This article offers suggestions for categorizing combat-related moral injuries, highlights possible causes of these injuries in veterans, and touches upon broadly-conceived measures to prevent and repair them. The first part identifies three prevailing definitions – lost trust, guilt, and harm to one’s capacity for right action and moral virtue – and argues for an emphasis on the latter. In service of highlighting areas for future empirical research and clinical awareness, the second part outlines possible veteran-related causes associated with these three (...) definitions, including unwarranted distrust of authorities, misapplying the theodicy problem to human acts, undue survivor’s guilt, wars that fail to meet ad bellum criteria, causing permissible collateral damage, and killing combatants without regret and for pleasure. The third part mentions strategies for preventing character harm, and then discusses the cognitive, rehabituative, and psychological aspects of moral repair. (shrink)

In this chapter, the authors argue that the concept of “moral injury” needs regimentation: Current definitions are both too broad and too narrow. They are too broad because they ignore or conflate important differences between the kinds of moral conflicts discussed in the literature. They are too narrow because they exclude the possibility of moral injury in the absence of internal moral conflict. The authors argue that it is necessary to first develop a conception of moral health, and (...) they propose a Strawsonian conception of moral health as the ability to participate in the moral community. The account offered in this chapter thus includes some cases that are not recognized as moral injuries in the literature and rejects some cases that are commonly described as moral injuries. (shrink)

Moral injury emerged in the healthcare discussion quite recently because of the difficulties and challenges healthcare workers and healthcare systems face in the context of the COVID-19 pandemic. Moral injury involves a deep emotional wound and is unique to those who bear witness to intense human suffering and cruelty. This article aims to synthesise the very limited evidence from empirical studies on moral injury and to discuss a better understanding of the concept of moral injury, its (...) importance in the healthcare context and its relation to the well-known concept of moral distress. A scoping literature review design was used to support the discussion. Systematic literature searches conducted in April 2020 in two electronic databases, PubMed/Medline and PsychInfo, produced 2044 hits but only a handful of empirical papers, from which seven well-focused articles were identified. The concept of moral injury was considered under other concepts as well such as stress of conscience, regrets for ethical situation, moral distress and ethical suffering, guilt without fault, and existential suffering with inflicting pain. Nurses had witnessed these difficult ethical situations when faced with unnecessary patient suffering and a feeling of not doing enough. Some cases of moral distress may turn into moral residue and end in moral injury with time, and in certain circumstances and contexts. The association between these concepts needs further investigation and confirmation through empirical studies; in particular, where to draw the line as to when moral distress turns into moral injury, leading to severe consequences. Given the very limited research on moral injury, discussion of moral injury in the context of the duty to care, for example, in this pandemic settings and similar situations warrants some consideration. (shrink)

The clinical literature on moral injury sometimes mentions the making of amends as part of a possible treatment plan. However, it is typically unclear how clinicians are conceiving of the making of amends or “atonement,” particularly in the context of the debilitating cluster of symptoms known as moral injury. This chapter reviews some culturally prominent conceptions of atonement. It then raises a number of objections to these and recommends an alternative model – a “reconciliation theory” of atonement – (...) that can avoid these objections. This theory conceives of wrongdoing as damaging relationships among victims, wrongdoers, and communities, and of atonement as repairing this damage. Atonement for serious wrongdoing isn't easy, but it isn't impossible either. Atonement comes in degrees. When pursued well, it offers benefits to victims and communities as well as to wrongdoers themselves. (shrink)

This book brings together leading interdisciplinary scholars to broaden and deepen the conversation about moral injury. In original essays, the contributors present new research to show how the humanities are crucial for understanding the expressions, meaning, and significance of moral injury. Moral injury is the disorientation we suffer when we are complicit in some moral transgression. Most existing work addresses moral injury from a clinical or neuroscientific perspective. The essays in this volume show how the humanities (...) are crucial for understanding the meaning and significance of moral injury, as well as suggesting how to grapple with its lived challenges. The chapters address the conceptual, sociological, historical, and ritualistic dimensions of moral injury across three thematic sections. Section 1 explores how tools of the humanities provide new lenses for understanding conceptual and genealogical themes about moral injury. Section 2 highlights the experiences of moral injury in combat soldiers, law enforcement, and noncombatants such as photojournalists. These chapters examine the power and limits to theorizing moral phenomena by appeals to lived experience. Section 3 considers how humanistic inquiry illuminates important dimensions of the aftermath of moral injury beyond the scope of clinical research. These chapters consider how ritual, relationship repair, and atonement might shape the ways people navigate moral injury and consider how such responses shape our understandings of what we owe to one another. Moral Injury and the Humanities: Interdisciplinary Perspectives is an essential resource for researchers and advanced students in philosophy, religious studies, literature, journalism, and the arts who are interested in moral injury. (shrink)

