Ethical dilemmas: The precarious path to moral injury

Moral injury is a phenomenon that first emerged in the ’90s from research on the mental impacts on defence, the military, and veterans; but since events such as the pandemic, there has been a greater focus on the toll that moral injury can have in all vocations.

In a recent episode of The HR Leader Podcast, Associate Professor Wendy Bonython, associate dean of learning and teaching in the faculty of law at Bond University, talked about her research on moral injuries.

“It’s a relatively recent phenomenon that’s been recognised in the literature,” Bonython said.

“Moral injury was a phenomenon that started emerging from some work undertaken by an American psychiatrist who worked primarily with veteran populations in the 1990s.”

These veteran groups did not respond well to recognised psychiatric therapies or psychological interventions or those sorts of things, she said.

Academic literature showed that moral injury is different to mental illness or psychological disorders, she found: “It typically arises in response to something that fundamentally challenges or conflicts with the personal ethics or morals or organisational values that a person finds themselves within.”

Ethical dilemmas

Internal conflicts between a worker’s ethics and what they are required to carry out at work, where “they felt conflicted deeply with their own morality and sense of ethics”, is a risk factor for moral injury, she said.

During the COVID-19 pandemic, we began to see the mental impacts that frontline workers faced when approaching confronting situations, she said.

“Which patient gets the limited supply of ventilation, or how do we decide which patient lives and which one doesn’t?” she added.

“It was really a lens that brought through some of these issues about professions [other than defence], that suffered from potential moral injury exposure quite to the fore.”

Bonython said that workers may face ethical dilemmas with the use of AI, impacting their professional identities. “[For] some people in certain industries and professions … actually doing the work themselves manually feels like a fundamental ethical obligation,” she said.

She stressed that discussions surrounding AI must consider the impacts of use on workers’ professional identity. She said: “Does it create that sense of compromise between how they view themselves within the organisation or within the profession and what they’re being asked to do?”

Policies are not enough

“Some of the evidence that was led at the royal commission made it clear that there is a very strong link between moral injury and suicidality and suicide, and that not all people who end up experiencing suicidality or suicide as a result of moral injury will necessarily ever achieve a diagnosed psychiatric condition status beforehand,” she said.

Bonython urged employers to ask: “What sorts of support and policies do I need to be implementing to avoid people from transitioning from being exposed to potentially morally injurious events to developing full-on moral injury type harms?”

In the context of healthcare workers, Bonython suggested support systems, debriefs, and counselling to proactively protect employees from facing the brunt of these harms.

She emphasised that her research provides an opportunity for employers to re-evaluate the policies that they have in place, their implementation, and awareness among middle management.

“It’s about taking [policy] seriously rather than just treating them as a compliance or box-ticking exercise,” she said.