Moral injury

وَلَا تَأۡكُلُوٓاْ أَمۡوَٰلَكُم بَيۡنَكُم بِٱلۡبَٰطِلِ وَتُدۡلُواْ بِهَآ إِلَى ٱلۡحُكَّامِ لِتَأۡكُلُواْ فَرِيقࣰ ا مِّنۡ أَمۡوَٰلِ ٱلنَّاسِ بِٱلۡإِثۡمِ وَأَنتُمۡ تَعۡلَمُونَ

Do not consume your property wrongfully, nor use it to bribe judges, intending sinfully and knowingly to consume parts of other people’s property

وَإِذَا قِيلَ لَهُ ٱتَّقِ ٱللَّهَ أَخَذَتۡهُ ٱلۡعِزَّةُ بِٱلۡإِثۡمِۚ فَحَسۡبُهُۥ جَهَنَّمُۖ وَلَبِئۡسَ ٱلۡمِهَادُ

When he is told, ‘Beware of God,’ his arrogance leads him to sin. Hell is enough for him: a dreadful resting place

ثُمَّ أَنتُمۡ هَٰٓؤُلَآءِ تَقۡتُلُونَ أَنفُسَكُمۡ وَتُخۡرِجُونَ فَرِيقࣰ ا مِّنكُم مِّن دِيَٰرِهِمۡ تَظَٰهَرُونَ عَلَيۡهِم بِٱلۡإِثۡمِ وَٱلۡعُدۡوَٰنِ وَإِن يَأۡتُوكُمۡ أُسَٰرَىٰ تُفَٰدُوهُمۡ وَهُوَ مُحَرَّمٌ عَلَيۡكُمۡ إِخۡرَاجُهُمۡۚ أَفَتُؤۡمِنُونَ بِبَعۡضِ ٱلۡكِتَٰبِ وَتَكۡفُرُونَ بِبَعۡضࣲۚ فَمَا جَزَآءُ مَن يَفۡعَلُ ذَٰلِكَ مِنكُمۡ إِلَّا خِزۡيࣱ فِي ٱلۡحَيَوٰةِ ٱلدُّنۡيَاۖ وَيَوۡمَ ٱلۡقِيَٰمَةِ يُرَدُّونَ إِلَىٰٓ أَشَدِّ ٱلۡعَذَابِۗ وَمَا ٱللَّهُ بِغَٰفِلٍ عَمَّا تَعۡمَلُونَ

Yet here you are, killing one another and driving some of your own people from their homes, helping one another in sin and aggression against them. If they come to you as captives, you still pay to set them free, although you had no right to drive them out. So do you believe in some parts of the Scripture and not in others? The punishment for those of you who do this will be nothing but disgrace in this life, and on the Day of Resurrection they will be condemned to the harshest torment: God is not unaware of what you do

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُواْ لَا تُحِلُّواْ شَعَٰٓئِرَ ٱللَّهِ وَلَا ٱلشَّهۡرَ ٱلۡحَرَامَ وَلَا ٱلۡهَدۡيَ وَلَا ٱلۡقَلَٰٓئِدَ وَلَآ ءَآمِّينَ ٱلۡبَيۡتَ ٱلۡحَرَامَ يَبۡتَغُونَ فَضۡلࣰ ا مِّن رَّبِّهِمۡ وَرِضۡوَٰنࣰ اۚ وَإِذَا حَلَلۡتُمۡ فَٱصۡطَادُواْۚ وَلَا يَجۡرِمَنَّكُمۡ شَنَـَٔانُ قَوۡمٍ أَن صَدُّوكُمۡ عَنِ ٱلۡمَسۡجِدِ ٱلۡحَرَامِ أَن تَعۡتَدُواْۘ وَتَعَاوَنُواْ عَلَى ٱلۡبِرِّ وَٱلتَّقۡوَىٰۖ وَلَا تَعَاوَنُواْ عَلَى ٱلۡإِثۡمِ وَٱلۡعُدۡوَٰنِۚ وَٱتَّقُواْ ٱللَّهَۖ إِنَّ ٱللَّهَ شَدِيدُ ٱلۡعِقَابِ

so, you who believe, do not violate the sanctity of God’s rites, the Sacred Month, the offerings, their garlands, nor those going to the Sacred House to seek the bounty and pleasure of their Lord––but when you have completed the rites of pilgrimage you may hunt. Do not let your hatred for the people who barred you from the Sacred Mosque induce you to break the law: help one another to do what is right and good; do not help one another towards sin and hostility. Be mindful of God, for His punishment is severe

وَتَرَىٰ كَثِيرࣰ ا مِّنۡهُمۡ يُسَٰرِعُونَ فِي ٱلۡإِثۡمِ وَٱلۡعُدۡوَٰنِ وَأَكۡلِهِمُ ٱلسُّحۡتَۚ لَبِئۡسَ مَا كَانُواْ يَعۡمَلُونَ

You [Prophet] see many of them rushing into sin and hostility and consuming what is unlawful. How evil their practices are

لَوۡلَا يَنۡهَىٰهُمُ ٱلرَّبَّٰنِيُّونَ وَٱلۡأَحۡبَارُ عَن قَوۡلِهِمُ ٱلۡإِثۡمَ وَأَكۡلِهِمُ ٱلسُّحۡتَۚ لَبِئۡسَ مَا كَانُواْ يَصۡنَعُونَ

Why do their rabbis and scholars not forbid them to speak sinfully and consume what is unlawful? How evil their deeds are

(And eat not up your property among yourselves in vanity�) [2:188]. Said Muqatil ibn Hayyan: �This verse was revealed about Imra' al-Qays ibn 'Abis al-Kindi and 'Abdan ibn Ashu' al-Hadrami. It so happened that these two men came to the Prophet, Allah bless him and give him peace, with a dispute regarding a piece of land. Imra' al-Qays had the land and 'Abdan was reclaiming it. And so Allah, exalted is He, revealed this verse, and the land was given to 'Abdan without a judgment pronouncement�.

