COVID-19 Information for Veterans and their Families Report

Moral Injury: What is it and why should I care?

The COVID-19 pandemic has put Veterans working on the front lines and first responders in unprecedented situations that can produce feelings of pride and personal satisfaction but also heightened stress and anxiety. You may experience more concern about your own welfare and that of your family, colleagues, and community. You may also be required to make high-stake decisions that may weigh heavily and leave you feeling distressed or conflicted. Left unresolved, this distress can lead to operational stress injuries, posttraumatic stress injuries, or moral injuries.

What is moral injury?

Moral injury has been defined as “psychological, social and spiritual impact of events involving betrayal or transgression of one’s own deeply held moral beliefs and values occurring in high stakes situations.”

There isn’t a lot of evidence-based literature about moral injury for Veterans and first responders during COVID-19. Still, research on healthcare providers suggests it can occur when a caregiver feels acute responsibility for an incident or cannot act in a patient’s best interest, or when organizational constraints interfere with the ability to provide the best or ethically correct care.

Potentially morally injurious experiences (MIEs) you may encounter, whether or not you are a Veteran on the front lines, during the pandemic include:

  • Being expected to perform duties with minimal training or direction
  • Having to work with insufficient personal protective gear, medical equipment, or staff
  • Making decisions about who does and does not receive medical intervention
  • Witnessing suffering on a large scale

What are the effects of moral injury?

Moral injury can produce effects that are similar to posttraumatic stress disorder. It can have a significant impact on individuals, families, and organizations, so addressing it promptly is important. Moral injury can affect your personal life, prompting feelings of guilt, shame, anger, anxiety, and sadness. It can lead to self-criticism and judgment, as well as stress-related and mood disorders. It can also have short- and long-term consequences for your professional life, including reduced job satisfaction, capacity to work, and overall engagement.

If you think you’ve experienced an MIE or have a moral injury, reach out to and seek help from family, friends, colleagues, leadership, and healthcare professionals.

See the Guide to Moral Injury for more information.

Content contributors

  • Dr. Lorraine Smith-MacDonald
  • Dr. Liana Lentz
  • Dr. Suzette Brémault-Philips

Sources

  • Canadian Institute for Public Safety Research and Treatment. (2019). Glossary of terms: A shared understanding of the common terms used to describe psychological trauma (version 2.1). Regina, SK: Author. http://hdl.handle.net/10294/9055
  • Jinkerson, J.D. (2016). Defining and assessing moral injury: A syndrome perspective. Traumatology, 22(2), 122–130. https://doi.org/10.1037/trm0000069
  • Frankfurt, S., & Frazier, P. (2019). A review of research on moral injury in combat veterans. Military Psychology, 28(5), 318–330. https://doi.org/10.1037/mil0000132
  • Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003
  • Shay, J. (1994). Achilles in Vietnam: Combat Trauma and the Undoing of Character. New York: Scribner.
  • Severinsson, E. (2003). Moral stress and burnout: qualitative content analysis. Nursing and Health Sciences, 5, 59–66. https://doi.org/10.1046/j.1442-2018.2003.00135.x
  • Shoorideh, F.A., Ashktorab, T., Yaghmaei, F., & Majd, H.A. (2015). Relationship between ICU nurses’ moral distress with burnout and anticipated turnover. Nursing Ethics, 22(11), 64–76. http://doi.org/10.1177/0969733014534874
  • Corley, M.C., Elswick, R.K., Gorman, M., & Clor T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33(2), 250–256.