News photos and stories of health professionals in intensive care units overflowing with ill patients have been among the most iconic images of the COVID-19 pandemic. These clinicians have shown physical and emotional exhaustion, and also claim to be morally distressed by witnessing and participating in patients’ care and deaths in sheer numbers under circumstances that feel morally wrong. Moral distress among healthcare professionals is a concept several decades old but still evolving.

This article explores the causes and levels of moral distress experienced by clinicians caring for low-income patients of safety net practices in the US during the COVID-19 pandemic.