(O ye who believe! Profane not Allah�s monuments�) [5:2]. Said Ibn �Abbas: �This was revealed about al-Hutam whose full name is Sharih ibn Dubay�ah al-Kindi. This man went from al-Yamamah to Medina to see the Prophet, Allah bless him and his Household and give him peace. When he arrived at Medina, he went in alone to speak with the Prophet, Allah bless him and give him peace. He said: �What do you call people for?� he said: �To testify that there is no god but Allah, to establish the prayer and to pay the poor due�. The man said: �This is good, except that I have chiefs without whose consultation I cannot take any decision. It may be that I embrace Islam and bring them with me�. And then he left. Before this, the Prophet, Allah bless him and give him peace, had said to his Companions: �A man will enter in on you and will speak with the tongue of the devil�. When the man left, the Messeng

Consume not your goods between you that is to say do not let one consume the goods of the other in deception that which is illicit according to the Law such as theft and extortion; and do not proffer them the regulation of these goods or any bribes to the judges that you may consume as a result of any arbitration a portion of other people’s goods embroiled in sin while you are aware that you are in error.

And when it is said to him ‘Fear God’ in your actions he is seized by vainglory pride and rage in his sin the one he was commanded to avoid committing. So Hell shall be enough it suffices for him — how evil a cradling a resting place it is!

Then there you are killing one another and expelling a party of you from their habitations conspiring tazzāharūna the original ta’ has been assimilated with the zā’; a variant reading has it without the assimilation that is tazāharūna assisting one another against them in sin in disobedience and enmity injustice and if they come to you as captives a variant reading for usārā has asrā you ransom them a variant reading for tafdūhum has tufādūhum that is to say you deliver them from captivity with money etc. and this ransoming was one of the things to which they were pledged; yet their expulsion was forbidden you muharramun ‘alaykum ikhrājuhum is semantically connected to wa-tukhrijūna ‘and expelling’ and the statement that comes in between is parenthetical that is expulsion was forbidden you in the same way that non-ransoming was forbidden you. Qurayza had allied themselves with the Aws an

And (remember) when We took your covenant (saying): Shed not the blood of your (people), nor turn out your own people from their dwellings. Then, (this) you ratified and (to this) you bore witness (84)After this, it is you who kill one another and drive out a party of you from their homes, assist (their enemies) against them, in sin and transgression. And if they come to you as captives, you ransom them, although their expulsion was forbidden to you. Then do you believe in a part of the Book and reject the rest? Then what is the recompense of those who do so among you, except disgrace in the life of this world, and on the Day of Resurrection they shall be consigned to the most grievous torment. And Allah is not unaware of what you do (85)Those are they who have bought the life of this world at the price of the Hereafter. Their torment shall not be lightened nor shall they be helped (86)

حَدَّثَنَا أَحْمَدُ بْنُ يُونُسَ، حَدَّثَنَا أَبُو شِهَابٍ، عَنِ ابْنِ عَوْنٍ، عَنْ مُجَاهِدٍ، عَنْ عَبْدِ الرَّحْمَنِ بْنِ أَبِي لَيْلَى، عَنْ كَعْبِ بْنِ عُجْرَةَ، قَالَ أَتَيْتُهُ يَعْنِي النَّبِيَّ صلى الله عليه وسلم فَقَالَ ‏"‏ ادْنُ ‏"‏‏.‏ فَدَنَوْتُ فَقَالَ ‏"‏ أَيُؤْذِيكَ هَوَامُّكَ ‏"‏‏.‏ قُلْتُ نَعَمْ‏.‏ قَالَ ‏"‏ فِدْيَةٌ مِنْ صِيَامٍ أَوْ صَدَقَةٍ أَوْ نُسُكٍ ‏"‏‏.‏ وَأَخْبَرَنِي ابْنُ عَوْنٍ عَنْ أَيُّوبَ قَالَ صِيَامُ ثَلاَثَةِ أَيَّامٍ، وَالنُّسُكُ شَاةٌ، وَالْمَسَاكِينُ سِتَّةٌ‏.‏

Narrated Ka`b bin 'Ujra:I came to the Prophet (ﷺ) and he said to me, "Come near." So I went near to him and he said, "Are your lice troubling you?" I replied, "Yes." He said, "(Shave your head and) make expiation in the form of fasting, Sadaqa (giving in charity), or offering a sacrifice." (The sub-narrator) Aiyub said, "Fasting should be for three days, and the Nusuk (sacrifice) is to be a sheep, and the Sadaqa is to be given to six poor persons

