Moral injury and the COVID-19 pandemic: A philosophical viewpoint

Abstract

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.

An Ethical Framework for Visitation of Inpatients Receiving Palliative Care in the COVID-19 Context

“…As above, we would argue that the frequent reliance on ad-hoc appeals for compassionate exemptions undermines just approaches to decision-making through making these instances seem an inappropriately exceptional (rather than expected) aspect of care. This case-by-case approach could also expose healthcare providers, tasked with deciding exemptions, to risk of moral injury due to their perception of a difference between their personal ethics and those of the prevailing institution (Akram 2021).…”

Intention-Based Critical Factors Affecting Willingness to Adopt Novel Coronavirus Prevention in Pakistan: Implications for Future Pandemics

“…In the sense of contextual behaviors, Borges et al [ 65 ] stated that the COVID-19 pandemic brought into light many moral dilemmas. Akram [ 66 ] reported that the U.S. healthcare system adopted utilitarian policies to deal with moral injuries during the COVID-19 pandemic outbreak. Liang et al [ 67 ] studied and revealed respondents’ depressive behaviors and moral collapse from China’s Hubei province during the pandemic outbreak.…”

Predict, prevent and manage moral injuries in Canadian frontline healthcare workers and leaders facing the COVID-19 pandemic: Protocol of a mixed methods study

“…Alarming prevalence of depression and anxiety have for example been reported worldwide ( da Silva and Neto, 2021 ; Lai et al, 2020 ; Sahebi et al, 2021 ; Wang et al, 2020 ). A less documented yet severe and preoccupying mental health consequence of the pandemic is the increased risk of moral injury (MI) in these workers (F. Akram, 2021a , Akram, 2021b ; Litam and Balkin, 2021 ; Shale, 2020 ). MI can arise from having to deal with the risk of being infected and infecting those close to them.…”