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Physician moral injury in the context of moral, ethical and legal codes
  1. Philip Day1,
  2. Jennifer Lawson2,
  3. Sneha Mantri3,
  4. Abhi Jain4,
  5. David Rabago5,
  6. Robert Lennon5
  1. 1Department of Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
  2. 2Department of Pediatrics and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University of School Medicine, Durham, North Carolina, USA
  3. 3Department of Neurology and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
  4. 4St Mark's School of Texas, Dallas, Texas, USA
  5. 5Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
  1. Correspondence to Dr Philip Day, Family and Community Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; philip.day{at}utsouthwestern.edu

Abstract

After 40 years of attributing high rates of physician career dissatisfaction, attrition, alcoholism, divorce and suicide to ‘burnout’, there is growing recognition that these outcomes may instead be caused by moral injury. This has led to a debate about the relative diagnostic merits of these two terms, a recognition that interventions designed to treat burnout may be ineffective, and much perplexity about how—if at all—this changes anything.

The current research seeks to develop the construct of moral injury outside military contexts, generate more robust validity tests and more fully describe and measure the experiences of persons exposed to moral harms. Absent from the literature is a mechanism through which to move from the collective moral injury experience of physicians to a systematic change in the structure of medical practice. To address this, after providing a brief history, definitions and contrasts between burnout, moral distress and moral injury, we review the interplay of moral and ethical codes in the context of moral injury. We conclude by suggesting that professional associations can potentially prevent moral injury by providing protections for physicians within their codes of ethics.

  • ethics
  • interests of health personnel/institutions
  • applied and professional ethics
  • codes of/position statements on professional ethics
  • public policy

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Footnotes

  • Contributors PD drafted, revised and created the final version of the paper. He is the guarantor. JL, SM, AJ, DR significantly revised several draft versions of the paper and approved the final version. RL drafted the original version of the paper, created the figures, significantly contributed to revisions and reviewed and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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