حَدَّثَنَا عَلِيُّ بْنُ عَبْدِ اللَّهِ، حَدَّثَنَا سُفْيَانُ، عَنِ الزُّهْرِيِّ، قَالَ سَمِعْتُهُ مِنْ، فِيهِ عَنْ حُمَيْدِ بْنِ عَبْدِ الرَّحْمَنِ، عَنْ أَبِي هُرَيْرَةَ، قَالَ جَاءَ رَجُلٌ إِلَى النَّبِيِّ صلى الله عليه وسلم فَقَالَ هَلَكْتُ‏.‏ قَالَ ‏"‏ مَا شَأْنُكَ ‏"‏‏.‏ قَالَ وَقَعْتُ عَلَى امْرَأَتِي فِي رَمَضَانَ‏.‏ قَالَ ‏"‏ تَسْتَطِيعُ تُعْتِقُ رَقَبَةً ‏"‏‏.‏ قَالَ لاَ‏.‏ قَالَ ‏"‏ فَهَلْ تَسْتَطِيعُ أَنْ تَصُومَ شَهْرَيْنِ مُتَتَابِعَيْنِ ‏"‏‏.‏ قَالَ لاَ‏.‏ قَالَ ‏"‏ فَهَلْ تَسْتَطِيعُ أَنْ تُطْعِمَ سِتِّينَ مِسْكِينًا ‏"‏‏.‏ قَالَ لاَ‏.‏ قَالَ ‏"‏ اجْلِسْ ‏"‏‏.‏ فَجَلَسَ فَأُتِيَ النَّبِيُّ صلى الله عليه وسلم بِعَرَقٍ فِيهِ تَمْرٌ ـ وَالْعَرَقُ الْمِكْتَلُ الضَّخْمُ ـ قَالَ ‏"‏ خُذْ هَذَا، فَتَصَدَّقْ بِهِ ‏"‏‏.‏ قَالَ أَعَلَى أَفْقَرَ مِنَّا، فَضَحِكَ النَّبِيُّ صلى الله عليه وسلم حَتَّى بَدَتْ نَوَاجِذُهُ قَالَ ‏"‏ أَطْعِمْهُ عِيَالَكَ ‏"‏‏.‏

Narrated Abu Huraira:A man came to the Prophet (ﷺ) and said, "I am ruined!" The Prophet (ﷺ) said, "What is the matter with you?" He said, "I had sexual relation with my wife (while I was fasting) in Ramadan." The Prophet (ﷺ) said, "Have you got enough to manumit a slave?" He said, "No." The Prophet (ﷺ) said, "Can you fast for two successive months?" The man said, "No." The Prophet (ﷺ) said, "Can you feed sixty poor persons?" The man said, "No." Then the Prophet (ﷺ) said to him, "Sit down," and he sat down. Afterwards an 'Irq, i.e., a big basket containing dates was brought to the Prophet (ﷺ) and the Prophet (ﷺ) said to him, "Take this and give it in charity." The man said, "To poorer people than we?" On that, the Prophet (ﷺ) smiled till his premolar teeth became visible, and then told him, "Feed your family with it." (See Hadith No. 157, Vol)

حَدَّثَنَا قُتَيْبَةُ، حَدَّثَنَا أَبُو صَفْوَانَ، عَنْ يُونُسَ بْنِ يَزِيدَ، عَنِ ابْنِ شِهَابٍ، عَنْ أَبِي سَلَمَةَ، عَنْ عَائِشَةَ، قَالَتْ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ لاَ نَذْرَ فِي مَعْصِيَةٍ وَكَفَّارَتُهُ كَفَّارَةُ يَمِينٍ ‏"‏ ‏.‏ قَالَ وَفِي الْبَابِ عَنِ ابْنِ عُمَرَ وَجَابِرٍ وَعِمْرَانَ بْنِ حُصَيْنٍ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ لاَ يَصِحُّ لأَنَّ الزُّهْرِيَّ لَمْ يَسْمَعْ هَذَا الْحَدِيثَ مِنْ أَبِي سَلَمَةَ ‏.‏ قَالَ سَمِعْتُ مُحَمَّدًا يَقُولُ رَوَى غَيْرُ وَاحِدٍ مِنْهُمْ مُوسَى بْنُ عُقْبَةَ وَابْنُ أَبِي عَتِيقٍ عَنِ الزُّهْرِيِّ عَنْ سُلَيْمَانَ بْنِ أَرْقَمَ عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ عَنْ أَبِي سَلَمَةَ عَنْ عَائِشَةَ عَنِ النَّبِيِّ صلى الله عليه وسلم ‏.‏ قَالَ مُحَمَّدٌ وَالْحَدِيثُ هُوَ هَذَا ‏.‏

Narrated 'Aishah:That the Messenger of Allah (ﷺ) said: "There is no vowing for disobedience, and its atonement is the atonement of an oath

