Harms, Wrongs, and Medical Moral Injury

Abstract

In this article I explore the contribution of ethical analysis and theological reflection to understanding and responding to moral injury of healthcare workers in light of the COVID pandemic. I begin by critically appraising the relevance of moral injury for healthcare contexts, and suggest that the term ‘medical moral injury’ should be used to differentiate it from ‘military moral injury’. I briefly relate medical moral injury to other relevant phenomena, such as moral dilemmas, moral distress, and moral residue, arguing that moral injury in healthcare contexts might take chronic as well as acute forms. I suggest that agent regret might play an important role in understanding medical moral injury. The associated distinction between harms and wrongs, and so regret and remorse, help us identify different kinds of moral injury, and the distinct role that apology plays in each instance. Theological reflection on penitence, forgiveness, and lament also contributes to understanding and responding to potentially morally injurious events. I conclude that while psychological intervention plays an important role in medical moral injury, moral and theological perspectives provide both crucial lenses through which to understand these potentially injurious moral landscapes, and resources to assist healthcare workers in navigating them more safely.

Moral Injury Post-COVID-19: More Than Military? A Theological Perspective

“…The original trauma context recedes, disappears into the background. This is also observed by Sloane (2023) and Čartolovni et al (2021) as failure to deal with the “moral” aspect of moral injury in most of the literature. Catchphrases such as “deeply held beliefs” and “moral compass” are used without much content, meaning, or significance, to satisfy the definition of moral injury (Čartolovni et al, 2021).…”

“…This compares with 59.6% of respondents who experienced moral distress in the 12 months prior to the pandemic.ICU and ED staff were simply unable to employ best-practice and were forced to allow people to suffer respiratory distress and even die from respiratory failure who had good prospect of recovery had they been provided with standard treatment. (Sloane, 2023, p. 15)A wide range of pre-pandemic moral frustrations and distress, “pessimism or cynicism towards patients, co-workers, supervisors, healthcare institutions, insurers, health-related industries such as pharmaceutical and biotechnology companies, and even wider society in its attitude and expectations about medical care” (Alexander, 2020, p. 83) proliferated and intensified in the crisis environment of the pandemic. 10…”

“…ICU and ED staff were simply unable to employ best-practice and were forced to allow people to suffer respiratory distress and even die from respiratory failure who had good prospect of recovery had they been provided with standard treatment. (Sloane, 2023, p. 15)…”

“…Alexander (2020) and Sloane are more circumspect, using “medical moral injury” to distinguish this from military experience. Sloane, in particular, notes that “differentiating kinds of moral injury and the contexts in which they occur matters not just for their diagnosis, but also to effective clinical, moral, and theological responses” (Sloane, 2023, p. 1). Further, Čartolovni et al (2021) note how the use of moral injury in medical contexts has been criticized for the lack of conceptual clarity in relationship to existing discussions such as burnout and moral distress among HCWs.…”

“… 5. “Differentiating kinds of moral injury and the context… matters not just to their diagnosis, but also to effective clinical, moral and theological responses” (Sloane, 2023, p. 12).…”