An advanced perspective on moral challenges and their health-related outcomes through an integration of the moral distress and moral injury theories

Abstract

Both the models of moral distress and of moral injury place an emphasis on various types of moral challenges that may violate the individual’s conscience, evoking moral emotions. Yet, there appears to be great conceptual confusion as regards both scholarly perspectives. The purpose of this article is to further elaborate on the qualitative content and conceptual demarcations of the theories of moral injury and moral distress. In the light of this theoretical elaboration, we propose an integrated moral distress and injury scale that provides a more holistic overview of these moral challenges. We suggest that the utility and applicability of the moral injury and moral distress theories may benefit from the integration of these concepts. A practical implication of our theoretical understanding is that processes of recovery, which involve moral dimensions, are complex. In line with this understanding, we advocate a holistic approach to health and well-being among military service members and Veterans.

Potential Circumstances Associated With Moral Injury and Moral Distress in Healthcare Workers and Public Safety Personnel Across the Globe During COVID-19: A Scoping Review

“…Although the concepts of MD and MI share similarities, there remains ambiguity around their definitions ( 15 , 27 , 28 ). One approach proposed by Litz and Kerig ( 29 ) is to conceptualize MD and MI as existing on a continuum, with MD appearing on the less severe end of this spectrum.…”

“…However, others have suggested that MD and MI result from different types of insults, with MD resulting from the long-term accumulation of damage from organizational oppression, while MI results from the immediate harm resulting from a single substantial act going against individual beliefs ( 30 ). Given the limitations of these definitions, it has been suggested to integrate and synthesize the concepts of MD and MI as one, to better explore moral stressors holistically ( 28 ). Accordingly, we have taken a similar approach to explore these concepts conjointly in the context of COVID-19.…”

Developing a Global Medicine Student Pre- and Post-Travel Curriculum

“…The curriculum focuses on the learning objective of de ning and normalizing emotional and moral distress during global health work and developing a resiliency strategy for staying well while working outside of the US (24). One key aspect is creating a space for students to re ect on their personal challenges with developing resiliency.…”

Thank You for Hearing My Voice – Listening to Women Combat Veterans in the United States and Israeli Militaries

“…After military service, former military personnel may develop post-traumatic stress disorder (PTSD) or other related psychiatric conditions, which may impair their adaptation to a new post-military, civilian life (Grimell, 2018a, p. 193). These challenges involve physical, mental and moral elements (Shay, 1994;Grimell, 2018b;Molendijk, 2018;Grimell and Nilsson, 2020;p. 380).…”

“…After military service, former military personnel may develop post-traumatic stress disorder (PTSD) or other related psychiatric conditions, which may impair their adaptation to a new post-military, civilian life ( Grimell, 2018a , p. 193). These challenges involve physical, mental and moral elements ( Shay, 1994 ; Grimell, 2018b ; Molendijk, 2018 ; Grimell and Nilsson, 2020 ; p. 380). A study on United States combat veterans vs. non-combat veterans revealed that combat veterans are more than three times as likely to screen positive for lifetime PTSD ( Thomas et al, 2017 ).…”