Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its (...) importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

In this chapter, the authors argue that the concept of “moral injury” needs regimentation: Current definitions are both too broad and too narrow. They are too broad because they ignore or conflate important differences between the kinds of moral conflicts discussed in the literature. They are too narrow because they exclude the possibility of moral injury in the absence of internal moral conflict. The authors argue that it is necessary to first develop a conception of moral health, and (...) they propose a Strawsonian conception of moral health as the ability to participate in the moral community. The account offered in this chapter thus includes some cases that are not recognized as moral injuries in the literature and rejects some cases that are commonly described as moral injuries. (shrink)

In this article, I confront Flanigan’s recent attempt to show, not merely that women have a right to commit prenatal injury, but also that women who act on this right are praiseworthy and should not be criticized for this injury. I show that Flanigan’s arguments do not work, and I establish presumptive grounds against any such right, namely: prenatal injury, by definition, involves intentional or negligent harm and, as such, may be subsumed under a wider class of (...) actions that are presumptively wrong. (shrink)

This article offers suggestions for categorizing combat-related moral injuries, highlights possible causes of these injuries in veterans, and touches upon broadly-conceived measures to prevent and repair them. The first part identifies three prevailing definitions – lost trust, guilt, and harm to one’s capacity for right action and moral virtue – and argues for an emphasis on the latter. In service of highlighting areas for future empirical research and clinical awareness, the second part outlines possible veteran-related causes associated with these three (...) definitions, including unwarranted distrust of authorities, misapplying the theodicy problem to human acts, undue survivor’s guilt, wars that fail to meet ad bellum criteria, causing permissible collateral damage, and killing combatants without regret and for pleasure. The third part mentions strategies for preventing character harm, and then discusses the cognitive, rehabituative, and psychological aspects of moral repair. (shrink)

This article, originally presented as a keynote address at the 2019 McCain conference, proposes that we must take seriously the “moral” component of moral injury. In addition to psychological treatment, wounded warriors suffering moral injury require atonement for genuine transgressions, and insight when the conduct they regard as transgression actually is not. The article defines the dimensions of moral injury as parallel to those of physical injury: pain, loss of functionality, and (in some cases) disfigurement. It (...) then asks how atonement can be achieved, turning to an unusual source for inspiration: the laws of atonement set out by the medieval Jewish philosopher Moses Maimonides. Maimonides proposes four requirements: verbal confession, repentance, reparation, and apology. The article explains their meaning in the context of contemporary wounded warriors. Finally, it argues that Judaism’s unique tradition of collective atonement offers an important model for the armed services. (shrink)

This book turns to virtue language as an important resource for understanding moral injury, a form of subjectivity where one feels they can no longer strive to be good as a result of wartime experience. Drawing specifically on Iris Murdoch’s moral philosophy, and examining the experiences of civilians during the Bosnian War, Joseph Wiinikka-Lydon argues that current research into war and current understandings of subjectivity need new ways to articulate the moral dimension of being a subject if we are (...) to understand how violence affects one’s moral being and development. He develops an understanding of the human person as a tensile moral subject, one that forefronts the moral challenges and vulnerability inherent in lives affected by war. With these resources, Wiinikka-Lydon argues for a moral vocabulary and images of the human as a moral being that can better articulate the experience of violence and moral injury. (shrink)

This article offers suggestions for categorizing combat-related moral injuries, highlights possible causes of these injuries in veterans, and touches upon broadly-conceived measures to prevent and repair them. The first part identifies three prevailing definitions – lost trust, guilt, and harm to one’s capacity for right action and moral virtue – and argues for an emphasis on the latter. In service of highlighting areas for future empirical research and clinical awareness, the second part outlines possible veteran-related causes associated with these three (...) definitions, including unwarranted distrust of authorities, misapplying the theodicy problem to human acts, undue survivor’s guilt, wars that fail to meet ad bellum criteria, causing permissible collateral damage, and killing combatants without regret and for pleasure. The third part mentions strategies for preventing character harm, and then discusses the cognitive, rehabituative, and psychological aspects of moral repair. (shrink)

Public and clinical interest in a condition called moral injury – psychological distress resembling posttraumatic stress disorder (PTSD) but said to originate from shame, guilt, or transgression in...

