Coined by Jonathan Shay, a clinician who works with combat veterans, the term ‘moral injury’ refers to an injury that occurs when one’s moral beliefs are betrayed. Shay developed the term to capture the shame and guilt of veterans he saw in his clinical practice. Since then, debates about moral injury have centered around the ‘what’ and the ‘who’ of moral injury. Clinicians universally acknowledge the challenge of treating moral injuries. I will argue that this is in part because there (...) is an essential piece of the theoretical construct that has been left behind. Namely, when veterans are morally injured, they are not only haunted by what they have done but also by the specter of a world without morals. (shrink)

BackgroundPublic Safety Personnel are routinely exposed to human suffering and need to make quick, morally challenging decisions. Such decisions can affect their psychological wellbeing. Participating in or observing an event or situation that conflicts with personal values can potentially lead to the development of moral injury. Common stressors associated with moral injury include betrayal, inability to prevent death or harm, and ethical dilemmas. Potentially psychologically traumatic event exposures and post-traumatic stress disorder can be comorbid with moral injury; however, moral injury (...) extends beyond fear to include spiritual, cognitive, emotional or existential struggles, which can produce feelings of severe shame, guilt, and anger.ObjectiveThis scoping review was designed to identify the extant empirical research regarding the construct of moral injury, its associated constructs, and how it relates to moral distress in firefighters, paramedics, and police officers.MethodsA systematic literature search of peer-reviewed research was conducted using databases MEDLINE, EMBASE, APA PsychInfo, CINHAL PLUS, Web of Science, SCOPUS, and Google Scholar. Included studies were selected based on the inclusion criteria before being manually extracted and independently screened by two reviewers.ResultsThe initial database search returned 777 articles, 506 of which remained after removal of duplicates. Following review of titles, abstracts, and full texts, 32 studies were included in the current review. Participants in the articles were primarily police officers, with fewer articles focusing on paramedics and firefighters. There were two studies that included mixed populations. Most studies were qualitative and focused on four topics: values, ethical decision-making, organizational betrayal, and spirituality.ConclusionPublic safety organizations appear to recognize the experience of moral distress or moral injury among public safety personnel that results from disconnects between personal core values, formal and informal organizational values, vocational duties, and expectations. Further research is needed to better understand moral distress or moral injury specific to public safety personnel and inform training and treatment in support of public safety personnel mental health. (shrink)

This study investigates the relationship between moral stress reactions and resulting coping efforts in severely morally challenging situations. Long-term positive reactions and post-traumatic stress disorder (PTSD) indicators following morally challenging situations are also studied. The sample consisted of cadets and officers (n = 332) from Norway and Sweden. Long-term positive reactions were found to be associated with limited moral stress reactions during the challenging episode and frequent use of acceptance and positive reappraisal coping strategies. Long-term high scores on a PTSD (...) indicator scale covaried with high scores on Openness, a strong moral stress reaction, and frequent use of instrumental coping strategies. The main conclusion is that the immediate moral stress reaction and coping strategies following morally challenging situations appear to be related to both positive long-term reactions and to indicators of PTSD. (shrink)

A philosopher examines the complicated phenomenon of gaslighting “Gaslighting” is suddenly in everyone’s vocabulary. It’s written about, talked about, tweeted about, even sung about (in “Gaslighting” by The Chicks). It’s become shorthand for being manipulated by someone who insists that up is down, hot is cold, dark is light—someone who isn’t just lying about such things, but trying to drive you crazy. The term has its origins in a 1944 film in which a husband does exactly that to his wife, (...) his crazy-making efforts symbolized by the rise and fall of the gaslights in their home. In this timely and provocative book, Kate Abramson examines gaslighting from a philosophical perspective, investigating it as a distinctive moral phenomenon. Gaslighting, Abramson writes, is best understood as a form of interpersonal interaction, a particular way of fundamentally undermining someone. The gaslighter, Abramson argues, aims to make his target experience herself as incapable of reasoning, perceiving, or reacting in ways that would allow her to form appropriate beliefs, perceptions, or emotions in the first place. He seeks not only to induce in her this unmoored sense of herself but also to make it a reality. Using examples and analysis, Abramson gives an account of gaslighting and its immorality, and argues that such a discussion can help us understand other aspects of social life—from racism and sexism to the structure of interpersonal trust. (shrink)