This article offers suggestions for categorizing combat-related moral injuries, highlights possible causes of these injuries in veterans, and touches upon broadly-conceived measures to prevent and repair them. The first part identifies three prevailing definitions – lost trust, guilt, and harm to one’s capacity for right action and moral virtue – and argues for an emphasis on the latter. In service of highlighting areas for future empirical research and clinical awareness, the second part outlines possible veteran-related causes associated with these three (...) definitions, including unwarranted distrust of authorities, misapplying the theodicy problem to human acts, undue survivor’s guilt, wars that fail to meet ad bellum criteria, causing permissible collateral damage, and killing combatants without regret and for pleasure. The third part mentions strategies for preventing character harm, and then discusses the cognitive, rehabituative, and psychological aspects of moral repair. (shrink)

This article, originally presented as a keynote address at the 2019 McCain conference, proposes that we must take seriously the “moral” component of moral injury. In addition to psychological treatment, wounded warriors suffering moral injury require atonement for genuine transgressions, and insight when the conduct they regard as transgression actually is not. The article defines the dimensions of moral injury as parallel to those of physical injury: pain, loss of functionality, and (in some cases) disfigurement. It (...) then asks how atonement can be achieved, turning to an unusual source for inspiration: the laws of atonement set out by the medieval Jewish philosopher Moses Maimonides. Maimonides proposes four requirements: verbal confession, repentance, reparation, and apology. The article explains their meaning in the context of contemporary wounded warriors. Finally, it argues that Judaism’s unique tradition of collective atonement offers an important model for the armed services. (shrink)

This article, originally presented as a keynote address at the 2019 McCain conference, proposes that we must take seriously the “moral” component of moral injury. In addition to psychological treatment, wounded warriors suffering moral injury require atonement for genuine transgressions, and insight when the conduct they regard as transgression actually is not. The article defines the dimensions of moral injury as parallel to those of physical injury: pain, loss of functionality, and (in some cases) disfigurement. It (...) then asks how atonement can be achieved, turning to an unusual source for inspiration: the laws of atonement set out by the medieval Jewish philosopher Moses Maimonides. Maimonides proposes four requirements: verbal confession, repentance, reparation, and apology. The article explains their meaning in the context of contemporary wounded warriors. Finally, it argues that Judaism’s unique tradition of collective atonement offers an important model for the armed services. (shrink)

In Sin Sick, Joshua Pederson draws on the latest research about identifying and treating the pain of perpetration to advance and deploy a literary theory of moral injury that addresses fictional representations of the mental anguish of those who have injured or killed others. Pederson's work foregrounds moral injury, a recent psychological concept distinct from trauma that is used to describe the psychic wounds suffered by those who breach their own deeply held ethical principles. Complementing writings on trauma (...) theory that posit the textual manifestation of trauma as absence, Sin Sick draws argues that moral injury appears in literature in a variety of forms of excess. Pederson closely reads works by Dostoevsky (Crime and Punishment), Camus (The Fall), and veterans of the wars in Iraq and Afghanistan (Brian Turner's Here, Bullet; Kevin Powers' The Yellow Birds; Phil Klay's Redeployment; and Roy Scranton's War Porn), contending that recognizing and understanding the suffering of perpetrators, without condoning their crimes, enriches the experience of reading—and of being human. (shrink)

In this article, I confront Flanigan’s recent attempt to show, not merely that women have a right to commit prenatal injury, but also that women who act on this right are praiseworthy and should not be criticized for this injury. I show that Flanigan’s arguments do not work, and I establish presumptive grounds against any such right, namely: prenatal injury, by definition, involves intentional or negligent harm and, as such, may be subsumed under a wider class of (...) actions that are presumptively wrong. (shrink)

If I am injured in the course of medical investigation or treatment, I may be eligible to receive compensation for some of the adverse consequences of my injury—at least, if I live in a developed country. In most such countries, there exists some form of state-administered compensation scheme for medical injuries. However, even within the developed world, there is considerable variation in the eligibility criteria for compensation. Different countries would, for example, respond very differently to the following pair of (...) cases... (shrink)

