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What causes moral injury and moral distress?

Moral injury happens when one is exposed to a potentially morally injurious event, or PMIE

PMIEs involve exposure to actions, omission of actions, or events that go against a person’s morals. 

There are at least three types of potentially morally injurious events, all of which can occur once or be ongoing:5

  • Self-oriented moral transgressions: Behaving against your own morals or failing to do something you think is “right.”
  • Other-oriented moral transgressions: Witnessing someone else’s immoral behaviour.
  • Betrayal: Experiencing a transgression committed by a trusted person or group.

Remember, a PMIE can be the absence of an event. It’s also important to note that HCPs who want to act morally can find themselves constrained by their resources. An example of this could be wanting to provide compassionate care to patients but feeling impeded by time constraints.

Research has unearthed a variety of PMIEs associated with the pandemic. A few are listed here:

  • Lack of PPE
  • Lack of enough people to do the work
  • Fear of infecting family and loved ones
  • Getting infected and feeling guilty for disappointing colleagues while dealing with illness
  • Being made the face of policies that prevent a caring role (e.g., having to implement no-visitors policies for families of dying patients)
  • Lack of action or support from leadership to fix problems that impact patient care