حَدَّثَنَا أَبُو إِسْمَاعِيلَ التِّرْمِذِيُّ، - وَاسْمُهُ مُحَمَّدُ بْنُ إِسْمَاعِيلَ بْنِ يُوسُفَ حَدَّثَنَا أَيُّوبُ بْنُ سُلَيْمَانَ بْنِ بِلاَلٍ، حَدَّثَنَا أَبُو بَكْرِ بْنُ أَبِي أُوَيْسٍ، عَنْ سُلَيْمَانَ بْنِ بِلاَلٍ، عَنْ مُوسَى بْنِ عُقْبَةَ، وَمُحَمَّدِ بْنِ عَبْدِ اللَّهِ بْنِ أَبِي عَتِيقٍ، عَنِ الزُّهْرِيِّ، عَنْ سُلَيْمَانَ بْنِ أَرْقَمَ، عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ، عَنْ أَبِي سَلَمَةَ، عَنْ عَائِشَةَ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ لاَ نَذْرَ فِي مَعْصِيَةِ اللَّهِ وَكَفَّارَتُهُ كَفَّارَةُ يَمِينٍ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ غَرِيبٌ وَهُوَ أَصَحُّ مِنْ حَدِيثِ أَبِي صَفْوَانَ عَنْ يُونُسَ ‏.‏ وَأَبُو صَفْوَانَ هُوَ مَكِّيٌّ وَاسْمُهُ عَبْدُ اللَّهِ بْنُ سَعِيدِ بْنِ عَبْدِ الْمَلِكِ بْنِ مَرْوَانَ وَقَدْ رَوَى عَنْهُ الْحُمَيْدِيُّ وَغَيْرُ وَاحِدٍ مِنْ جِلَّةِ أَهْلِ الْحَدِيثِ ‏.‏ وَقَالَ قَوْمٌ مِنْ أَهْلِ الْعِلْمِ مِنْ أَصْحَابِ النَّبِيِّ صلى الله عليه وسلم وَغَيْرِهِمْ لاَ نَذْرَ فِي مَعْصِيَةِ اللَّهِ وَكَفَّارَتُهُ كَفَّارَةُ يَمِينٍ ‏.‏ وَهُوَ قَوْلُ أَحْمَدَ وَإِسْحَاقَ وَاحْتَجَّا بِحَدِيثِ الزُّهْرِيِّ عَنْ أَبِي سَلَمَةَ عَنْ عَائِشَةَ ‏.‏ وَقَالَ بَعْضُ أَهْلِ الْعِلْمِ مِنْ أَصْحَابِ النَّبِيِّ صلى الله عليه وسلم وَغَيْرِهِمْ لاَ نَذْرَ فِي مَعْصِيَةٍ وَلاَ كَفَّارَةَ فِي ذَلِكَ ‏.‏ وَهُوَ قَوْلُ مَالِكٍ وَالشَّافِعِيِّ ‏.‏

Narrated 'Aishah:That the Prophet (ﷺ) said: "There is no vowing in disobedience to Allah, and its atonement is the atonement of an oath

حَدَّثَنَا أَبُو بَكْرِ بْنُ أَبِي شَيْبَةَ، حَدَّثَنَا مُحَمَّدُ بْنُ مُصْعَبٍ، عَنِ الأَوْزَاعِيِّ، عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ، عَنْ هِلاَلِ بْنِ أَبِي مَيْمُونَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ رِفَاعَةَ الْجُهَنِيِّ، قَالَ كَانَ النَّبِيُّ ـ صلى الله عليه وسلم ـ إِذَا حَلَفَ قَالَ ‏ "‏ وَالَّذِي نَفْسُ مُحَمَّدٍ بِيَدِهِ ‏"‏ ‏.‏

It was narrated that Rifa'ah Al - Juhani said:"When the Prophet (ﷺ) took an oath he would say: 'By the One in Whose Hand is the soul of Muhammad

حَدَّثَنَا هِشَامُ بْنُ عَمَّارٍ، حَدَّثَنَا عَبْدُ الْمَلِكِ بْنُ مُحَمَّدٍ الصَّنْعَانِيُّ، حَدَّثَنَا الأَوْزَاعِيُّ، عَنْ يَحْيَى بْنِ أَبِي كَثِيرٍ، عَنْ هِلاَلِ بْنِ أَبِي مَيْمُونَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ رِفَاعَةَ بْنِ عَرَابَةَ الْجُهَنِيِّ، قَالَ كَانَتْ يَمِينُ رَسُولِ اللَّهِ ـ صلى الله عليه وسلم ـ التَّى يَحْلِفُ بِهَا أَشْهَدُ عِنْدَ اللَّهِ ‏ "‏ وَالَّذِي نَفْسِي بِيَدِهِ ‏"‏ ‏.‏

It was narrated that Rifa'ah bin 'Arabah A-Juhani said:"The swearing of the Messenger of Allah (ﷺ) when he took an oath and I bear witness before Allah was: 'By the One in Whose Hand is my soul

ومنها : مشابهة اليهود والنصارى في اتخاذ المساجد والسرج عليها ومنها : محادة الله ورسوله ومناقضة ما شرعه فيها ومنها : التعب العظيم مع الوزر الكثير والإثم العظيم ومنها : إماتة السنن وإحياء البدع

تجنبت إتيان الحبيب تأثما % إلا أن هجران الحبيب هو الإثم

| فصل وأما الإثم والعدوان فهما قرينان قال الله تعالى وتعاونوا على

فالإثم ما كان محرم الجنس كالكذب والزنا وشرب الخمر ونحو ذلك والعدوان ما كان محرم القدر والزيادة

والعرب تقول في وصف الرجل بالصدق والوفاء : طاهر الثياب وتقول للغادر والفاجر : دنس الثياب وقال أبي بن كعب : لا تلبسها على الغدر والظلم والإثم ولكن البسها وأنت بر طاهر