Amidst the return of military personnel from post-9/11 conflicts, a construct describing the readjustment challenges of some has received increasing attention: moral injury. This term has been variably defined with mental health professionals more recently conceiving of it as a transgression of moral beliefs and expectations that are witnessed, perpetrated, or allowed by the individual. To the extent that morality is a system of conceptualizing right and wrong, individuals’ moral systems are in large measure developmentally and socially derived and (...) interpreted. Thus, in seeking to provide care and aid in reintegration for combat veterans, it is necessary to consider communities that have contributed to an individual’s formation and that might have participated in the interpretation of his/her suffering. This can take many forms, but given that morality is often complexly intertwined with issues of religion, faith, and spirituality for many individuals, and recognizing that much of the current focus on moral injury is emanating out of healthcare contexts, we devote particular attention to how chaplains might be more intentionally engaged in healthcare systems such as the Veterans Health Administration to provide non-judgmental, person-centered, culturally-relevant care rooted in communities of practice to veterans with moral injury. (shrink)

In this article, I undertake three main tasks. First, I argue that, contrary to the standard view, moral injury is not a species of PTSD (post-traumatic stress disorder) but rather, on the most coherent conception of moral injury, PTSD is (in effect) a species of moral injury. In doing so, I make use of the notion of caring deeply about something or someone worthy of being cared deeply about. Second, I consider so-called “dirty hands” actions in police (...) work and in war, and distinguish these from the morally legitimate, but harmful, actions of police officers and of war fighters, such as the morally legitimate use of coercive force and lethal force (respectively). While the morally legitimate use of harmful methods is constitutive of these occupational roles, “dirty hands” methods are not. Roughly speaking, a “dirty hands” action is one that is morally wrong and (typically) unlawful but done for the sake of a good outcome. Both categories of action are conducive to moral injury, but “dirty hands” actions much more so, especially given the slippery moral slope from “dirty hands” actions to egregious moral wrongdoing. Third, I offer some recommendations for reducing moral injury among police officers and war fighters. (shrink)

Since Jonathan Shay's work with Vietnam veterans, moral injury has largely focused on the harm done to soldiers' moral character through their participation in warfare. This essay argues for the inclusion of noncombatants in the scope of inquiry involving moral injury. Specifically, it argues for the necessity of ordinary citizens assuming responsibility for the moral injury done to soldiers and civilians alike in the post‐9/11 wars.

This book turns to virtue language as an important resource for understanding moral injury, a form of subjectivity where one feels they can no longer strive to be good as a result of wartime experience. Drawing specifically on Iris Murdoch’s moral philosophy, and examining the experiences of civilians during the Bosnian War, Joseph Wiinikka-Lydon argues that current research into war and current understandings of subjectivity need new ways to articulate the moral dimension of being a subject if we are (...) to understand how violence affects one’s moral being and development. He develops an understanding of the human person as a tensile moral subject, one that forefronts the moral challenges and vulnerability inherent in lives affected by war. With these resources, Wiinikka-Lydon argues for a moral vocabulary and images of the human as a moral being that can better articulate the experience of violence and moral injury. (shrink)

Rather than focusing on the legal and political questions that surround genocidal rape, in this paper I treat a vital area of inquiry that has received much less attention: the moral significance of genocidal rape. My aim is to augment existing moral accounts of rape in order to address the specific contexts of genocidal rape. I move beyond understanding rape primarily as a violation of an individual's interests or agential abilities. The account I offer builds on these approaches (as well (...) as on a pluralist approach), by arguing that rape, as a moral injury, negatively affects the very human dignity of victims. My account also emphasizes the relational harm that marks genocidal rape. (shrink)

Working in the language of first-order arithmetic we consider models of the base theory P - . Suppose M is a model of P - and let M satisfy induction for σ 1 -formulas. First it is shown that the Friedberg-Muchnik finite injury argument can be performed inside M, and then, using a blocking method for the requirements, we prove that the Sacks splitting construction can be done in M. So, the "amount" of induction needed to perform the known (...) finite injury priority arguments is Σ 1 -induction. (shrink)

Philosophers are wont to say that certain concepts, e.g., the concept of pain, exhibit ‘first/third-person asymmetry’, whereas others, e.g., the concept of injury, do not. The question I wish to address here concerns the status of such claims. They are commonly seen as nothing more than summary reports of how the relevant words are ordinarily used: as statements of ‘grammatical fact’. I want to argue against this view of their status.

Public and clinical interest in a condition called moral injury – psychological distress resembling posttraumatic stress disorder (PTSD) but said to originate from shame, guilt, or transgression in...

