Moral Injury in Health Care Settings

Besides combat veterans, moral injury as a term and phenomenon is gaining traction in the health care industry. This article drives home that moral injury occurs in all strata of society. In addition, it points out, especially in a healthcare setting (as well as the VA system in the US) how much the doctors have lost control of practicing medicine. By this, I mean that the insurance companies, medicalization of behavior, medicalization of morality, and ‘evidence based outcomes’ all contribute to a sense of despair. The wife (she’s a psychiatrist) tells of her local small hospital and the experience not only on her family, but on the clinicians involved:

At that small hospital, the specialists treating my husband [also a doctor] had recently transitioned from private practice to being employees of a health system. The system had bound the physicians so tightly with scheduling control, data and metrics, policies and punishments that they, too, could barely breathe. They had almost no control over their patient interactions or their referral options.

They were bound so tightly, in fact, that they stopped struggling because it was futile. It was in part about being too busy; it was also about being shackled, straitjacketed and hamstrung. They knew what patients needed, but did not have the latitude or the autonomy to get it. They looked beaten, distant, as if they had given up, disengaged, stopped empathizing, depersonalized, as if they felt that they couldn’t accomplish much, so why even bother to try?

The continued drive towards technological solutions that divest us of morality is well chronicled. Roger Brooke says:

The medicalization of psychological life is the most pressing aspect of something that is more general and insidious in the field of (clinical) psychology. It is, as Heidegger described in his essay, The Question Concerning Technology, our compulsion to set upon everything in our world with appropriating agendas.

Edward Curtin recently wrote:

We now inhabit a technological nightmare (that seems like a paradise to so many) in which technology and technique – the standardized means for realizing a predetermined end most efficiently – dominate the world. In such a world, not only does the end justify the means, but to consider such a moral issue is beside the point [emphasis added]. We are speeding ahead to nowhere in the most “efficient” way possible.  No questioning allowed! 

That the daily necessity to bow to insurance carriers and their metrics gods is often diametrically opposed to the caregiver’s Hippocratic oath is also an affront to their moral sense of being.