Moral Injury Guide

What is moral injury?

Moral injury refers to the psychological, social and spiritual impact of events in which a person performs, witnesses, or fails to prevent acts that conflict with one’s own deeply held moral beliefs and values.

Moral injury is a specific type of psychological injury that reflects an enduring impact on an individual’s self-image and world view.

When a moral injury does occur, the range of outcomes are broad and can include:

  1. Feelings of guilt, shame, anger, sadness, anxiety, and disgust
  2. Intrapersonal outcomes including lowered self-esteem, high self-criticism, beliefs about being bad, damaged, unworthy or weak, and self-destructive behaviours
  3. Interpersonal outcomes including loss of faith in people, avoidance of intimacy, and lack of trust in authority figures
  4. Existential and spiritual outcomes including loss of faith in previous religious beliefs, and no longer believing in a just world

The history of moral injury

A report on the history of moral injury, based on research from the King’s Centre for Military Health Research (KCMHR), released by King’s College London and Forces in Mind Trust (FiMT):

Why do we need to study moral injury?

The research and clinical community are in its early stages of understanding what moral injury really is, how to best treat it, and how to potentially prevent it.

Evidence suggests that moral injuries are common among military personnel and Veterans. Research, including research from the Centre of Excellence on Post-Traumatic Stress Disorder (PTSD) and Related Mental Health Conditions, has shown that military members who are exposed to potentially morally injurious events are at an elevated risk of developing adverse mental health outcomes such as PTSD and depression.

Researchers also recognize that moral injury may resonate with those who work in high-pressure environments such as health care. During the COVID-19 pandemic in particular, front-line health-care workers have faced moral stress from making critical decisions, often with limited resources.

Moral injury resources

A Guide to Moral Injury

The Centre of Excellence on PTSD partnered with Phoenix Australia – Centre for Posttraumatic Mental Health to co-develop Moral Stress Amongst Healthcare Workers During COVID-19: A Guide to Moral Injury (PDF, 6.1 MB).

This is a practical resource for health-care workers and organizations that defines moral injury, lays out the stressors that may lead to moral injury, provides a framework for managing events in the workplace, and outlines actions that can be taken at the organizational, team, and individual levels to avoid or reduce harms.

Racial Inequities and Moral Distress

Recognizing that COVID-19 has disproportionately affected racialized people and communities, the Centre of Excellence on PTSD released Racial Inequities and Moral Distress: A Supplement to Moral Stress Amongst Healthcare Workers During COVID-19 (PDF, 4.2 MB).

In additional to systemic discrimination within our society and the Canadian health care system, the COVID-19 pandemic has created and perpetuated stressors that can further weigh on racialized health-care workers. We created Racial Inequities and Moral Distress to name this issue.

Moral injury webinar

In this webinar, hosted by the University of Saskatchewan, speakers from the Centre of Excellence on PTSD provide an introduction to moral injury and share how to recognize and support Veterans who may be living with moral injury.

This webinar also includes voices from the research community and a Veteran voice. This lived and living experience and expertise is valued as highly as technical expertise in the developing understanding of moral injury.

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