“…Study sites were always indicated, North America and Europe, specifically England/UK were represented more than other regions. Studies were conducted across a number of different healthcare systems from the non-universal insurance system of the USA [ 40 – 42 , 44 , 48 , 57 , 62 , 63 , 69 , 76 , 78 , 85 , 87 ] to universal government-funded health system (single-payer) of Italy [ 43 , 64 , 65 , 67 , 86 ], UK [ 6 , 46 , 51 , 66 , 68 , 72 , 74 , 77 , 81 ], Sweden [ 45 ], Canada [ 47 , 49 , 52 , 54 – 56 , 61 , 70 , 71 , 73 , 75 , 79 , 82 , 84 ], Norway [ 58 – 60 ] and Australia [ 50 ], to the universal private health insurance system of Netherlands [ 39 ], and the universal public insurance system (social insurance) of Romania [ 53 ]. Although clear themes emerged that related to different healthcare systems and funding mechanisms for care (e.g., what is available to the individuals in that system based on resources and guidelines), overall, descriptions of events which could cause moral distress showed some consiste...…”