Philosophers are wont to say that certain concepts, e.g., the concept of pain, exhibit ‘first/third-person asymmetry’, whereas others, e.g., the concept of injury, do not. The question I wish to address here concerns the status of such claims. They are commonly seen as nothing more than summary reports of how the relevant words are ordinarily used: as statements of ‘grammatical fact’. I want to argue against this view of their status.

If I am injured in the course of medical investigation or treatment, I may be eligible to receive compensation for some of the adverse consequences of my injury—at least, if I live in a developed country. In most such countries, there exists some form of state-administered compensation scheme for medical injuries. However, even within the developed world, there is considerable variation in the eligibility criteria for compensation. Different countries would, for example, respond very differently to the following pair of (...) cases... (shrink)

Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained (...) of their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)

This article explores how meanings around risk, health/safety, and workers’ bodies are constructed in an academic context. I do so through the study of a single academic in Australia who sustained a back injury at work. Through an analysis of in-depth interviews and documents, I attempt to show the embodied experience of an injured worker’s struggle for care, recovery, and survival in the neoliberal academy. Writing from the nexus of workplace health and safety and critical management literatures, the raw (...) testimony of this injured academic lays bare the violences that are enabled within a wider culture of self-discipline, individualism, and performativity in the university. The story presented in this article exposes how physiological and psychological injuries can be exacerbated through the very health and safety procedures that are designed to prevent and alleviate harm. Please note that this article contains references to suicide and suicidal ideation. (shrink)

This article, originally presented as a keynote address at the 2019 McCain conference, proposes that we must take seriously the “moral” component of moral injury. In addition to psychological treatment, wounded warriors suffering moral injury require atonement for genuine transgressions, and insight when the conduct they regard as transgression actually is not. The article defines the dimensions of moral injury as parallel to those of physical injury: pain, loss of functionality, and (in some cases) disfigurement. It (...) then asks how atonement can be achieved, turning to an unusual source for inspiration: the laws of atonement set out by the medieval Jewish philosopher Moses Maimonides. Maimonides proposes four requirements: verbal confession, repentance, reparation, and apology. The article explains their meaning in the context of contemporary wounded warriors. Finally, it argues that Judaism’s unique tradition of collective atonement offers an important model for the armed services. (shrink)

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms (...) included “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)

In this article, I undertake three main tasks. First, I argue that, contrary to the standard view, moral injury is not a species of PTSD (post-traumatic stress disorder) but rather, on the most coherent conception of moral injury, PTSD is (in effect) a species of moral injury. In doing so, I make use of the notion of caring deeply about something or someone worthy of being cared deeply about. Second, I consider so-called “dirty hands” actions in police (...) work and in war, and distinguish these from the morally legitimate, but harmful, actions of police officers and of war fighters, such as the morally legitimate use of coercive force and lethal force (respectively). While the morally legitimate use of harmful methods is constitutive of these occupational roles, “dirty hands” methods are not. Roughly speaking, a “dirty hands” action is one that is morally wrong and (typically) unlawful but done for the sake of a good outcome. Both categories of action are conducive to moral injury, but “dirty hands” actions much more so, especially given the slippery moral slope from “dirty hands” actions to egregious moral wrongdoing. Third, I offer some recommendations for reducing moral injury among police officers and war fighters. (shrink)

Although jus in bello violations create transgressive acts that cause moral injury, the primary consideration in thinking about moral injury should be jus ad bellum. If one is fighting in an ad bellum just war, then transgressive acts can be rationalized in a way that allows for consolation. But for morally sensitive combatants engaged in an ad bellum unjust war, consolation is more difficult since there is no way to justify or rationalize morally problematic deeds committed in defense (...) of an unjust cause. Morally serious combatants should consider the question of jus ad bellum as they struggle to deal with moral injury, along with other values such as obedience and loyalty. Such an inquiry can produce further trauma when the justness of the war is called into question. The paper examines moral injury and justice in war, grounding the discussion in concrete examples: the Second World War, the Vietnam War, and the U.S. war in Iraq. It concludes that in a democracy, ordinary citizens should demonstrate solidarity with combatants suffering moral injury, since those combatants serve in wars—even unjust wars—authorized by us and fought in our names. (shrink)

