Though origins of the term “moral injury” can be traced back to religious bioethics, most modern usage comes from a recognition of a syndrome of guilt, shame, and sense of betrayal experienced by soldiers returning from war. One feels like they crossed a line with respect to their moral beliefs. The spectrum of acts that can lead to moral injury is broad, ranging from killing of an enemy combatant who is shooting at the soldier (seemingly acceptable under wartime ethics), to killing of civilians or children (unacceptable). One need to witness the killing - dropping bombs or napalm can result in moral injury as well - nor need it be killing; harassment, hazing, and assault can result in moral injury, as can bearing witness to an event. While there is often overlap between moral injury and post-traumatic stress disorder (PTSD), they are not synonymous.

Today we talk with Shira Maguen, psychologist and Professor at UCSF and the San Francisco VA. One of the many fascinating parts of our discussion is when we talk about the moral injury faced by healthcare workers during COVID. I encourage you to listen to the last podcast to hear what moral injury can sound like - being asked to care for patients under far less than ideal circumstances, care that is the best under the circumstances but is not standard of care, wondering if as a result patients may have been harmed or died.

One common feature of moral injury in combat is a feeling of betrayal by superior officers who order soldiers to act in a way that contravenes their self-conception of right and wrong. One might say we in healthcare experienced a similar betrayal of leadership that flouted the science of mask wearing, stated that doctors were billing for COVID excessively to turn a profit, and touted unproven and potentially harmful medications as miracle cures.

We also talk about treatment (and it’s more than “I wanna hold your hand,” song choice hint)

Links:

Moral Injury Fact Sheet:
Moral Injury in Health Care Workers:
Health and Human Services: Moral Injury for Healthcare Workers:
Gender differences in Moral Injury
Moral Injury in the Wake of Coronavirus: Attending to the Psychological
Impact of the Pandemic on Healthcare Workers: Moral Injury

Moral Injury: Podcast with Shira Maguen

GeriPal - A Geriatrics and Palliative Medicine Podcast