Moral distress arises not only from organizational constraints on moral action but also from the environmental impacts of health care and climate change.

A narrow definition of moral distress may mask morally relevant distinctions between types of distress and the groups experiencing it.

Interdisciplinary ethics consultation helps address organizational policies, practices, and structures that can be sources of moral distress.

Physicians’ reliance on “culture” to explain patients’ noncompliance may serve as code for their discomfort with difference, uncertainty, and distress.

When patient-centered care conflicts with duties to follow guidelines, physicians should be transparent with patients.

The AMA Code of Medical Ethics’ opinions related to moral distress and medicine.

Transparency about teaching hospitals’ educational mission respects patient autonomy and aligns patients’ interests with those of trainees and the public.

The image, “Dirty Laundry: Drug Formulary Exclusions,” calls attention to how drug formularies undermine physicians’ and patients’ medical decision making.

Hospital medicine must expand its mission to include the teaching of medical ethics, professionalism, and communication to trainees during clinical rounds.

Incorporate palliative care ethics into research, education, practice, and systems design to reduce moral distress.