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.