Health Equity as Mission and Source of Moral Distress: examining health systems actions through a conflict of interest lens

In recent years, health systems throughout the United States have made public declarations committing to health equity. Yet clinicians in these systems often feel they are not set up to support equitable care. This discrepancy between proclaimed commitments and on-the-ground realities is one of the major reasons for the continued rise in clinician moral distress. Hospitals' mission statements are often multifaceted. Therefore, when one facet, such as research or education, is prioritized, another, such as health equity, may suffer. Do these represent conflicts of interests? Ethical dilemmas? What about the fiduciary responsibilities of a health system? How do those come into play when a hospital is deciding which aspects of its mission to prioritize? This article discusses hospital missions, values, and fiduciary responsibilities; characterizes the nature of the conflicts that arise when key aspects of these commitments and responsibilities are at odds; and offers hospitals and health systems insights for characterizing these conflicts when they arise. By assisting health systems to communicate better with their staff, the authors hope to propel systems further towards achieving health equity and concurrently decrease clinician moral distress.