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Moral Injury

Moral injury is the lasting psychological harm we experience when we commit, or learn of actions, that are inconsistent with our moral beliefs.

Moral Injury

Moral injury, also called moral harm or moral trauma, is the lasting psychological distress that we may experience when we commit, or learn of actions, that are inconsistent with our moral beliefs. Moral injury often occurs on the battlefield, but it may also be suffered in other places like hospitals, offices, and legislative buildings.

Moral injury most commonly occurs in one of four ways–two are “self-related” and two are “other-related.”

Acts of Commission:

The first “self-related” cause of moral injury arises from acts of commission, where we do something that is inconsistent with our moral values. For example, soldiers may suffer moral injury after bombing a building they were told contained enemy soldiers only to learn later it was filled with school children.

Acts of Ommission:

The second “self-related” cause of moral injury stems from acts of omission, where our moral codes require us to act but we do not do so. For example, during the height of the COVID-19, health care workers faced shortages of personal protective equipment and other medical supplies. They watched patients die because they were unable to provide the level of care that they should have and wanted to.

Bearing Witness:

The first “other-related” cause of moral injury is bearing witness, where we see our moral norms seriously violated by others. For example, in the Ukraine war, Russian soldiers reported seeing their fellow soldiers repeatedly commit atrocities against civilians. These soldiers likely suffered moral injury.

Betrayal:

The second “other-related” origin of moral injury is betrayal, where we see a person in a position of authority betray what is right. For example, some Theranos employees, who joined the company with the hope of improving the health care industry, suffered moral injury when they learned that the CEO had defrauded investors and customers by lying about what its product could do.

Moral injury often leads to feelings of guilt, shame, anger, anxiety, and powerlessness. It can even lead to suicidal thoughts. Those who suffer from moral injury tend to self-isolate and to disengage from society.

So, given the serious impact of moral injury, it’s essential to keep it in our frame of reference. And factoring moral injury into our decision making is the only way to fully evaluate the true consequences of an action.

Bibliography

Kelly Denton Borhaug, And Then Your Soul is Gone: Moral Injury and U.S. War Culture (2021).

H. Patricia Hynes, “The Iraq War and Moral Injury,” Truthout, March 20, 2013, at https://truthout.org/articles/the-iraq-war-and-moral-injury/.

Giulia Lamiani et al., “When Healthcare Professionals Cannot Do the Right Thing: A Systematic Review of Moral Distress and Its Correlates,” Journal of Health Psychology 22:51-67 (2017).

Brett T. Litz et al., “Moral Injury and Moral Repair in War Veterans: A Preliminary Model and Intervention Strategy,” Clinical Psychology Review, 29: 695-706 (2009).

Michael Matthews, “Stress Among UAV operators: Posttraumatic Stress Disorder, Existential Crisis, or Moral Injury? Ethics and Armed Forces: Controversies in Military Ethics and Security Policy (2014).

Michael Matthews, “Moral Injury: Toxic Leadership, Maleficent Organizations, and Psychological Distress,” Psychology Today, March 10, 2018, at https://www.psychologytoday.com/us/blog/head-strong/201803/moral-injury.

Robert Meagher, Killing from the Inside Out (2014).

Jeffrie Murphy & Jean Hampton, Forgiveness and Mercy (1988).

Renos K. Papadopoulos, ed., Moral Injury and Beyond: Understanding Human Anguish and Healing Traumatic Wound (2020).

Elizabeth Rosner & Kate Sheehy, “Top Manhattan ER Doc Commits Suicide, Shaken by Coronavirus Onslaught,” New York Post, April 27, 2020, at https://nypost.com/2020/04/27/manhattan-er-doc-lorna-breen-commits-suicide-shaken-by-coronavirus/

Jonathan Shay, “Moral Injury,” Psychoanalytic Psychology, 21(2): 182-191 (2014).

Jonathan Shay, Achilles in Vietnam (1994).

Simon Talbot & Wendy Dean, “Physicians Aren’t ‘Burning Out.’  They’re Suffering from Moral Injury,” Boston Globe, July 26, 2018, at https://www.bostonglobe.com/ideas/2018/08/04/physicians-aren-burning-out-they-suffering-moral-injury/xGsJTQBHBzHdM2CvrWLa0M/story.html.

Syracuse University, “The Moral Injury Project,” at http://moralinjuryproject.syr.edu/.

Joseph Wiinikka-Lydon, Moral Injury and the Promise of Virtue (2019).

David Wood, What Have We Done? (2016).

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Framing

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Integrity

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Moral Emotions

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Obedience to Authority

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Obedience to Authority is the tendency people have to try to comply with superiors’ wishes, even when to do so conflicts with their own moral judgment.

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Role Morality

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Role morality describes how people sometimes apply different ethical standards depending on what role they see themselves playing.

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