التحرج الخروج من حرج المخالفة وبناء تفعل يكون للدخول في الشيء كتمنى إذا دخل في الأمنية وتولج في الأمر : دخل فيه ونحوه وللخروج منه كتحرج وتحوب وتأثم إذا أراد الخروج من الحرج والحوب : هو الإثم

Triggers and factors associated with moral distress and moral injury in health and social care workers: A systematic review of qualitative studies.: Objective: At some point in their career, many healthcare workers will experience psychological distress associated with being unable to take morally or ethically correct action, as it aligns with their own values; a phenomenon known as moral distress. Similarly, there are increasing reports of healthcare workers experiencing long-term mental and psychological pain, alongside internal dissonance, known as moral injury. This review examined the triggers and factors associated with moral distress

Measuring moral distress and moral injury: A systematic review and content analysis of existing scales.: Background: Moral distress (MD) and moral injury (MI) are related constructs describing the negative consequences of morally challenging stressors. Despite growing support for the clinical relevance of these constructs, ongoing challenges regarding measurement quality risk limiting research and clinical advances. This study summarizes the nature, quality, and utility of existing MD and MI scales, and provides recommendations for future use. Method: We identified psychometric studies describing t

Prevalence, Predictors, and Experience of Moral Suffering in Nursing and Care Home Staff during the COVID-19 Pandemic: A Mixed-Methods Systematic Review.: (1) Background: Nursing and care home staff experienced high death rates of older residents and increased occupational and psychosocial pressures during the COVID-19 pandemic. The literature has previously found this group to be at risk of developing mental health conditions, moral injury (MI), and moral distress (MD). The latter two terms refer to the perceived ethical wrongdoing which contravenes an individual's moral beliefs and elicits adverse emotional responses. (2) Method: A systematic re

Instruments to assess moral distress among healthcare workers: A systematic review of measurement properties.: Background: An increasing number of professionals are challenged by the evolution of modern healthcare and society, often characterized by more expectations with reduced resources. Moral distress is among the psychophysical conditions now most under investigation in order to improve the wellbeing of professionals, the sustainability of organizations and the quality of care. Over the last decades, several instruments have been developed to assess the frequency or intensity of moral distress in di

Ethics education to support ethical competence learning in healthcare: an integrative systematic review.: Background: Ethical problems in everyday healthcare work emerge for many reasons and constitute threats to ethical values. If these threats are not managed appropriately, there is a risk that the patient may be inflicted with moral harm or injury, while healthcare professionals are at risk of feeling moral distress. Therefore, it is essential to support the learning and development of ethical competencies among healthcare professionals and students. The aim of this study was to explore the avail

Influence of the ethical climate on workers' health among healthcare professionals: a systematic review.: Objective: To evaluate the influence of the ethical climate on workers' health among healthcare professionals. Method: Systematic review and meta-analysis conducted in MEDLINE/PubMed, EMBASE, SciVerse Scopus (Elsevier), Cumulative Index to Nursing and Allied Health Literature and Web of Science. Trained reviewers performed the selection, data extraction, and assessment of methodological quality. Meta-analysis was applied for data synthesis. Results: Among the 2644 studies, 20 were included for a

Moral Distress and Moral Injury in Nephrology During the COVID-19 Pandemic.

Across the world, challenges for clinicians providing health care during the coronavirus disease 2019 (COVID-19) pandemic are highly prevalent and have been widely reported. Perspectives of provider groups have conveyed wide-ranging experiences of adversity, distress, and resilience. In understanding and responding to the emotional and psychological implications of the pandemic for renal clinicians, it is vital to recognize that many experiences also have been ethically challenging. The COVID-19 pandemic has prompted rapid and extensive transformation of health care systems and widely impacted care provision, heightening the risk of barriers to fulfillment of ethical duties. Given this, it is likely that some clinicians also have experienced moral distress, which can occur if an individual is unable to act in accordance with their moral judgment owing to external barriers. This review pr…

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Moral injury in healthcare workers: causes & interventions.

Background: Moral injury (MI), characterized by psychological distress from morally transgressive events, has been predominantly studied in military personnel but has gained increased attention in healthcare workers (HCWs) since the COVID-19 pandemic. Sources of data: In this review, we narratively synthesize literature on the causes, risks, consequences, and interventions of MI in HCWs. Areas of agreement: There is consensus that the COVID-19 pandemic presented HCWs with unique challenges such as fear of infection and patients dying without family, which increased the risk of MI in HCWs. Areas of controversy: Broader healthcare experiences, not unique to a pandemic, are less well understood. In this review, we discuss evidence of such experiences including restrictive practices in psychiatric settings and experiences of discrimination. Growing points: Recent studies have highlighted the…

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The hidden crisis: Moral injury among French healthcare workers.

Background: Amidst reports that one in five doctors and one in four nurses might leave their professions within three to five years due to high levels of burnout, this qualitative review explored the deeper crisis impacting healthcare workers in France, questioning whether factors beyond burnout contributed to their distress. Methodology: This study analyzed testimonies from French healthcare workers and reviewed relevant literature to uncover the underlying causes of their distress. Results: The qualitative analysis revealed profound distress among healthcare workers, stemming from a misalignment between their ethical standards, specifically the principle to 'put patients first,' and the practical realities of their work. Testimonies underscored unsustainable working conditions and economic pressures that compel healthcare workers to make decisions that compromise care quality and their…

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Moral injury and associated context, contributors and consequences within mental healthcare professionals: a scoping review.

