Moral injury is a new test for employers

When I am unsure if something is ethical, my favourite ‘ready reckoner’ is to apply the reflection test – I ask myself if I could look myself in the mirror after doing it.

Would my self-image be helped or hindered by the action? I could also call it ‘the slumber test’. Will I be able to sleep at night after doing what I’m setting out to do?

I’ve spent years studying the ethical and psychological toll that comes with doing things that stop us from meeting our own eyes in the mirror. There is a price that comes when we violate our most precious moral beliefs.

In military communities, this price is called a ‘moral injury’. Psychiatrist Jonathan Shay, the foundational voice on the subject, describes it poetically as “the soul wound inflicted by doing something that violates one’s own ethics, ideals, or attachments”.

This needs attention

As parochial as talk of souls might be, organisations should start paying attention to this risk for three reasons:

1. So they can take steps to prevent their workers from being affected by moral injuries (basically, as an OH&S issue).
2. So they know how to spot and manage moral injuries if they do occur.
3. To figure out what support and remuneration they should offer if it turns out moral injuries are an ‘occupational hazard’.

The OH&S analogy is apt. Today, we expect organisations to think about their duty of care in a broad sense – taking an active interest in their employees’ wellbeing, seeking to reduce the risk of physical injuries, managing and minimising psychological stressors and mental illness, and providing fair training, support, and compensation when physical or mental stressors are likely to have a negative effect on employee wellbeing.

So, it follows that if some ethical issues can have an effect on wellbeing, they should be treated seriously by organisations claiming to care about their people.

How moral injury takes place

Moral injury is still a contested topic. Some people think it’s just a variation of post-traumatic stress disorder (PTSD), others think it’s no different from moral emotions like guilt, regret or remorse, and others still see it as something distinct.

Among veterans (who tend to dominate discussions of moral injury), the condition is seen as a condition akin to PTSD – a different kind of war trauma with different causes and different treatment pathways.

Whilst PTSD originates in feelings of fear and physical insecurity, moral injuries arise when we witness a betrayal or violation of our most deeply held beliefs about what’s right. It has to happen in a high stakes situation and the wrongdoing has to have been committed by someone in a position of ‘moral authority’ – a position you yourself might hold.

A group of US psychologists who have studied the issue offer a similar definition, describing moral injuries as “maladaptive beliefs about the self and the world” that emerge in response to the betrayal of what’s right. The injury is caused by the betrayal, but it’s in the beliefs and our response to them that it actually resides.

When we suffer a moral injury, our beliefs about ourselves, our world, or both are shattered in the wake of what we’ve witnessed or done.

Our moral beliefs are one of the ways we see the world and one of the ways we conceptualise ourselves. Everything flips when people no longer adhere to a ‘code’, good people are forced to do bad things for good reasons, or our different identities contradict one another.

This contradiction gives rise to ‘fragmentation’. Our moral beliefs, identities and actions no longer harmonise with one another. In the words of Les Miserables’ Inspector Javert, we find ourselves thrown into “a world that cannot hold”. Fragmentation demands reunification, and the way we go about this will determine both the extent of the moral injury and the likelihood of recovery.

How we respond to the conflict

If we can accept the critical event as being a rare product of extreme circumstances and a particular context, it’s possible to move on. We can accept guilt and seek forgiveness, admit our trust in a moral authority was betrayed and sever ties, or concede that the world is not as fair as we had thought.

This approach is relatively risk-free, albeit unpleasant.

However, if we are unable to see the event as context-dependent and, instead, see it as reflecting something universal – or worse, something about us – then a moral injury is likely to occur.

For example, if we have a handshake agreement to honour a business deal which is then betrayed, leading to widespread unemployment, we might decide that people are no longer trustworthy and either withdraw from them altogether or ‘get them before they get us’ next time. Either approach has an impact on a person’s ability to flourish in society.

Another possibility lies in concluding that we must be bad in order for us to have done what we did. Even if we were doing our duty without fault, guilt lingers and an employee could be permanently tainted by what they have done: “How can I say I am a good person when my actions resulted in this?”

Finally, we can recalibrate our moral beliefs. Perhaps, as many veterans argue, we were wrong to think the world was predictable or reliable to begin with. Maybe our moral injury isn’t an injury at all. Perhaps it’s a sign we’ve learned something new.

What employers can do

Moral injuries must be addressed because they affect a person’s future ethical decision making and their capacity for happiness.

This gives organisations another reason to have a robust ethical culture that guards against wrongdoing and refuses to ask people to act against their conscience.

However, this won’t always be possible. Sometimes professional demands require people to ‘get their hands dirty’, witness wrongdoing or even participate in something they feel contradicts their moral beliefs.

A committed parent may be required to decline an insurance claim, leaving the claimants – a family– homeless. How will he go home and sit with his children knowing his actions have put another family in jeopardy? A nurse may be legally prohibited from helping someone to end their life. Can she be a good person while allowing someone to needlessly suffer?

The question of moral injury has typically been posed as an individual problem but, if the OH&S analogy is a valid one, we should think about the responsibilities of organisations in the wake of what we’re learning.

An organisation violates its duty of care if it exposes workers to risk without reason, consent, support or fair compensation. Perhaps we might say the same for moral injuries, with one important caveat: it would be perverse and potentially corruptive to offer financial incentives for people to compromise their values and moral beliefs, offering a salary increase to be exposed to ethical risks, for instance.

A clear ethical purpose with which staff can identify and that is consistent with their moral beliefs is a more appropriate incentive. Not only might this prevent wrongdoing in the first instance, it can help reunify a fragmented identity if a moral injury does occur.