ALEXANDRIA, VA – Frontline healthcare workers, social service, and other essential workers are being forced to make life and death decisions for themselves as well as patients that is likely to take a large toll on their mental health for years to come! Moral injury is an affliction of conscience that was first identified in combat veterans. Not to be mistaken for post-traumatic stress disorder, moral conscience has its own treatment protocols. It happens under high stake situations where no good choice is possible or when emergency conditions require rapid responses by instinct or training without time to weigh a decision.
Rita Nakashima Brock, Ph.D., a noted researcher, author and speaker on moral injury, is senior vice president, Moral Injury and director of the Shay Moral Injury Center for Volunteers of America. She leads the organization’s efforts to deepen understanding about moral injury in the many populations who experience it.
Volunteers of America, one of the largest providers of housing and services for America’s most vulnerable, assists more than 1.5 million people annually. The organization has a large employment force of frontline caregivers including those who care for more than 8,000 seniors housed in more than 20 locations. These are seniors in need of skilled nursing care and assisted living.
“The fight against the coronavirus is strikingly similar to battlefield medicine,” Brock explained. “The virus requires desperate and unrelenting encounters with patients, a lethal environment of high personal risk, an unseen lethal enemy, extreme physical and mental fatigue and inadequate resources—lack of PPE.”
“Increasingly swamped hospitals have created death panels to decide who should live or die, Brock continued, or they are considering ‘do not resuscitate’ orders. These policies do not mitigate the moral impact on those who, after fighting to save people, must kill them because of an algorithm!”
For those on the front lines of Volunteers of America, there are equally dire decisions that include when and how to isolate those infected when caregivers must go from patient to patient. Since the onset of the virus, there have been questions as to how to get test kits and how to deal with cases when there is no test. Health departments are often overwhelmed and caregivers are forced to make life-or-death decisions. They must also weigh the chances of contracting coronavirus and bringing it home to their families.
“Working past exhaustion only to see so many deaths, can have a moral impact,” said Brock. “And losing patients when you may have been the unknowing carrier, can be devastating.”
As with soldiers, healthcare and essential workers can be made to feel abandoned, unsupported and without leadership. Being sent into a potentially lethal situation without support can leave individuals feeling helpless and betrayed. Betrayal wrecks trust, profoundly disrupts identity, and destroys relationships. It is also suspected of causing or aggravating post-traumatic stress symptoms—nightmares, intrusive memories, hyper-vigilance, depression, and irrational anger.
For those who cannot rectify their experience with their moral values, their conscience declares internal war. The aftermath of devastating experiences can accumulate relentlessly for weeks for months and lead to extreme pain and anguish. Often those experiencing moral injury turn to overworking, drinking or using drugs, self-isolation and silent despair, depression, abandonment of their career and, in worse cases, suicide.
“It’s those individuals who are often the most experienced and humane professionals who have moral injury,” Brock explained. “They become crushed by the decisions they had to make and often find themselves in unrelenting grief, consumed by fury and humiliation at the authorities who failed them or bereft of faith or meaning.”
Brock recommends that we all need to support those on the frontlines by taking the time to regularly thank them. Being compassionate and sharing grief, even though it has to be virtual right now, is beneficial to those who are struggling. For those essential workers who continue to go to work in spite of their fear, it’s particularly important that people show their appreciation—thank the healthcare worker, the grocery store clerk, the social worker, the caregivers, restaurant workers, etc. Many of them are putting their lives on the line for little compensation as well.
“No one will come out of this pandemic unchanged,” Brock added. “But how we are changed is something we can influence.”
For more information on Volunteers of America, visit www.voa.org. For more information on the Shay Moral Injury Center Volunteers of America, visit www.voa.org/moral-injury-war-inside.