Objectives: We sought to examine the contributory factors as well as consequences of moral injury amongst healthcare workers within mental healthcare settings. Methods: Several databases were searched for relevant studies from database inception until May 2023. Keywords and concepts included moral injury and distress in mental healthcare and psychiatry. We identified 961 studies, of which 48 were assessed for eligibility. Eventually, 35 studies were included in the review. Papers were selected for inclusion if 1) they included mental healthcare professionals (MHP) regardless of practice setting, 2) moral injury as experienced by MHP was one of their main variables of interest, 3) were written in English. Year of publication, location of study, participant characteristics, study design, settings in which injury occur (context), factors contributing to moral injury (contributors), and its …

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Introduction to the special issue "Moral injury care: Practices and collaboration".

Since moral injury was introduced in the psychological literature little more than a decade ago, it has received substantial attention from mental health professionals as well as chaplains. This special issue features ways that chaplains are and can be engaged in addressing moral injury within health care contexts, especially the Department of Veterans Affairs. The efforts highlighted in this special issue provide building blocks for advancing moral injury care practices, research agendas, and interdisciplinary collaborations into the future.

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Moral injury in the wake of coronavirus: Attending to the psychological impact of the pandemic.

Moral injury is a helpful lens through which we can better understand and prepare for the downstream psychosocial impact faced by health care providers during the coronavirus pandemic. Moral injury is psychological weight caused by a transgression of one's own or shared morals and values and can manifest as guilt, shame, inability to self-forgive, demoralization, and, in the worst case, self-harming behaviors. Given the morally challenging and life-threatening decisions our health care workers need to make daily in the face of consistent and ongoing death and loss, it is important to prepare for moral injury and the psychological toll by offering psychological support early and as often as needed at both the personal and institutional level. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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Healthcare workers' perspectives on a prescription phone program to meet the health equity needs of patients in the emergency department: a qualitative study.

Objectives: People experiencing homelessness and marginalization face considerable barriers to accessing healthcare services. Increased reliance on technology within healthcare has exacerbated these inequities. We evaluated a hospital-based prescription phone program aimed to reduce digital health inequities and improve access to services among marginalized patients in Emergency Departments. We examined the perceived outcomes of the program and the contextual barriers and facilitators affecting outcomes. Methods: We conducted a constructivist qualitative program evaluation at two urban, academic hospitals in Toronto, Ontario. We interviewed 12 healthcare workers about their perspectives on program implementation and outcomes and analyzed the interview data using reflexive thematic analysis. Results: Our analyses generated five interrelated program outcomes: building trust with patients, …

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Measures of morally injurious experiences: A quantitative comparison.

A recent body of literature has examined the psychological effects of perpetrating or failing to prevent acts that violate one's sense of right and wrong. The objective of this study was to examine and compare correlations between the two most widely used instruments measuring this construct in a sample of military veterans and relevant psychosocial variables. Individuals (N = 182) who reported military combat experience completed the Moral Injury Events Scale and the Moral Injury Questionnaire-Military Version, along with measures of combat exposure, depression, posttraumatic stress disorder, alcohol concerns, anger, guilt, and shame. Results indicate similar correlations between the morally injurious experiences instruments and negative psychosocial variables, but different correlations with combat exposure. Implications for further research in the conceptualization and treatment of mo…

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Moral distress among infection prevention and control professionals: A scoping review.

Background: The COVID-19 pandemic highlighted the vital role of Infection Prevention and Control Professionals (IPCPs) in safeguarding public health. Amid rapidly evolving guidelines, critical personal protective equipment shortages, and surging workloads, IPCPs encountered unprecedented moral and ethical dilemmas. However, their experiences, ethical challenges, and the resulting moral distress remain understudied. Methods: A scoping review following Arksey and O'Malley's methodology was conducted to examine current research on ethical challenges and moral distress among IPCPs. Searches in CINAHL, MEDLINE via OVID, Emcare, Scopus, and Korea Citation Index yielded two extracted articles. Results: Common themes included high workload, increased recognition, pressure to deliver accurate and timely information, need for peer support, and evidence-based practice. Differences in nationality, r…

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Examining moral injury in clinical practice: A narrative literature review.

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included "moral injury" and "moral distress," identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal,…

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Pilot evidence of genetic and environmental contributions to problematic pornography use, pornography use frequency, and moral disapproval to pornography.

Background: Compulsive sexual behavior disorder is a new construct defined in the International Classification of Diseases. Problematic pornography use (PPU) is a common presentation. Prior studies have demonstrated genetic bases of sexual behavior using twin samples. However, these studies have failed to report outcomes for PPU indicators. Aim: We conducted an analysis on twin data that included measures of PPU, pornography use, moral disapproval of pornography use, and past 30-day masturbation frequency. Method: Our data were derived from a larger study piloting a community panel approach to twin research. Specifically, we partnered with YouGov to sample community members from across the United States who identified as having a same-sex twin. We then employed a large survey battery to twin identifying members. Participants were provided with bonus remuneration (~$25 USD) if both twins …

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The role of constraint in the development of nicotine, marijuana, and alcohol dependence in young adulthood.