Amidst the return of military personnel from post-9/11 conflicts, a construct describing the readjustment challenges of some has received increasing attention: moral injury. This term has been variably defined with mental health professionals more recently conceiving of it as a transgression of moral beliefs and expectations that are witnessed, perpetrated, or allowed by the individual. To the extent that morality is a system of conceptualizing right and wrong, individuals’ moral systems are in large measure developmentally and socially derived and (...) interpreted. Thus, in seeking to provide care and aid in reintegration for combat veterans, it is necessary to consider communities that have contributed to an individual’s formation and that might have participated in the interpretation of his/her suffering. This can take many forms, but given that morality is often complexly intertwined with issues of religion, faith, and spirituality for many individuals, and recognizing that much of the current focus on moral injury is emanating out of healthcare contexts, we devote particular attention to how chaplains might be more intentionally engaged in healthcare systems such as the Veterans Health Administration to provide non-judgmental, person-centered, culturally-relevant care rooted in communities of practice to veterans with moral injury. (shrink)

We are printing, by kind permission of the Law Commission, two sections of the report of the Law Commission on injuries to unborn children. This report was the result of a request to the Law Commission by the Lord Chancellor at the time (Lord Hailsham of Saint Marylebone) to advise on `what the nature and extent of civil liability for antenatal injury should be'. The Law Commission followed its usual practice in such circumstances of consulting various bodies and obtaining (...) expert advice on the subject and then embodying the results in a working paper (Working Paper No. 47 - injuries to unborn children) published on 19 January 1973, which preceded their report (Cmnd 5709). Meanwhile a Royal Commission is considering much wider issues of civil liability for injury (including antenatal injury) but the terms of reference for the Law Commission were much narrower and confined to the position of children injured before birth. In the section relating to the present law the report makes it clear that it is probable that liability under the common law already exists. The Scottish Law Commission has also issued a report (Cmnd 5371). They were given different terms of reference and came to somewhat different conclusions. We are printing from this long report the paragraphs discussing the medical background and the summary of recommendations. As will be evident on reading the paragraphs on the medical background to injuries to the unborn child, events are moving very rapidly, particularly in the study of congenital defects and the effects of drugs but the problems of proof present great difficulty. Other causes of injury to the unborn child are better known to the general public: for example, those following the illness, infection and disease of the mother during pregnancy, injury caused in attempted termination of pregnancy and the risks resulting from the mother's condition. The summary of the recommendations sets out very clearly the legal position of the unborn child, as the Law Commission sees it, arising from injury before birth, the final conclusion being that `legislation is desirable'. These extracts from the report, apart from their intrinsic interest, lead on to the paper by Mr Kennedy and Dr Edwards in which they set out their criticisms of it, and provide quick references to the original document. (shrink)

The point of this article is to test how well Josiah Royce’s philosophy of community can be utilized to conceptualize moral injury and recovery.1 The term “moral injury” is of recent coinage, articulated by those working with combat veterans and their challenges returning to civilian life, particularly veterans returned from Vietnam and from America’s recent presence in the Middle East. The basic idea is that, in combat, soldiers harm their own moral capacities by committing or participating in acts (...) that they understand to be morally repugnant. The consequences of such harm include difficulty with participating well or fully in civilian life, even to the point of committing violence against loved ones. Despite the... (shrink)