This article explores how meanings around risk, health/safety, and workers’ bodies are constructed in an academic context. I do so through the study of a single academic in Australia who sustained a back injury at work. Through an analysis of in-depth interviews and documents, I attempt to show the embodied experience of an injured worker’s struggle for care, recovery, and survival in the neoliberal academy. Writing from the nexus of workplace health and safety and critical management literatures, the raw (...) testimony of this injured academic lays bare the violences that are enabled within a wider culture of self-discipline, individualism, and performativity in the university. The story presented in this article exposes how physiological and psychological injuries can be exacerbated through the very health and safety procedures that are designed to prevent and alleviate harm. Please note that this article contains references to suicide and suicidal ideation. (shrink)

I argue that, given certain prominent views of personal identity and prudence, the nonidentity problem, or a very similar problem, can arise postconception. I clarify and defend this claim by considering the implications of these views for prenatal injury.

Circumscribed delusional beliefs can follow brain injury. We suggest that these involve anomalous perceptual experiences created by a deficit to the person's perceptual system, and misinterpretation of these experiences due to biased reasoning. We use the Capgras delusion (the claim that one or more of one's close relatives has been replaced by an exact replica or impostor) to illustrate this argument. Our account maintains that people voicing this delusion suffer an impairment that leads to faces being perceived as drained (...) of their normal affective significance, and an additional reasoning bias that leads them to put greater weight on forming beliefs that are observationally adequate rather than beliefs that are a conservative extension of their existing stock. We show how this position can integrate issues involved in the philosophy and psychology of belief, and examine the scope for mutually beneficial interaction. (shrink)

Moral injury names how the lived experience of armed conflict can damage an individual's ethical foundations, often with serious consequences. While the term has gained increasing acceptance for the clinical treatment of veterans and as a means of better understanding the impact of war, it is generally applied to individualized trauma. As part of the roundtable, “Moral Injury, Trauma, and War,” this essay argues that moral injury is also a useful means of addressing political violence at a (...) societal level. It explores the term's value within international human rights discourse and practice, particularly in efforts to document and analyze the systematic commission of atrocities to achieve accountability and reconciliation. The essay presents field research among Iraqi human rights investigators as a means of reflecting on the value of rediscovering agency in the aftermath of societal trauma. In this way, moral injury provides guidance on the essential ethical qualities of the lived experience of violent repression, an issue central to a more complete understanding of international affairs. (shrink)

In "On the Concept of 'Psychiatric Disorder,'" Miriam Solomon strives to resolve the tension between thinking of bereavement as a normal reaction to loss, and recognizing that its most extreme forms look very much like major depressive episodes and benefit from psychiatric treatment. To do this, she introduces the idea that a condition can be both normal and a mental disorder, or in other words, that some mental disorders are normal. Although I very much like the idea that some mental (...) are predictable responses to stressors, I have trouble making sense of the argument Solomon provides. I am going to focus on two reasons why.First, the concept of psychological injury is not new and does not do the work Solomon needs... (shrink)

Although jus in bello violations create transgressive acts that cause moral injury, the primary consideration in thinking about moral injury should be jus ad bellum. If one is fighting in an ad bellum just war, then transgressive acts can be rationalized in a way that allows for consolation. But for morally sensitive combatants engaged in an ad bellum unjust war, consolation is more difficult since there is no way to justify or rationalize morally problematic deeds committed in defense (...) of an unjust cause. Morally serious combatants should consider the question of jus ad bellum as they struggle to deal with moral injury, along with other values such as obedience and loyalty. Such an inquiry can produce further trauma when the justness of the war is called into question. The paper examines moral injury and justice in war, grounding the discussion in concrete examples: the Second World War, the Vietnam War, and the U.S. war in Iraq. It concludes that in a democracy, ordinary citizens should demonstrate solidarity with combatants suffering moral injury, since those combatants serve in wars—even unjust wars—authorized by us and fought in our names. (shrink)

Joseph J. Fins calls for a reconsideration of severe brain injury treatment, including discussion of public policy and physician advocacy.

