Confidentiality and ethics in moral injury

Emerging research on moral injury highlights potential ethical issues including challenges relating to confidentiality and ethical research conduct. Specifically, individuals with moral injury may be hesitant to disclose morally injurious events because of potential legal consequences or breaches of confidentiality.

This reluctance to share may limit appropriate care and support. The authors offer advice for ethically sound practices in moral injury. Though these suggestions are not exhaustive, they may offer some guidance. 

Advice for ethical practice when working with moral injury:

• Non-disclosure where possible.
• Patients should be consistently provided with information about the limits of confidentiality with specific examples.
• Where disclosure is considered, it is good practice to seek advice from senior colleagues and/or the organisation’s lawyers to assist with making a decision.
• Structured guidelines for clinicians to help them decide whether to breach confidentiality and how to manage the consequences.
• If disclosure is required, this is best done with the patient (if no risk is identified).

Further, another study proposes the ethical responsibilities of researchers studying moral injury in protecting participants from harm, ensuring informed consent, and maintaining the dignity and integrity of those involved with specific reference to moral injury.

For example, the authors explore how research with moral injury may introduce specific challenges such as managing disclosures of potentially illegal acts. The authors offer practical recommendations that researchers, research ethics committees, and other regulatory bodies may find useful. Please see the article for further information.