Moral injury names how the lived experience of armed conflict can damage an individual's ethical foundations, often with serious consequences. While the term has gained increasing acceptance for the clinical treatment of veterans and as a means of better understanding the impact of war, it is generally applied to individualized trauma. As part of the roundtable, “Moral Injury, Trauma, and War,” this essay argues that moral injury is also a useful means of addressing political violence at a (...) societal level. It explores the term's value within international human rights discourse and practice, particularly in efforts to document and analyze the systematic commission of atrocities to achieve accountability and reconciliation. The essay presents field research among Iraqi human rights investigators as a means of reflecting on the value of rediscovering agency in the aftermath of societal trauma. In this way, moral injury provides guidance on the essential ethical qualities of the lived experience of violent repression, an issue central to a more complete understanding of international affairs. (shrink)

Head injuries are an inherent risk of participating in the major collision sports played in Australia. Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic traumatic encephalopathy. (...) We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare. (shrink)

The clinical literature on moral injury sometimes mentions the making of amends as part of a possible treatment plan. However, it is typically unclear how clinicians are conceiving of the making of amends or “atonement,” particularly in the context of the debilitating cluster of symptoms known as moral injury. This chapter reviews some culturally prominent conceptions of atonement. It then raises a number of objections to these and recommends an alternative model – a “reconciliation theory” of atonement – (...) that can avoid these objections. This theory conceives of wrongdoing as damaging relationships among victims, wrongdoers, and communities, and of atonement as repairing this damage. Atonement for serious wrongdoing isn't easy, but it isn't impossible either. Atonement comes in degrees. When pursued well, it offers benefits to victims and communities as well as to wrongdoers themselves. (shrink)

I argue that, given certain prominent views of personal identity and prudence, the nonidentity problem, or a very similar problem, can arise postconception. I clarify and defend this claim by considering the implications of these views for prenatal injury.

Moral injury is a term whose popularity has grown in psychology and psychiatry, as well as philosophy, over the last several years. This presents challenges, because these fields use the term in different ways and draw their understanding from different sources, creating the potential for contradiction. This, however, is also an opportunity. Comparison between behavioral sciences and philosophy can help enrich understandings of harms considered not just psychological but moral. To this end, I provide an overview of the more (...) influential writing of moral injury, mapping them into three broad discourses: clinical, juridical-critical, and structural. This overview then leads to a discussion of how comparative engagement among these discourses promises to expand on current theories of moral harm. I argue that such a comparison will demonstrate that more emphasis on structural violence will strengthen current understandings of moral injury, often understood in a more narrow sense to be a result of more direct, physical violence, allowing us to view moral injury as a result of institutional and social violence and injustices. (shrink)

Working in the language of first-order arithmetic we consider models of the base theory P - . Suppose M is a model of P - and let M satisfy induction for σ 1 -formulas. First it is shown that the Friedberg-Muchnik finite injury argument can be performed inside M, and then, using a blocking method for the requirements, we prove that the Sacks splitting construction can be done in M. So, the "amount" of induction needed to perform the known (...) finite injury priority arguments is Σ 1 -induction. (shrink)

Rather than focusing on the legal and political questions that surround genocidal rape, in this paper I treat a vital area of inquiry that has received much less attention: the moral significance of genocidal rape. My aim is to augment existing moral accounts of rape in order to address the specific contexts of genocidal rape. I move beyond understanding rape primarily as a violation of an individual's interests or agential abilities. The account I offer builds on these approaches (as well (...) as on a pluralist approach), by arguing that rape, as a moral injury, negatively affects the very human dignity of victims. My account also emphasizes the relational harm that marks genocidal rape. (shrink)

Since Jonathan Shay's work with Vietnam veterans, moral injury has largely focused on the harm done to soldiers' moral character through their participation in warfare. This essay argues for the inclusion of noncombatants in the scope of inquiry involving moral injury. Specifically, it argues for the necessity of ordinary citizens assuming responsibility for the moral injury done to soldiers and civilians alike in the post‐9/11 wars.

Note: Content within this article regarding moral injury, sexual trauma, and mental health may be distressing to some people.Wars in Iraq and Afghanistan involving Coalition troops are over but sol...