The personality-related construct of behavioral disinhibition is hypothesized to confer a generalized risk for alcohol and drug dependence. On average, rates of substance use and scores on measures of disinhibition peak in adolescence and decline as people mature into adulthood. The present study investigated this developmental change by evaluating the relationship between disinhibition and substance use disorders using a longitudinal study of 2,608 twins assessed at ages 17, 24, and 29. These ages include the period of highest risk for substance use disorders (ages 17-24) as well as when substance dependence symptoms typically decline (ages 24-29). Disinhibition was measured with the Multidimensional Personality Questionnaire higher-order scale of Constraint, as well as its constituent facet scales of Harm Avoidance, Control, and Traditionalism. Constraint's relationship with substance …

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The Prosocial and Antisocial Behaviour in Sport Scale: further evidence for construct validity and reliability.

The purpose of this research was to provide further evidence for the construct validity (i.e., convergent, concurrent, and discriminant validity) of the Prosocial and Antisocial Behaviour in Sport Scale (PABSS), an instrument that has four subscales measuring prosocial and antisocial behaviour toward teammates and opponents. We also investigated test-retest reliability and stability of the PABSS. We conducted three studies using athletes from a variety of team sports. In Study 1, participants (N = 129) completed the PABSS and measures of physical and verbal aggression, hostility, anger, moral identity, and empathy; a sub-sample (n = 111) also completed the PABSS one week later. In Study 2, in addition to the PABSS, participants (N = 89) completed measures of competitive aggressiveness and anger, moral attitudes, moral disengagement, goal orientation, and anxiety. In Study 3, participants…

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Neural development of mentalizing in moral judgment from adolescence to adulthood.

The neural mechanisms underlying moral judgment have been extensively studied in healthy adults. How these mechanisms evolve from adolescence to adulthood has received less attention. Brain regions that have been consistently implicated in moral judgment in adults, including the superior temporal cortex and prefrontal cortex, undergo extensive developmental changes from adolescence to adulthood. Thus, their role in moral judgment may also change over time. In the present study, 51 healthy male participants age 13–53 were scanned with functional magnetic resonance imaging (fMRI) while they viewed pictures that did or did not depict situations considered by most individuals to represent moral violations, and rated their degree of moral violation severity. Consistent with predictions, a regression analysis revealed a positive correlation between age and hemodynamic activity in the temporo-p…

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A terror management analysis of the psychological functions of religion.

From a terror management theory (TMT) perspective, religion serves to manage the potential terror engendered by the uniquely human awareness of death by affording a sense of psychological security and hope of immortality. Although secular beliefs can also serve a terror management function, religious beliefs are particularly well suited to mitigate death anxiety because they are all encompassing, rely on concepts that are not easily disconfirmed, and promise literal immortality. Research is reviewed demonstrating that mortality salience produces increased belief in afterlife, supernatural agency, human ascension from nature, and spiritual distinctions between mind and body. The social costs and benefits of religious beliefs are considered and compared to those of secular worldviews. The terror management functions of, and benefits and costs associated with, different types of religious o…

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The influence of social variables and moral disengagement on prosocial and antisocial behaviours in field hockey and netball.

In this study, we examined: (a) the effects of perceived motivational climate and coaching character-building competency on prosocial and antisocial behaviours towards team-mates and opponents in field hockey and netball; (b) whether the effects of perceived character-building competency on sport behaviours are mediated by moral disengagement; and (c) whether these relationships are invariant across sport. Field hockey (n = 200) and netball (n = 179) players completed questionnaires assessing the aforementioned variables. Structural equation modelling indicated that mastery climate had positive effects on prosocial and negative effects on antisocial behaviour towards team-mates, while performance climate had a positive effect on antisocial behaviour towards team-mates. Perceived character-building competency had a positive effect on prosocial behaviour towards opponents and negative effe…

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On positive psychological outcomes: what helps groups with a history of conflict to forgive and reconcile with each other?

Three studies examined the roles of traditional and novel social psychological variables involved in intergroup forgiveness. Study 1 (N = 480) revealed that among the pro-Pinochet and the anti-Pinochet groups in Chile, forgiveness was predicted by ingroup identity (negatively), common ingroup identity (positively), empathy and trust (positively), and competitive victimhood (the subjective sense of having suffered more than the outgroup, negatively). Political ideology (Right vs. Left) moderated the relationship between empathy and forgiveness, trust and forgiveness, and between the latter and competitive victimhood. Study 2 (N = 309), set in the Northern Irish conflict between Protestants and Catholics, provided a replication and extension of Study 1. Finally, Study 3 (N = 155/108) examined the longitudinal relationship between forgiveness and reconciliation in Northern Ireland, revealin…

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Protective factors against suicidal behavior in depressed adults reporting childhood abuse.

Most previous studies compared suicidal behavior in subjects with and without a history of childhood abuse, whereas less attention was paid to the comparison of suicide attempters and nonattempters among subjects reporting childhood abuse. To identify risk and protective factors against suicidal behavior, we compared suicide attempters with nonattempters among the sample of 119 depressed inpatients who reported childhood abuse. Compared with nonattempters, suicide attempters were younger, had more self-rated depression severity and suicidal ideation, higher trait aggression and more cluster B personality disorder comorbidity, less coping potential, and fewer moral objections to suicide (MOS)/religious beliefs. Logistic regression showed that more severe suicidal ideation and fewer MOS/religious beliefs were associated with suicidal acts in subjects with reported childhood abuse. Furtherm…

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More than nation and knowledge: cultural micro-diversity and organ donation in Switzerland.

