VanderWeele Tyler J, Wortham Jennifer S, Carey Lindsay B, Case Brendan W, Cowden Richard G, Duffee Charlotte, Jackson-Meyer Kate, Lu Francis, Mattson Seth A, Padgett Robert Noah, Peteet John R, Rutledge Jonathan, Symons Xavier, Koenig Harold G
Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Front Psychol. 2025 Mar 5;16:1422441. doi: 10.3389/fpsyg.2025.1422441. eCollection 2025.
We propose new definitions for moral injury and moral distress, encompassing many prior definitions, but broadening moral injury to more general classes of victims, in addition to perpetrators and witnesses, and broadening moral distress to include settings not involving institutional constraints. We relate these notions of moral distress and moral injury to each other, and locate them on a "moral trauma spectrum" that includes considerations of both persistence and severity. Instances in which moral distress is particularly severe and persistent, and extends beyond cultural and religious norms, might be considered to constitute "moral injury disorder." We propose a general assessment to evaluate various aspects of this proposed moral trauma spectrum, and one that can be used both within and outside of military contexts, and for perpetrators, witnesses, victims, or more generally.
我们提出了道德伤害和道德困扰的新定义，涵盖了许多先前的定义，但将道德伤害的范围扩大到更广泛的受害者群体，除了犯罪者和目击者之外，还包括其他受害者，并将道德困扰的范围扩大到包括不涉及制度约束的情况。我们将这些道德困扰和道德伤害的概念相互联系起来，并将它们置于一个“道德创伤谱系”中，该谱系包括对持续性和严重性的考量。道德困扰特别严重且持续，并且超出文化和宗教规范的情况，可能被视为构成“道德伤害障碍”。我们提出了一项综合评估，以评估这个提议的道德创伤谱系的各个方面，该评估可在军事背景内外使用，适用于犯罪者、目击者、受害者或更广泛的人群。
