Al Giwa1, David Crutchfield2, Debbie Fletcher3, Jennifer Gemmill4, Jason Kindrat5, Austin Smith6, Patricia Bayless7. 1. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 2. Maricopa County Correctional Health Services, Phoenix, Arizona. 3. Overton Brooks VA Medical Center, Shreveport, Louisiana. 4. Department of Emergency Medicine, Methodist Hospital, San Antonio, Texas. 5. Department of Clinical Emergency Medicine, Indiana University Health/Indiana University School of Medicine, Hendricks Regional Health, Danville, Indiana. 6. Intermountain Park City Hospital, Park City, Utah. 7. Creighton University School of Medicine, Valleywise Health Medical Center, Phoenix, Arizona.
Abstract
BACKGROUND: Moral injury, which is described as the psychological distress that results from actions, or lack of them, that go against one's beliefs or values, has become front and center among issues facing the practice of emergency medicine. Although it predates the COVID-19 outbreak, the pandemic has played a significant role in the increased rate of burnout, and even suicide, among emergency physicians. CASE REPORTS: This paper includes several clinical vignettes to highlight incidents that may occur in the emergency department (ED) when physicians experience violations of their moral codes, leading to distress and moral injury. These scenarios explore the conflicts posed between competing bioethical principles such as beneficence, nonmaleficence, end-of-life decision-making, medical futility, respect for self-determination (autonomy), resource scarcity and triage, duty to care, and physician impairment. DISCUSSION: There are significant similarities between moral injury and post-traumatic stress disorder (PTSD), with some authors describing moral injury as a subset of PTSD. We explore these commonalities to provide coping mechanisms and mitigation strategies for those suffering from moral injury. CONCLUSION: Physicians experiencing moral injury may benefit from the many available evidence-based treatments for PTSD to identify and manage moral injury and to support patient care and personal well-being.
BACKGROUND: Moral injury, which is described as the psychological distress that results from actions, or lack of them, that go against one's beliefs or values, has become front and center among issues facing the practice of emergency medicine. Although it predates the COVID-19 outbreak, the pandemic has played a significant role in the increased rate of burnout, and even suicide, among emergency physicians. CASE REPORTS: This paper includes several clinical vignettes to highlight incidents that may occur in the emergency department (ED) when physicians experience violations of their moral codes, leading to distress and moral injury. These scenarios explore the conflicts posed between competing bioethical principles such as beneficence, nonmaleficence, end-of-life decision-making, medical futility, respect for self-determination (autonomy), resource scarcity and triage, duty to care, and physician impairment. DISCUSSION: There are significant similarities between moral injury and post-traumatic stress disorder (PTSD), with some authors describing moral injury as a subset of PTSD. We explore these commonalities to provide coping mechanisms and mitigation strategies for those suffering from moral injury. CONCLUSION: Physicians experiencing moral injury may benefit from the many available evidence-based treatments for PTSD to identify and manage moral injury and to support patient care and personal well-being.
Authors: Janice Blanchard; Anne M Messman; Suzanne K Bentley; Michelle D Lall; Yiju Teresa Liu; Rory Merritt; Randy Sorge; Jordan M Warchol; Christopher Greene; Deborah B Diercks; James Griffith; Rita A Manfredi; Melissa McCarthy Journal: Acad Emerg Med Date: 2022-05-22 Impact factor: 5.221