All of the above will require a certain kind of moral courage,but unless a series of concerted and systematic challenges are made, nurses are likely to continue to face a wide range of ethical situations leading to the experience of moral distress, and subsequent loss of moral integrity. Mindful of this, and whatever we may call the phenomenon that is moral distress, and whatever the arguments for and against the varied conceptualisations of moral distress, what is really important is that something should be done about this serious and demoralising problem now rather than later