Center for Clinical Medical Ethics, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA.
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
J Med Ethics. 2023 May;49(5):361-366. doi: 10.1136/medethics-2022-108163. Epub 2022 Jun 15.
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.
道德伤害是由严重违背个人道德信仰引起的，会导致情绪和生存困境。这一现象最初由美国国防部和退伍军人事务部的心理学家和精神病学家描述，但后来已被更广泛地应用。虽然它在 COVID-19 之前就被应用于医疗保健领域，但自疫情爆发以来，医疗保健专业人员对道德伤害的关注有所增加。他们可以从有丰富识别和处理道德伤害经验的战斗老兵那里学到很多东西，尤其是其社会层面。退伍军人认识到复杂的社会因素会导致道德伤害，因此需要采取社区方法进行治疗。我们认为，在医疗保健中也必须给予类似的关注，团队导向和多维度的方法对于减轻医疗保健专业人员所面临的痛苦以及解决导致道德伤害的根本原因至关重要。