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. (shrink)

Today’s fast-moving, media lifeworld embodies many of the metaphors of its analog predecessors – including those of warfare and conflict. The metaphor of warfare is used to describe everything from corporate marketing strategies to political campaigns, often with harmful consequences. In one way of exploring the front lines of the resulting war on truth, we describe some lessons learned from the experience of military veterans who have actually endured the liminality of combat, and who emerge with what is increasingly termed (...) moral injuries. We use their experience as an analogy for competing narratives in cyberspace, where objective standards of truth and facticity are apparent casualties, and where fake news is emerging as victorious. We then apply models of social construction, specifically the practical theory of the Coordinated Management of Meaning, and the metaphor of jazz improvisation in the context of Schutz’s lifeworld phenomenology as possibly useful, helpful, and hopeful ways of acting into the complexity of truth together. (shrink)

We live in an anxious world, riddled with unpredictable threats to our safety and unexpected hatreds directed toward us. It is easy to obsess on the terrors around us, about which we can do little, and lose perspective on the real and sometimes devastating risks that we encounter in our daily lives. These everyday risks need to be regularly revisited — to remind ourselves that they can be reduced with the application of sharp minds, careful scholarship, and political will.Medical errors (...) in the American health-care system are just such a problem. The risk of death or serious injury at the hands of the American health-care system is not trivial, as we have learned over the past few years as the health-care establishment has acknowledged the level of iatrogenic injury in the system. If, as the Institute of Medicine reported in To Err Is Human, as many as 100,000 people every year are dying in hospitals, clinics, and doctors’ offices as the result of actions or omissions that could have been avoided, then this is a social problem of great magnitude and one that the law must try to correct. (shrink)

We live in an anxious world, riddled with unpredictable threats to our safety and unexpected hatreds directed toward us. It is easy to obsess on the terrors around us, about which we can do little, and lose perspective on the real and sometimes devastating risks that we encounter in our daily lives. These everyday risks need to be regularly revisited — to remind ourselves that they can be reduced with the application of sharp minds, careful scholarship, and political will.Medical errors (...) in the American health-care system are just such a problem. The risk of death or serious injury at the hands of the American health-care system is not trivial, as we have learned over the past few years as the health-care establishment has acknowledged the level of iatrogenic injury in the system. If, as the Institute of Medicine reported in To Err Is Human, as many as 100,000 people every year are dying in hospitals, clinics, and doctors’ offices as the result of actions or omissions that could have been avoided, then this is a social problem of great magnitude and one that the law must try to correct. (shrink)

As moral injury is a still-emerging concept within the area of military mental health, prevalence estimates for moral injury and its precursor, potentially morally injurious events (PMIEs), remain unknown for many of the world’s militaries. The present study sought to estimate the prevalence of PMIEs in the Canadian Armed Forces (CAF), using data collected from CAF personnel deployed to Afghanistan, via logistic regressions controlling for relevant sociodemographic, military, and deployment characteristics. Analyses revealed that over 65% of CAF members (...) reported exposure to at least one event that would be considered a PMIE. The most commonly PMIEs individuals reported included seeing ill or injured women and children they were unable to help (48.4%), being unable to distinguish between combatants and non-combatants (43.6%), and finding themselves in a threatening situation where they were unable to respond due to the rules of engagement under which they were required to operate (35.4%). These findings provide support for both the presence of exposure to PMIEs in CAF members and the need for formal longitudinal data collection regarding PMIE exposure and moral injury development. (shrink)

Our essay will address both the right-to-die movement in America and the emerging culture of neglect in the treatment of a class of patients with disorders of consciousness with which the right-to-die movement is entwined. We trace the etiology of these two themes through changes in our scientific understanding of brain injury and recovery against a growing societal acculturation to dominion over one's self at life's end.

This article deals with issues of litigation based on claims of personal injuries. It briefly describes the way that economists have tended to think about the “litigation process.” It discusses a number of areas of empirical work. It begins with case outcomes and looks at the ways in which the legal system itself can influence matter through the encouragement of information transfer and the rules used for allocating legal costs. It considers the role of lawyers by looking at the effects (...) of different legal fee arrangements on case outcomes. Furthermore, it discusses the liability-based legal system that produces the deterrence benefits often claimed for in conceptual work. The deterrent potentials of liability-based litigations are subject to objective and subjective contexts of the injurer. Finally, the article concludes that alternative means such as the “no fault” scheme that allots compensation irrespective of personal fault of the accused, require greater analysis. (shrink)

This book expands the conversation on moral injury to include a more formal role for society in it. The author utilizes an interdisciplinary practical theology combining liberation theologies and cultural studies to interrogate how dominate ideologies can complicate moral injury reintegration among veterans.

