When filial duty exceeds capacity: How moral obligations become caregiver distress.

Family caregiving is usually explained through burden, yet comparable demands can produce different moral and psychological consequences. We conducted a longitudinal qualitative study with 76 adult children who were primary caregivers for older parents with advanced cancer across nine provinces in China. Repeat interviews traced how filial responsibility changed as illness progressed and palliative care entered family decision-making. Four linked processes were identified: care became part of moral identity; endurance became the expected response to prolonged uncertainty; human limits were interpreted as moral failure; and good care was reconstructed without abandoning commitment. We define filial moral distress as suffering generated when the care a person believes a good child should provide exceeds what can be sustained, and that discrepancy is judged as evidence of moral inadequacy. Relational, clinical and structural conditions could intensify or interrupt this process. The findings show how valued obligations become psychologically harmful through self-evaluation rather than through demands alone.