WELLNESS
Moral Injury: What It Is and What We Can Do About It By Stephanie Balint, Vytas Karalius, MD, Amanda Ritchie, MD, Cindy Bitter, MD, MA, MPH, Amy Kontrick, MD, Al’ai Alvarez, MD, and Amanda J. Deutsch, MD, MPH on behalf of the SAEM Wellness Committe
SAEM PULSE | MARCH-APRIL 2023
Moral injury as a term used to describe the psychological, emotional, and spiritual harm resulting from participating in or witnessing acts that violate one’s deeply held moral and ethical values.
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For many of us, moral injury happens not infrequently while working in the emergency department (ED); however, moral injury is not synonymous with burnout. On February 7, 2023, the SAEM Wellness Committee sponsored a national webinar, Moral Injury: What It Is, What It's Not, and What We Can Do About It. The webinar explored how moral injury manifests at work, how it impacts us, and how we may act as individuals and institutions and start healing from it. Healing requires that we name and recognize moral injury. Participant engagement during the webinar allowed us to learn more about
the extent of impact moral injury has in our practice. It was empowering and disheartening to hear and see reverberations of experiences shared throughout the hour. We also learned collective strategies to combat moral injury.
Strategies to Combat Moral Injury While searching the PubMed database for “moral injury” yields 578 results, adding “mitigation” narrows the results to five. Despite limited data, our webinar showed that everyone understood and had experienced a moral injury. Here are some ways webinar participants described moral injury:
“When we don’t intervene in a situation when we know we should, we feel guilty.” “When we struggle with the duty to maintain standard of care when it may not be in line with our beliefs.” “When what we are asked to do conflicts our personal ideology or values or ethics.” “Not delivering care as we know we could.” “Doing what feels wrong.”