We live in an anxious world, riddled with unpredictable threats to our safety and unexpected hatreds directed toward us. It is easy to obsess on the terrors around us, about which we can do little, and lose perspective on the real and sometimes devastating risks that we encounter in our daily lives. These everyday risks need to be regularly revisited — to remind ourselves that they can be reduced with the application of sharp minds, careful scholarship, and political will.Medical errors (...) in the American health-care system are just such a problem. The risk of death or serious injury at the hands of the American health-care system is not trivial, as we have learned over the past few years as the health-care establishment has acknowledged the level of iatrogenic injury in the system. If, as the Institute of Medicine reported in To Err Is Human, as many as 100,000 people every year are dying in hospitals, clinics, and doctors’ offices as the result of actions or omissions that could have been avoided, then this is a social problem of great magnitude and one that the law must try to correct. (shrink)

We live in an anxious world, riddled with unpredictable threats to our safety and unexpected hatreds directed toward us. It is easy to obsess on the terrors around us, about which we can do little, and lose perspective on the real and sometimes devastating risks that we encounter in our daily lives. These everyday risks need to be regularly revisited — to remind ourselves that they can be reduced with the application of sharp minds, careful scholarship, and political will.Medical errors (...) in the American health-care system are just such a problem. The risk of death or serious injury at the hands of the American health-care system is not trivial, as we have learned over the past few years as the health-care establishment has acknowledged the level of iatrogenic injury in the system. If, as the Institute of Medicine reported in To Err Is Human, as many as 100,000 people every year are dying in hospitals, clinics, and doctors’ offices as the result of actions or omissions that could have been avoided, then this is a social problem of great magnitude and one that the law must try to correct. (shrink)

Background: Benzodiazepines have been widely used in clinical practice for over four decades and continue to be one of the most consumed and highly prescribed class of drugs available in the treatment of anxiety, depression, and insomnia. The literature indicates that Benzodiazepine users at a significantly increased risk of Motor Vehicle accidents compared to non-users but the impact on injuries at workplace is not well-defined. We aimed to investigate whether use of benzodiazepine is associated with increased risk of occupational injuries.Methods: (...) PubMed, Embase, and Scopus databases were searched. A meta-analysis was performed to calculate odds ratio and 95% confidence interval among case controls, cross-sectional studies, either questionnaire or laboratory exams based.Results: A total of 13 studies met inclusion criteria, involving 324,168 OI from seven different countries, with an estimated occurrence of benzodiazepine positivity of 2.71%. A total of 14 estimates were retrieved. Of them, 10 were based on laboratory analyses, three on institutional databases, while one study was based on questionnaires. Regarding the occupational groups, three estimates focused on commercial drivers, that exhibited a reduced risk ratio for benzodiazepine positivity compared to other occupational groups. Eventually, no increased risk for benzodiazepine positivity was identified, either from case control studies, or cross sectional studies, when only laboratory based estimates were taken in account.Conclusions: Even though benzodiazepines have the potential to increase injury rates among casual and chronic users, available evidence are insufficient to sustain this hypothesis, particularly when focusing on laboratory-based studies. (shrink)

Note: Content within this article regarding moral injury, sexual trauma, and mental health may be distressing to some people.Wars in Iraq and Afghanistan involving Coalition troops are over but sol...

The point of this article is to test how well Josiah Royce’s philosophy of community can be utilized to conceptualize moral injury and recovery.1 The term “moral injury” is of recent coinage, articulated by those working with combat veterans and their challenges returning to civilian life, particularly veterans returned from Vietnam and from America’s recent presence in the Middle East. The basic idea is that, in combat, soldiers harm their own moral capacities by committing or participating in acts (...) that they understand to be morally repugnant. The consequences of such harm include difficulty with participating well or fully in civilian life, even to the point of committing violence against loved ones. Despite the... (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the (...) society. Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the (...) society. Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

As part of the roundtable, “Moral Injury, Trauma, and War,” this essay explores the relationship between revisionist just war theory and moral injury. It proceeds in four sections. First, it offers a brief overview of the just war tradition, focusing on traditionalist and revisionist accounts, respectively. Next, it explores the relationship between moral injury and armed conflict. Then, it explores the links between moral injury and revisionist accounts of just war theory. Finally, by way of conclusion, (...) the essay signals two potential complementary paths forward that future research could use to clarify the revisionist position and its link with moral injury. (shrink)

The prevalence of tainted legacies within Christian ethics, across the academy, and in contemporary public debate raises difficult questions about handling legacies implicated in traumatic pasts. This essay uses the concept of moral injury to illuminate the moral complexities of tainted religious legacies and employs feminist and womanist ethics to provide strategies for moral repair in the wake of these and other such legacies. It first argues that, despite significant limitations, moral injury provides purchase on the experience of (...) encountering tainted religious legacies by naming the type of agency involved, describing the moral harm tainted legacies cause, and highlighting the social and institutional context of that harm. It then argues that feminist and womanist responses to morally injurious forms of Christianity—particularly explorations of redemptive suffering—not only resonate with responses to Yoder’s case and other tainted legacies current in public debate but also provide criteria for assessing those responses. (shrink)

