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Repairing moral injury takes a team: what clinicians can learn from combat veterans
  1. Jonathan M Cahill1,
  2. Warren Kinghorn2,3,
  3. Lydia Dugdale1
  1. 1Center for Clinical Medical Ethics, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA
  2. 2Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
  3. 3Duke Divinity School, Durham, North Carolina, USA
  1. Correspondence to Dr Lydia Dugdale, Center for Clinical Medical Ethics, Department of Medicine, Columbia University Irving Medical Center, New York 10032-3784, NY, USA; lsd2134{at}cumc.columbia.edu

Abstract

Moral injury results from the violation of deeply held moral commitments leading to emotional and existential distress. The phenomenon was initially described by psychologists and psychiatrists associated with the US Departments of Defense and Veterans Affairs but has since been applied more broadly. Although its application to healthcare preceded COVID-19, healthcare professionals have taken greater interest in moral injury since the pandemic’s advent. They have much to learn from combat veterans, who have substantial experience in identifying and addressing moral injury—particularly its social dimensions. Veterans recognise that complex social factors lead to moral injury, and therefore a community approach is necessary for healing. We argue that similar attention must be given in healthcare, where a team-oriented and multidimensional approach is essential both for ameliorating the suffering faced by health professionals and for addressing the underlying causes that give rise to moral injury.

  • COVID-19
  • health workforce
  • mental health
  • ethics- medical
  • morals

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Footnotes

  • Contributors The article was conceived by JMC and LD. The first draft was provided by JMC. Major revisions were made by JMC, WK and LD. The final draft was edited and approved by JMC, WK and LD. The guarantor is JMC.

  • Funding This work was funded in part by the McDonald Agape Foundation.

  • Competing interests None declared.

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

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