Philosophers are wont to say that certain concepts, e.g., the concept of pain, exhibit ‘first/third-person asymmetry’, whereas others, e.g., the concept of injury, do not. The question I wish to address here concerns the status of such claims. They are commonly seen as nothing more than summary reports of how the relevant words are ordinarily used: as statements of ‘grammatical fact’. I want to argue against this view of their status.

This paper explores similarities and differences between grief over the death of a person and other experiences of loss that are sometimes termed 'grief', focusing on the impact of serious illness and bodily injury. It takes the form of a dialogue between a physician/ neurophysiologist and a philosopher. Adopting a broad conception of grief, we suggest that experiences of lost or unrealized possibilities are central to all forms of grief. However, these unfold in different ways over prolonged periods. Experiences (...) of grief are complex, diverse, difficult to articulate, and frequently under-acknowledged. This diversity, we note, complicates discussions of how to distinguish typical from pathological forms of grief. We raise the concern that thinking of grief through the lens of bereavement eclipses other circumstances in which people are required to comprehend and adapt to loss. With this lack of acknowledgment, the phenomenology of grief is characterized in ways that are overly tidy and people are deprived of important interpretive resources. (shrink)

Guilt is a moral emotion that plays an important role in some understandings and manifestations of moral injury. In “Ulterior Motives and Moral Injury in War,” I note that soldiers returning from war are often assailed by profound feelings of guilt. Such soldiers might feel irrevocably diminished as persons, which is characteristic of a type of moral injury. I explore how the ulterior motives of the leaders who authorized the war might exacerbate the moral injury of (...) soldiers. According to the argument I develop, civilian and military leaders, by virtue of their practical authority over combatants serving in the military, confer upon those combatants a particular purpose. The ulterior motives that the leaders harbor constitutively determine the content of the purpose they confer. So long as a combatant remains under the practical authority of her leaders, there is nothing she can do to divest herself of the specific purpose conferred upon her. Even if the war and her conduct in it are just by hypothesis, her sense of integrity might demand more: that she helps kill only for scrupulous purposes. It might be impossible to reconcile the demands of integrity with the cynical purpose that her self-serving, career-minded, opportunistic leaders confer upon her. This failure to justify to herself the carnage she helps cause can exacerbate the severity of any psychological trauma she suffers. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the (...) society. Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The tort law of negligence is one of our principal forms of protection against accidental physical injury. But it is underspecified in one respect and incomplete in another. The common law of negligence is underspecified in that its norm of reasonable care does not register clearly enough the fact that it is reasonable to take greater precautions against some kinds of physical injuries — severe and irreparable ones — than it is against other kinds — mild and fully repairable (...) ones. The common law of negligence is incomplete in that it relies on the award of money damages to induce prospective injurers to exercise reasonable care prospectively, yet does not so much as attempt to fully monetize the harm done by unreasonable risks that result in death. (shrink)

Moral injury describes the effects of violence on veterans beyond what trauma discourse can describe. I put moral injury in conversation with a separate but related concept, dirty hands. Focusing on Michael Walzer's framing of dirty hands and Jonathan Shay's understanding of moral injury, I argue that moral injury can be seen as part of the dirt of a political leader's dirty hands decisions. Such comparison can focus more attention on the broader institutional context in which (...) such dirty hands decisions are executed, while contributing to the growing vocabulary of moral conflict, trauma, and harm. (shrink)

