Introduction: Much has changed in healthcare during the coronavirus disease (COVID)-19 pandemic. Medicine, a profession of traditional principles and virtues, has faced unprecedented challenges in the light of scarce and unequal distribution of ventilators, testing, and personal protective equipment. Healthcare workers have been- and are increasingly likely to be- forced into situations that require difficult decision making under life-and-death conditions. Concepts of “medical necessity” and “maximum benefit” challenge healthcare systems that already struggle to manage unequal treatment and access to services, giving rise to moral distress and moral injury on the front lines.
Method: This article focuses on moral injury in the context of coronavirus disease (COVID)-19 pandemic. I review recent literature to highlight the psychological impact of many morally-injurious events that have been reported during the COVID-19 pandemic. With the help of a clinical vignette, I point out how healthcare systems adopt many utilitarian policies in times of excessive healthcare burden and offer a viewpoint that many morally injurious events happen when physicians, traditionally practicing Kantian and virtue ethics, are forced to follow utilitarian policies of healthcare system.
Conclusion: One form of moral injury may arise from inherent conflicts between individual deontological moral judgments and organizational utilitarian moral judgments. More research is needed to validate the philosophical viewpoint as well as to explore whether increased awareness and education of key principles within moral philosophy can better equip healthcare workers in situations when public health takes precedence over individual health.
Purpose of Review
This review focuses on recent advances in our understanding of the interactions between psychological stress, the immune system, and periodontitis, including the dynamic role of host stress responses in altering immune function, altering the oral microbiome and biofilm formation, and promoting local and systemic disease progression.
Recent Findings
Within the context of periodontal health and disease, stress leads to an impairment of effective antimicrobial defense, shifts in oral microbiome profiles toward more pathogenic gene expression and taxa composition, increased translocation, and biofilm formation. The link between stress and periodontitis is multiform and includes hypothalamic–pituitary–adrenal (HPA) axis and catecholamine activation, production of immune mediators of inflammation and, clinically, syndromes of depression, bipolar disorder, anxiety disorders, and sleep-wake disorders.
Summary
Psychological stress appears to be an important modifiable risk factor for the development and progression of periodontitis and other periodontal diseases.
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