Moral injury: What is it and Why Should I Care?

The COVID-19 pandemic has put public safety personnel (PSP) in unprecedented situations that can produce feelings of pride and personal satisfaction but also heightened stress and anxiety. You may experience more concern about your own welfare and that of your family, colleagues, and community. You may also be required to make high-stake decisions that may weigh heavily and leave you feeling distressed or conflicted. Left unresolved, this distress can lead to operational stress injuries, posttraumatic stress injuries, or moral injuries. 

What is moral injury?

Moral injury has been defined as “a particular trauma syndrome including psychological, existential, behavioural, and interpersonal issues that emerge following perceived violations of deep moral beliefs by oneself or trusted individuals.”

There isn’t a lot of evidence-based literature about moral injury for PSPs specifically. Still, research on healthcare providers suggests it can occur when a caregiver feels acute responsibility for an incident or cannot act in a patient’s best interest, or when organizational constraints interfere with the ability to provide the best or ethically correct care.

The actions taken by PSPs are often guided by strong personal and organizational values. This makes you susceptible to moral injury during this pandemic: you may have to make or carry out decisions that clash with deeply held personal and organizational morals and values.

Potentially morally injurious experiences (MIEs) you may encounter during the pandemic include:

• Being expected to perform duties with minimal training or direction
• Having to work with insufficient personal protective gear, medical equipment, or staff
• Making decisions about who does and does not receive medical intervention
• Witnessing suffering on a large scale

What are the effects of moral injury?

Moral injury can produce effects that are similar to posttraumatic stress disorder. It can have a significant impact on individuals, families, and organizations, so addressing it promptly is important. Moral injury can affect your personal life, prompting feelings of guilt, shame, anger, anxiety, and sadness. It can lead to self-criticism and judgment, as well as stress-related and mood disorders. It can also have short- and long-term consequences for your professional life, including reduced job satisfaction, capacity to work, and overall engagement.

If you think you’ve experienced an MIE or have a moral injury, reach out to and seek help from family, friends, colleagues, leadership, and healthcare professionals.

The COVID-19 Readiness Resource Project (CRRP) features several virtual town halls that focus on moral injury:

• Moral Dilemmas and Moral Injury: Confronting Wicked Problems, Ticky Questions, and Tough Decisions with Drs. Alexandra Heber and Suzette Brémault-Philips, Robert Stewart, and Nathalie Dufresne-Meek

“Moral Dilemma’s and Moral Injury” Town Hall

• Risk and Resilience to Moral Injury Among Public Safety Personnel and Healthcare Providers with Drs. Margaret McKinnon and Ruth Lanius, Robert Stewart, and Lt. Wade Wallace

[EMBED VIDEO OF “RISK AND RESILIENCE TO MORAL INJURY” TOWN HALL] “Risk and Resilience to Moral Injury” Town Hall

See the Guide to Moral Injury developed by the Centre of Excellence on PTSD and Phoenix Australia

Content contributors:

• Lorraine Smith-MacDonald
• Liana Lentz
• Suzette Brémault-Philips

Sources

• Canadian Institute for Public Safety Research and Treatment. (2019). Glossary of terms: A shared understanding of the common terms used to describe psychological trauma (version 2.1). Regina, SK: Author. http://hdl.handle.net/10294/9055.
• Jinkerson, J.D. (2016). Defining and assessing moral injury: A syndrome perspective. Traumatology, 22(2), 122–130. https://doi.org/10.1037/trm0000069
• Frankfurt, S., & Frazier, P. (2019). A review of research on moral injury in combat veterans. Military Psychology, 28(5), 318–330. https://doi.org/10.1037/mil0000132
• Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
• Severinsson, E. (2003). Moral stress and burnout: qualitative content analysis. Nursing and Health Sciences, 5, 59–66.https://org/10.1046/j.1442-2018.2003.00135.x
• Shoorideh, F.A., Ashktorab, T., Yaghmaei, F., & Majd, H.A. (2015). Relationship between ICU nurses’ moral distress with burnout and anticipated turnover. Nursing Ethics, 22(11), 64–76.http://dio: 10.1177/0969733014534874

Corley, M.C., Elswick, R.K., Gorman, M., & Clor T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33(2), 250–256.

English: https://www.moralinjuryguide.ca/

French: https://blessuremorale.ca/