This study explored representations of self-injury in Japanese manga. A content analysis of fifteen slice-of-life manga published between 2000-2017 was conducted, focusing on forty scenes that depict eighteen characters engaging in self-injury. Most depictions of self-injury reflect a stereotypical perception of “self-injurer,” a young girl cutting herself to cope with negative emotion. Characters receive informal support from friends and partners, while parents are portrayed as unsupportive and even triggering. An emergent trend was observed among manga targeting male (...) readers to label self-injuring women as “menhera” - mentally vulnerable damsels in distress - inviting a fetishistic gaze on the self-injuring female bodies. (shrink)

This article is concerned with theories and therapeutic practices that interpret post-traumatic combat stress as a ‘moral injury’ produced by the shock of carrying out lethal violence in uncertain battlefield conditions. While moral injury is said to share many symptoms with post-traumatic stress disorder (PTSD), its proponents – military and Veterans Health Administration clinical psychologists, chaplains, and some psychiatrists – are concerned by PTSD’s inability to account for the meaning-based moral and ethical distress that counterinsurgency battlefields in Iraq (...) and Afghanistan are allegedly especially prone to produce in US soldiers. Moral injury theorists seem to want to describe a phenomenon that is both more profound than PTSD but which, as clinical psychologists Shira Maguen and Brett Litz state, is not itself a mental disorder. In this article, I examine the links between moral injury theory’s fringe diagnostic status and the fringe status of the kinds of violence it understands as uniquely injurious to soldiers’ psyches. Moral injury valorizes war-fighting and military culture while casting war as a source of almost inevitable psychopathology. I argue that moral injury theory represents an effort to carve out a distinct domain of psychological expertise but also a negotiation of the tension between war violence’s ‘normal’ practice and its excessive or morally hazardous manifestations – both of which link mental illness directly to the politics of war violence and post-war care. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 17-21 [Access article in PDF] Self-Injury:Symbolic Sacrifice/Self-Assertion Renders Clinicians Helpless Christa Krüger Keywords feminism, iconic communication, moral conflict, oppression, psychiatrist/psychologist roles, societal norms. POTTER'S PAPER CONSIDERS self-injury in women diagnosed with borderline person ality disorder (BPD) to be a form of body modification where the body is used to communicate meaning. She touches on symbolism as a possible explanatory theory for (...) this sort of self-injury. She also refers to the culture of body commodification as underlying self-injury. She then argues that clinicians have a duty to give uptake to the patient's own interpretations about the meaning of the self-injury. Giving uptake is a virtuous approach for ethical interactions with people diagnosed with BPD who self-injure, and it aims to preserve the communicator's integrity, along with other benefits. Potter offers five maxims for giving uptake properly. However, I shall argue that giving uptake can be very difficult for clinicians, and that an appreciation of this difficulty depends on an expansion and linkage of some of the theories that she touched on. Self-injury is revisited experimentally as a double-edged sword of symbolic sacrifice and iconic-symbolic self-assertion. This revisiting aims to illustrate how clinicians might be caught in a double bind, where giving uptake properly might be very difficult if not more or less doomed to fail.Potter's paper starts by situating self-injury in a broader discourse of body modifications. In this discourse the body is being used as a text, a tool to communicate meaning. The meaning that is communicated might be difficult or impossible to articulate otherwise (by using words, for example). The meaning of the communication is embedded in a context of social, cultural, religious, political, and other norms. Potter explores possible interpretations of the meaning of self-injury in women with BPD, including an interpretation of self-injury as symbolic sacrifice. She suggests that a cultural understanding/nonunderstanding of the meaning of a particular instance of self-injury is an important determinant of whether such self-injury is considered pathological/nonpathological. She then shifts the focus to the present-day culture in which women's bodies are commodified and objectified, and where women become alienated from their bodies. Self-injury might then be interpreted as an attempt to re-own one's body as a part of oneself. This re-owning is a socially transgressive act that violates repressive norms for the bodies of women. [End Page 17]Notwithstanding these possible significations of self-injury, Potter then argues that clinicians have a duty to give uptake to the patient's own interpretations, instead of jumping to conclusions (my oversimplification) about the meaning of the self-injury. Giving uptake, then, constitutes a framework for ethical interactions with people diagnosed with BPD who self-injure, and it aims to preserve the communicator's integrity. Potter offers five maxims for giving uptake properly.At the risk of losing their essence, I translate the five maxims for practicing psychiatrists as involving the following: critical self-reflection about one's own conceptual framework and cultural context; being receptive to the patient's conceptual framework and cultural context; giving the patient the benefit of the doubt; being open to the emergence of new meanings of self-injury; and keeping a range of possible interpretative options open, rather than insisting on having the final word. We should try to understand what the world looks like from the patient's position. All of this requires some moral effort.Potter describes a number of benefits that result from giving uptake. Giving uptake is a crucial corrective to the human tendencies of becoming overly committed to prevailing societal norms and conceptual schemes (stuck in our ways), of imposing our views on others, and of silencing or distorting the communications of our patients. Giving uptake allows clinicians to be dialogically responsive and to treat patients with respect and dignity. Giving uptake fosters trust in a therapeutic relationship where clinicians do not exploit their patients' vulnerabilities. Giving... (shrink)