The article assesses different models of professional ethics and develops a model which sees professional imperatives as the institutionally-guided expression of foundational moral principles. This article uses the model to assess the moral pressures placed on interrogators in undercover operations in which a detective poses as a suspect in pre-arraignment holding. While highly effective, the level of empathetic rapport required risks incurring compassion fatigue and burn out on the part of detectives.

In healthcare practice, care providers are confronted with decisions they have to make, directly affecting patients and inevitably harmful. These decisions are tragic by nature. This study investigates the role of Moral Case Deliberation in dealing with tragic situations. In MCD, caregivers reflect on real-life dilemmas, involving a choice between two ethical claims, both resulting in moral damage and harm. One element of the reflection process is making explicit the harm involved in the choice. How harmful are our decisions? We (...) investigated how facilitators of MCD experience the importance of addressing harm in MCD and what participants learn from reflecting on harm. The study was qualitative, focusing on the views and experiences of the facilitators of MCD. Semi-structured interviews were conducted with facilitators of MCD. The research focuses on the subjective experiences of facilitators. Grounded Theory was used for analysis. The results show two main categories. The first concerns the awareness of tragedy. Within this category, five themes were discerned: making explicit that there is no solution, visualizing consequences, uncovering pain, focusing on emotion, and exploring perspectives on harm. The second category concerns the support for healthcare professionals in dealing with the tragedy of the choices they face. In this category, five themes came forward: acknowledging, offering comfort, managing harm, consideration through dialogue and repairing harm. Our study shows that addressing harm in MCD in tragic situations provides an important moral learning opportunity for participants. By formulating and becoming aware of harm, MCD aids healthcare professionals in the task they are faced with, namely making difficult and painful choices. MCD helps healthcare professionals to repair moral damage, making clear at the same time that harm cannot be undone. (shrink)

Bernard Williams briefly discusses agent regret in his broader account of moral luck. The present paper first outlines one way to develop Williams’s notion with reference to the unintended harm; it then suggests that agent regret can be counteracted by externalizing the action that caused unintended harm, in Harry Frankfurt’s sense of externalization; and then the present paper argues that apology is a mechanism by which a person can externalize an offending action/effect—in that way counteracting agent regret. This function for (...) apology—self-repair—is different from others described in the literature, which address the role of apology in repairing relationships. The present paper describes a nonfictional example, that of a veteran of the U.S. war in Iraq who contacts a family gravely injured by him and his combat unit; the veteran is motivated to contact the family to apologize. The example serves as a prototypical case of agent regret. The example is taken from a recent literature on the clinical psychology of self-inflicted “moral injury”; categorizing this example of moral injury as agent regret also helps broaden our understanding of moral injury as a philosophical category and as a psychological phenomenon. (shrink)

Research on ethical leadership generally falls into two categories: one celebrates individual leaders and their ‘authentic’ personalities and virtuous stewardship of organizations; the other decries toxic leaders or individuals in positions of power who exhibit ‘dark’ personality traits or dubious morals. Somewhere between these extremes, leadership is ‘done’ by imperfect human beings who try to avoid violating their own ethical standards while at the same time navigating the realities of social and organizational life. This paper discusses the concept of ‘Moral (...) Recovery’ as an ethical leadership process that begins in moral failure, but enables eventual personal, organizational, and social change. It builds on the concept of ‘Moral Injury’ from the work of the psychiatrist Johnathan Shay and refers to the experiences of armed service personnel traumatized by experiences where either they, or their leaders, violated their own values. ‘Morally injured’ parties recover their sense of wellbeing through engaging with restorative communal actions which address the social causes of unethical practices. The process of Moral Recovery requires restorative communal actions which address the social causes of unethical practices. This paper will outline the concept of ‘Moral Recovery’ as a form of practical ethical leadership and change. It will illustrate its relevance to ethical leadership practice with reference to one high-profile case; Ray Anderson of Interface. As this paper is primarily conceptual, avenues for future research are identified, and implications for teaching practice are discussed. (shrink)

