Moral distress is anguish experienced when an individual makes a clear moral judgment about an action to take but is unable to act accordingly due to societal, institutional or contextual constraints. A systematic review of 13 studies on moral distress in the NICU and PICU found that they were predominantly based on nursing staff. Common themes were excessive use of technology perceived not to be in a patient’s best interest, and powerlessness to act. In nursing literature, nurses were often portrayed as victims, with physicians as perpetrators instigating ‘aggressive care’. Within medical literature moral distress was described in terms of dilemmas or ethical confrontations.