This book brings together leading interdisciplinary scholars to broaden and deepen the conversation about moral injury. In original essays, the contributors present new research to show how the humanities are crucial for understanding the expressions, meaning, and significance of moral injury. Moral injury is the disorientation we suffer when we are complicit in some moral transgression. Most existing work addresses moral injury from a clinical or neuroscientific perspective. The essays in this volume show how the humanities (...) are crucial for understanding the meaning and significance of moral injury, as well as suggesting how to grapple with its lived challenges. The chapters address the conceptual, sociological, historical, and ritualistic dimensions of moral injury across three thematic sections. Section 1 explores how tools of the humanities provide new lenses for understanding conceptual and genealogical themes about moral injury. Section 2 highlights the experiences of moral injury in combat soldiers, law enforcement, and noncombatants such as photojournalists. These chapters examine the power and limits to theorizing moral phenomena by appeals to lived experience. Section 3 considers how humanistic inquiry illuminates important dimensions of the aftermath of moral injury beyond the scope of clinical research. These chapters consider how ritual, relationship repair, and atonement might shape the ways people navigate moral injury and consider how such responses shape our understandings of what we owe to one another. Moral Injury and the Humanities: Interdisciplinary Perspectives is an essential resource for researchers and advanced students in philosophy, religious studies, literature, journalism, and the arts who are interested in moral injury. (shrink)

ABSTRACT Legislation recently adopted by the United States Congress provides producers of pandemic vaccines with near‐total immunity from civil lawsuits without making individuals injured by those vaccines eligible for compensation through the Vaccine Injury Compensation Program. The unusual decision not to provide an alternative mechanism for compensation is indicative of a broader problem of inconsistency in the American approach to vaccine‐injury compensation policy. Compensation policies have tended to reflect political pressures and economic considerations more than any cognizable set (...) of principles. This article identifies a set of ethical principles bearing on the circumstances in which vaccine injuries should be compensated, both inside and outside public health emergencies. A series of possible bases for compensation rules, some grounded in utilitarianism and some nonconsequentialist, are discussed and evaluated. Principles of fairness and reasonableness are found to constitute the strongest bases. An ethically defensible compensation policy grounded in these principles would make a compensation fund available to all individuals with severe injuries and to individuals with less‐severe injuries whenever the vaccination was required by law or professional duty. (shrink)

The prevalence of tainted legacies within Christian ethics, across the academy, and in contemporary public debate raises difficult questions about handling legacies implicated in traumatic pasts. This essay uses the concept of moral injury to illuminate the moral complexities of tainted religious legacies and employs feminist and womanist ethics to provide strategies for moral repair in the wake of these and other such legacies. It first argues that, despite significant limitations, moral injury provides purchase on the experience of (...) encountering tainted religious legacies by naming the type of agency involved, describing the moral harm tainted legacies cause, and highlighting the social and institutional context of that harm. It then argues that feminist and womanist responses to morally injurious forms of Christianity—particularly explorations of redemptive suffering—not only resonate with responses to Yoder’s case and other tainted legacies current in public debate but also provide criteria for assessing those responses. (shrink)