Objective: While recent studies of organ donation have recognized cultural factors, most analyses in developed countries have focused on awareness as the critical constraint. The present paper examines this assumption and assesses the number of potential organ donors as well as their knowledge and attitudes regarding organ donation. Methods: We conducted a telephone survey of 1509 adults using a stratified random sample of the main three language groups (German, French, and Italian) in Switzerland with oversampling of the Italian language group to compensate for its relatively small size. Because our analyses are performed separately on each language group, the oversampling does not distort our findings. Results: The three language groups display substantial differences with respect to patterns of knowledge, motives, and concerns underlying their willingness to donate organs--differences…

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Moral Injury: An Overview of Conceptual, Definitional, Assessment, and Treatment Issues.

Moral injury (MI) is a potential clinical problem characterized by functionally impairing moral emotions, beliefs, and behaviors as well as adverse beliefs about personal or collective humanity and life's meaning and purpose. MI can arise from personal transgressive acts or from being a victim of or bearing witness to others' inhumanity. Despite widespread interest in MI, until recently, there was no reliable measure of MI as an outcome, and prior research has revealed little about its causes, consequences, and intervention approaches. This review provides background information on the history of MI, defines key terms, and critically reviews assessment tools. Additionally, we describe a social-functional theory of the etiology of MI and a social-functional rehabilitation approach to treatment. This treatment approach, which can be used by any clinician regardless of clinical context, emp…

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Exploring the potential of psychedelic-assisted psychotherapy for moral injury: A scoping review.

This scoping review addresses the need to comprehensively explore the potential of psychedelic-assisted psychotherapy (PAP) to facilitate recovery from moral injury. Moral injury (MI), characterized by profound psychological distress arising from morally challenging experiences, has garnered increased attention as a complex mental health concern with significant functional sequelae, especially in the context of post-traumatic stress disorder (PTSD). There is growing interest in exploring alternative therapeutic approaches, with psychedelics emerging as an exciting potential intervention, as moral injury impacts treatment resistance, suicidality, social isolation, and overall functioning. Ten studies were included from 11,734 publications. Studies utilized psilocybin, MDMA, or LSD. None focused specifically on moral injury. Diagnoses included PTSD, alcohol use disorder, insomnia, human Im…

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Addressing moral injury in the military.

Moral injury is a relatively new, but increasingly studied, construct in the field of mental health, particularly in relation to current and ex-serving military personnel. Moral injury refers to the enduring psychosocial, spiritual or ethical harms that can result from exposure to high-stakes events that strongly clash with one's moral beliefs. There is a pressing need for further research to advance understanding of the nature of moral injury; its relationship to mental disorders such as posttraumatic stress disorder and depression; triggering events and underpinning mechanisms; and prevalence, prevention and treatment. In the meantime, military leaders have an immediate need for guidance on how moral injury should be addressed and, where possible, prevented. Such guidance should be theoretically sound, evidence-informed and ethically responsible. Further, the implementation of any prac…

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Complex Moral Injury: Shattered Moral Assumptions.

An infographic model of moral injury (MI) is introduced in this conceptual paper that distinguishes the development of a worldview discrepancy-induced genus of MI, called complex moral injury (C-MI), from a standard expression of moral injury (S-MI), clearly delineated as perpetration-focused and a violation of moral belief in the contemporary view. It builds upon a previous essay that examined the potential of paradoxical circumstance (e.g., clashes of value, competing moral expectations, and moral paradox) to inflict MI among military personnel during wartime (Fleming in J Relig Health 60(5):3012-3033, 2021). Accordingly, it heeds Litz et al.'s recommendation to expand the research of MI beyond the effects of perpetration and investigate the impact of morally injurious events that shake one's core moral beliefs about the world and self (Litz et al. in Clin Psychol Rev 29(8):695-706, 20…

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Moral Injury, Chaplaincy and Mental Health Provider Approaches to Treatment: A Scoping Review.

The aim of this research was to describe the evidence examining the approaches taken by mental health providers (MHPs) and chaplains to address symptoms related to moral injury (MI) or exposure to potentially morally injurious events (PMIEs). This research also considers the implications for a holistic approach to address symptoms related to MI that combines mental health and chaplaincy work. A scoping review of literature was conducted using Medline, PsycINFO, Embase, Central Register of Controlled Trials, Proquest, Philosphers Index, CINAHL, SocINDEX, Academic Search Complete, Web of Science and Scopus databases using search terms related to MI and chaplaincy approaches or psychological approaches to MI. The search identified 35 eligible studies: 26 quantitative studies and nine qualitative studies. Most quantitative studies (n = 33) were conducted in military samples. The studies exam…

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Moral Injury: An Increasingly Recognized and Widespread Syndrome.

Moral injury (MI), originally discussed in relationship to transgressing moral beliefs and values during wartime among military personnel, has expanded beyond this context to include similar emotions experienced by healthcare professionals, first responders, and others experiencing moral emotions resulting from actions taken or observations made during traumatic events or circumstances. In this article, we review the history, definition, measurement, prevalence, distinctiveness, psychological consequences, manifestations (in and outside of military settings), and correlates of MI in different settings. We also review secular psychological treatments, spiritually integrated therapies, and pastoral care approaches (specific for clergy and chaplains) used to treat MI and the evidence documenting their efficacy. Finally, we examine directions for future research needed to fill the many gaps …

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