Death by a Thousand Cuts”: Managing Moral Injury in Twenty-First Century Psychiatry
Presenting Author(s): Dr. Jennifer Gale Hibbard, Dr. Monique Jericho , MD FRCPCDate and time: 22 Mar 2025 from 14:05 to 15:05
Location: Hawthorn B
Abstract
Drs. Jericho and Hibbard are wellness coordinators for the department of psychiatry in Calgary. As a result of inquiry with interested physicians, the topic of “moral distress” was identified as a major contribution to the experience of burnout and disengagement. Moral injury science is an emerging area of research interest with connections to PTSD, vicarious trauma and wellness science. In the workshop, the presenters will provide an interactive and experiential approach to defining moral injury with discussion about how MI impacts psychiatrists working in today’s healthcare system. For many psychiatrists today, the neoliberalist approach of cost cutting is the only work environment they have ever known. The health, emotional well-being and sense of morality is undeniably affected, for good or for ill. In addition, psychiatrists are often trapped between the values and expectations of society which may be at odds with their own personal self beliefs and values. Psychiatrists are at risk for PMIEs (potentially morally injurious events) due to feelings of powerlessness, exposure to chronic societal issues, being blamed for uncontrollable situations and ongoing poor access to adequate resources to support patient care. Participants will be given opportunities to identify the potential downstream effects of near-continuous moral injury (Death by a thousand cuts) to individual and systemic well-being. Best practices for identifying, acknowledging and healing moral injury will be explored via “Moral injury guide for public safety personnel and leaders” (a free publication from the Canadian Institute for Public Safety Research and Treatment). Identification of approaches most like to be acceptable or feasible to psychiatrists will be collected as an outcome of the workshop.
Learning Objectives
1. Explore defining criteria of Moral injury and its’ impact on emotional well being of Health professionals;
2. Describe the range of potentially morally injurious events specifically associated with being a psychiatrist; and
3. Reference best evidence for identifying, healing and preventing moral injury.
Literature References
1. Moral injury guide for public safety personnel and leaders - published by Canadian Institute for public safety research and treatment: multiple contributing authors
2. Austin et al 2008. The balancing act: psychiatrists’ experience of moral distress. Med Health Care and Philos 11, pp 89-97
3. Elizabeth Epstein and Sarah Delgado, September 2010. Understanding and addressing moral distress . OJIN The online journal of issues in Nursing 15(3)
4. Terpou et al 2022. Moral wounds run deep: exaggerated midbrain functional network connectivity across the default mode network in post traumatic stress disorder. J. Psychiatry Neuroscience 2022 Feb 17;47(1):E56-E66