Moral harm during the COVID-19 pandemic

Moral harm is the suffering caused by acting in a way that violates our firmly held beliefs about right or wrong. It often involves committing acts of violence or feeling that we have failed to prevent the wrongdoings of others. It can also include feelings of being betrayed by authority figures in whom we had placed our trust or even our lives. Moral injuries often involve feelings of guilt, shame, loss of trust, and existential or spiritual distress such as doubt or loss of faith. It overlaps with post-traumatic stress disorder but is largely distinct from it (Koenig & Zaben, 2021).

Moral harm during the pandemic

Although first developed to describe the moral and spiritual pain experienced by veterans, there are many other potential situations that could be morally damaging. During the COVID-19 pandemic, healthcare workers have had to make high-stakes, life-or-death decisions about who receives certain types of treatment.

Many other workers were not given the power to make such decisions but had to be the ones to carry them out, inform patients and families, deal with the fallout, even when the decision was not one they would have. taken themselves. Sometimes the obligation to follow the instructions of the patient himself or his family, for example, to follow a do not resuscitate (or not) order, can go against the moral compass of a health care worker. health.

People may also blame themselves for the deaths of their patients or feel bad for not fighting harder to avoid the bad outcomes they anticipated – or believing they should have. Even outside of health care, many of us have faced difficult moral dilemmas in our personal lives as we tried to mitigate risk to keep ourselves and our families safe.

Exposure to such experiences does not guarantee moral harm, and many people will be able to overcome such challenges and emerge with their previous well-being intact. Several interventions have been developed for those who need help in their healing process. Koenig and Zaben (2021) wrote a recent review article describing many of them and breaking them down into three broad categories of treatment: secular psychological treatment, spiritually integrated therapies, and pastoral care.

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Psychological treatments

Psychological treatments help individuals process their morally harmful experiences both mentally and emotionally. Problematic and emotionally charged assumptions (e.g., “I should have known better”) are explored to help the person develop a more adaptive perspective and come to terms with their perceived moral transgressions (i.e., say in adaptive disclosure therapy). Individuals can also be encouraged to explore their values ​​and cultivate mindfulness and psychological flexibility (i.e. in acceptance and commitment therapy) or to revisit memories of traumatic events for treat more fully (v. therapy). Another intervention focuses on the development of forgiveness and the integration of family supports (ie healing through forgiveness). These interventions may conform to a wide variety of spiritual beliefs, but they focus primarily on psychological processes.

spiritual treatment

Spiritual treatments for moral injury are rooted in the idea that an individual’s experience of moral transgression will be based largely on their religious, spiritual, or existential worldview. Treatments can help build individual spiritual strengths (i.e. building spiritual strengths) and can even be integrated into more traditional psychological interventions (i.e. in integrated cognitive processing therapy spiritually or religiously integrated cognitive behavioral therapy).


Pastoral care can be beneficial given the spiritual dimension of hurt feelings, and chaplains are often well placed to offer assistance. Chaplains or other religious leaders may offer ritual penance to aid in self-forgiveness and spiritual healing (i.e. disclosure of the pastoral narrative). Other treatments integrate confession, grief work and spiritual formation (i.e. in reconciliation therapy for hurt feelings), integrate relevant scriptures (i.e. in structured pastoral care ) and even incorporate the idea of ​​community responsibility and community healing (i.e. in the case of moral harm). group interventions).

Many of the interventions described here are still relatively new and not widely available. Nonetheless, given the high number of moral dilemmas and potential moral wounds present during the pandemic, it is hoped that so many potential directions for healing are being explored. Especially given the diversity of spiritual beliefs and preferred methods of healing, it is good to see methods developing across multiple disciplines.

Taken together, these treatments summarized by Koenig and Zaben (2021) also offer a holistic view of what healing from moral injury might look like and provide hope that healing is possible.

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