Following other contributions about the MAX accidents to this journal, this paper explores the role of betrayal and moral injury in safety engineering related to the U.S. federal regulator’s role in approving the Boeing 737MAX—a plane involved in two crashes that together killed 346 people. It discusses the tension between humility and hubris when engineers are faced with complex systems that create ambiguity, uncertain judgements, and equivocal test results from unstructured situations. It considers the relationship between moral injury, principled outrage (...) and rebuke when the technology ends up involved in disasters. It examines the corporate backdrop against which calls for enhanced employee voice are typically made, and argues that when engineers need to rely on various protections and moral inducements to ‘speak up,’ then the ethical essence of engineering—skepticism, testing, checking, and questioning—has already failed. (shrink)

Autonomous weapon systems could in principle release military personnel from the onus of killing during combat missions, reducing the related risk of suffering a moral injury and its debilita...

The modern soldier is faced with a complex moral and psychological landscape. As Nancy Sherman puts it in The Untold War: Inside the Hearts and Minds of our Soldiers, ‘soldiers go to war to fight external enemies… but most fight inner wars as well.’ The modern soldier is no longer simply a warrior: he is at once a peacekeeper, diplomat, leader, sibling and friend. In the face of such challenges, some responsible for the teaching of soldiers have endeavoured to incorporate (...) a character-based training programme, designed to develop virtues that will assist soldiers in fulfilling the multiple roles required of them. However, these training programmes are stymied by the dearth of virtue-based discussion within the most influential guide to the moral conduct of soldiers: just war theory . JWT remains a primarily deontic system in which rights, duties and law are generally perceived as the most important considerations. Aretaic ethics has a great deal to offer both JWT and military education progra.. (shrink)

The need for research to advance scientific understanding must be balanced with ensuring the rights and wellbeing of participants are safeguarded, with some research topics posing more ethical quandaries for researchers than others. Moral injury is one such topic. Exposure to potentially morally injurious experiences can lead to significant distress, including post-traumatic stress disorder, depression, and selfinjury. In this article, we discuss how the rapid expansion of research in the field of moral injury could threaten the wellbeing, dignity and integrity (...) of participants. We also examine key guidance for carrying out ethically responsible research with participants’ rights to self-determination, confidentiality, non-maleficence and beneficence discussed in relation to the study of moral injury. We describe how investigations of moral injury are likely to pose several challenges for researchers including managing disclosures of potentially illegal acts, the risk of harm that repeated questioning about guilt and shame may pose to participant wellbeing in longitudinal studies, as well as the possible negative impact of exposure to vicarious trauma on researchers themselves. Finally, we offer several practical recommendations that researchers, research ethics committees and other regulatory bodies can take to protect participant rights, maximise the potential benefits of research outputs and ensure the field continues to expand in an ethically responsible way. (shrink)

One contested moral commitment shared by the American Medical Association and American Nurses Association has to do with the place of conscience in the practice of medicine. These organizations, each in their own way, urge their respective members to engage in careful moral discernment regarding their professional life, and they assert the existence of an obligation on the part of others to respect the conscientious objections of healthcare professionals and to accommodate objecting individuals. Yet despite the value that these organizations (...) place on conscience and objector rights, these organizations do not offer elaborate philosophical defenses of their positions. This shortcoming is exposed by the light of contemporary philosophical challenges to conscience-friendly policies. What such challenges demand is a philosophical defense of these organizations’ moral commitments and corresponding policy recommendations. The point of this article is to indicate how the Catholic philosophical tradition’s account of the nature and importance of conscience can philosophically underwrite these organizations’ conscience-related principles and practices. It can be seen, then, that the Catholic tradition is far from inimical to the contemporary practice of medicine and that, on the contrary, this tradition offers philosophically serious grounds on which to rest some of the most morally significant values and guidelines endorsed by these contemporary health-professional organizations and their members. (shrink)