal accounts of being instructed not to disclose.
Results
The themes that emerged from the data analysis centred around the participants' beliefs and perceptions, their experiences, and their feelings, significantly their feelings of distress. Moral distress was introduced to nursing by Andrew Jameton in 1985, who defined it as “… when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (Jameton, 1984). Participants in this study expressed feeling disempowered in the midst of a non-disclosure directive due to institutional constraints and did not have confidence in escalating their concerns, assuming no action would be taken. Morley et al. (2019), who provide a broader definition of moral distress (MD) support the feelings expressed by the participants who were particularly distressed when asked to lie. Morely et al., (2019) explains that MD must meet certain conditions such as possessing moral judgement regarding something they believe is wrong, and foreseeing a desirable outcome, and being unable to achieve it, in part due to the influence of institutional constraints, and resulting in negative psychological effects (El Ali et al., 2024; Morley et al., 2019).
Conclusion
Strong negative emotional responses to non-disclosure directives were held due to the conflict between personal moral beliefs and being asked to withhold information or lie, resulting in feelings of distress.
Reference List
El Ali, M., O'Neill, J., & Gillam, L. (2024). Paediatric nurses’ personal accounts of being told not to disclose information to children with serious illness – an interpretative Phenomenological study. Journal of Advanced Nursing. https://doi.org/https://doi.org/10.1111/jan.16596
Jameton, A. (1984). Nursing practice: the ethical issues. Prentice-Hall.
Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019). What is ‘moral distress’? A narrative synthesis of the literature. Nursing ethics, 26(3), 646-662. https://doi.org/10.1177/0969733017724354
To explore the relationship between paediatric nurses’ commitment to veracity in clinical practice and the moral injury that arises when they are compelled to act against their moral code.
Method
An interpretative phenomenological approach was implemented when interviewing Australian paediatric nurses about their experiences and attitudes with truth-telling to seriously ill children, specifically when asked to uphold a non-disclosure directive and, in some instances, lie directly to children. Twenty-six participants were interviewed, and they shared numerous personal accounts of being instructed not to disclose.
Results
The themes that emerged from the data analysis centred around the participants' beliefs and perceptions, their experiences, and their feelings, significantly their feelings of distress. Moral distress was introduced to nursing by Andrew Jameton in 1985, who defined it as “… when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (Jameton, 1984). Participants in this study expressed feeling disempowered in the midst of a non-disclosure directive due to institutional constraints and did not have confidence in escalating their concerns, assuming no action would be taken. Morley et al. (2019), who provide a broader definition of moral distress (MD) support the feelings expressed by the participants who were particularly distressed when asked to lie. Morely et al., (2019) explains that MD must meet certain conditions such as possessing moral judgement regarding something they believe is wrong, and foreseeing a desirable outcome, and being unable to achieve it, in part due to the influence of institutional constraints, and resulting in negative psychological effects (El Ali et al., 2024; Morley et al., 2019).
Conclusion
Strong negative emotional responses to non-disclosure directives were held due to the conflict between personal moral beliefs and being asked to withhold information or lie, resulting in feelings of distress.
Reference List
El Ali, M., O'Neill, J., & Gillam, L. (2024). Paediatric nurses’ personal accounts of being told not to disclose information to children with serious illness – an interpretative Phenomenological study. Journal of Advanced Nursing. https://doi.org/https://doi.org/10.1111/jan.16596
Jameton, A. (1984). Nursing practice: the ethical issues. Prentice-Hall.
Morley, G., Ives, J., Bradbury-Jones, C., & Irvine, F. (2019). What is ‘moral distress’? A narrative synthesis of the literature. Nursing ethics, 26(3), 646-662. https://doi.org/10.1177/0969733017724354
Biography
Mandy is a Senior Lecturer and Nurse Academic at the Australian Catholic University in Melbourne. With over two decades of experience in paediatric clinical practice, she brings deep practical knowledge to her teaching. Mandy has worked in the tertiary education sector for more than 20 years, supervising undergraduate nursing students across a broad range of clinical settings, including women’s and children’s health, residential care, medical-surgical wards, sub-acute units, and emergency departments.
In 2025, Mandy was awarded her PhD for research exploring the ethics of truth-telling in the care of seriously ill children. Her study revealed a troubling ethical tension: the expectation for clinicians to withhold the truth from children can directly conflict with their deeply held moral commitment to honesty. This conflict, her research found, is a significant contributor to moral injury—a psychological harm experienced when individuals are forced to act in ways that violate their core values.
Mandy’s work continues to explore the intersection of ethics, communication, and clinician well-being, with a focus on fostering morally sustainable practice in nursing and healthcare.