Although jus in bello violations create transgressive acts that cause moral injury, the primary consideration in thinking about moral injury should be jus ad bellum. If one is fighting in an ad bellum just war, then transgressive acts can be rationalized in a way that allows for consolation. But for morally sensitive combatants engaged in an ad bellum unjust war, consolation is more difficult since there is no way to justify or rationalize morally problematic deeds committed in defense (...) of an unjust cause. Morally serious combatants should consider the question of jus ad bellum as they struggle to deal with moral injury, along with other values such as obedience and loyalty. Such an inquiry can produce further trauma when the justness of the war is called into question. The paper examines moral injury and justice in war, grounding the discussion in concrete examples: the Second World War, the Vietnam War, and the U.S. war in Iraq. It concludes that in a democracy, ordinary citizens should demonstrate solidarity with combatants suffering moral injury, since those combatants serve in wars—even unjust wars—authorized by us and fought in our names. (shrink)

This book expands the conversation on moral injury to include a more formal role for society in it. The author utilizes an interdisciplinary practical theology combining liberation theologies and cultural studies to interrogate how dominate ideologies can complicate moral injury reintegration among veterans.

Philosophers are wont to say that certain concepts, e.g., the concept of pain, exhibit ‘first/third-person asymmetry’, whereas others, e.g., the concept of injury, do not. The question I wish to address here concerns the status of such claims. They are commonly seen as nothing more than summary reports of how the relevant words are ordinarily used: as statements of ‘grammatical fact’. I want to argue against this view of their status.

Today’s fast-moving, media lifeworld embodies many of the metaphors of its analog predecessors – including those of warfare and conflict. The metaphor of warfare is used to describe everything from corporate marketing strategies to political campaigns, often with harmful consequences. In one way of exploring the front lines of the resulting war on truth, we describe some lessons learned from the experience of military veterans who have actually endured the liminality of combat, and who emerge with what is increasingly termed (...) moral injuries. We use their experience as an analogy for competing narratives in cyberspace, where objective standards of truth and facticity are apparent casualties, and where fake news is emerging as victorious. We then apply models of social construction, specifically the practical theory of the Coordinated Management of Meaning, and the metaphor of jazz improvisation in the context of Schutz’s lifeworld phenomenology as possibly useful, helpful, and hopeful ways of acting into the complexity of truth together. (shrink)

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, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)

This study explored representations of self-injury in Japanese manga. A content analysis of fifteen slice-of-life manga published between 2000-2017 was conducted, focusing on forty scenes that depict eighteen characters engaging in self-injury. Most depictions of self-injury reflect a stereotypical perception of “self-injurer,” a young girl cutting herself to cope with negative emotion. Characters receive informal support from friends and partners, while parents are portrayed as unsupportive and even triggering. An emergent trend was observed among manga targeting male (...) readers to label self-injuring women as “menhera” - mentally vulnerable damsels in distress - inviting a fetishistic gaze on the self-injuring female bodies. (shrink)

The tort law of negligence is one of our principal forms of protection against accidental physical injury. But it is underspecified in one respect and incomplete in another. The common law of negligence is underspecified in that its norm of reasonable care does not register clearly enough the fact that it is reasonable to take greater precautions against some kinds of physical injuries — severe and irreparable ones — than it is against other kinds — mild and fully repairable (...) ones. The common law of negligence is incomplete in that it relies on the award of money damages to induce prospective injurers to exercise reasonable care prospectively, yet does not so much as attempt to fully monetize the harm done by unreasonable risks that result in death. (shrink)

Self-injury is a perilous and increasingly common behavior that is particularly prevalent among youth. Nonetheless, there is a deep-rooted public stigma towards people who self-injure. Consequently, people who engage in self-injury are reluctant to seek professional help or disclose their experiences to others. This article aims to combat stigma and promote help-seeking behavior by debunking the common myths surrounding self-injury in the Malaysian context. Specifically, this article aims to serve as an eye-opener for Malaysian counselors and other (...) mental health professionals to improve their multicultural knowledge, skills, and attitudes when working with those who self-injure. (shrink)

Our essay will address both the right-to-die movement in America and the emerging culture of neglect in the treatment of a class of patients with disorders of consciousness with which the right-to-die movement is entwined. We trace the etiology of these two themes through changes in our scientific understanding of brain injury and recovery against a growing societal acculturation to dominion over one's self at life's end.