Moral injury can follow exposure to potentially morally injurious events. While some people exposed to these events experience no symptoms, responses can range from short-term moral distress lasting days or weeks to moral injury, and in a minority of cases, to mental health disorders such as post-traumatic stress disorder (PTSD) or depression.
An example of a potentially morally injurious event might be a soldier who purposefully fires into the long grass who has an honest belief that an enemy combatant is there, but they later find out that they mistakenly shot a civilian child. Another example might be a healthcare worker who witnesses a colleague being publicly belittled by a manager, but they feel unable to intervene.
Though the majority of research exploring moral injury has been with military veterans, moral injury is not exclusive to the military. Indeed, moral injury can occur in any population. A non-military example might be a police officer working on domestic abuse cases who can witness extreme human suffering, but feel powerless to prevent further abuse due to perpetrators not being prosecuted or being found not guilty.
Moral injury does not only occur in the workplace. Studies have shown that refugees and human trafficking survivors can also experience moral injury.
Potentially morally injurious events fall into three different categories:
- Act of commission (doing something): When an individual has done something they should not have done
- For example: A junior prison officer uses force and unnecessary restraint to move a prisoner and the prisoner is badly injured as a result.
- For example: A veterinarian nurse witnesses a vet performing a procedure that put an animal under undue stress or harm (e.g., convenience euthanasia).
- Act of omission (not doing something): When an individual should have done something, but they did not
- For example: A humanitarian aid worker is unable to provide care to large numbers of desperate refugees due to a lack of resources.
- For example: A firefighter who is unable to rescue people from a burning building because they lack the necessary resources (e.g., lack of personal protective equipment).
- For example: A junior accountant who chooses not to speak up when a colleague is publicly humiliated by a senior leader.
- Betrayal: When an individual feels betrayed by others (often by a higher authority) who should have been looking out for their welfare
- For example: A first responder feels abandoned by their organisation after they experience an extremely distressing event at work and then ask for support as they are struggling and are told to ‘get on with it’.
- For example: Experiences of serious bullying or harassment from colleagues, managers, or clients.
- For example: A person reporting wrongdoing at work and then being isolated by their manager.
The impact of potentially morally injurious events depends on how an individual interprets and processes them. It is not exposure to the potentially morally injurious event that is central to the development of moral injury-related psychological problems. Rather, it is the way a person thinks about the event as they attempt to find meaning as to what happened that is central to the development of moral injury.
