Social workers are involved with people at critical points of the life course, including the dawn of life through pre-birth assessment undertaken where there are safeguarding concerns before a child is born, and the twilight of life through older age and end-of-life care. This paper explores the phenomenon of moral distress in these distinct and dissimilar fields of practice. Drawing on qualitative data from two England-based studies, we conducted an analysis of interviews (n=21) and surveys (n=71) to trace experiences of moral distress across pre-birth and end-of-life care.
Findings reveal shared patterns. Practitioners described moral distress not as uncertainty, but as inability to act on what they believed to be right, constrained by austerity, resource scarcity, and hierarchical decisions. Distress was expressed as sadness, emotional burden, and frustration, but participants also reported peer solidarity, coping strategies, and for some, moments of moral courage.
By juxtaposing dawn and twilight, we demonstrate how moral distress in social work is structurally generated rather than episodic. Implications include the need for reliable supervision, protected peer support, and policy reforms to ensure adequate resources that enable practitioners to uphold their values in practice.