Understanding moral injury at work

Exhaustion that working hours alone cannot explain

A customer service employee is instructed to give customers a message they believe is misleading. They have raised their concerns several times but are told that ‘those are the targets.’ That evening, their thoughts return not only to the workload but also to the question: ‘Why did I agree to this?’ This is an example of a dilemma that can have a moral dimension. However, it is not enough to conclude that moral injury has occurred. It helps us to see that the source of the burden is not simply pressure and fatigue, but a rupture in the person's sense of themselves as honest. The concept of moral injury emerged primarily in studies of military experiences and other situations with high moral stakes. It includes the possible consequences of participating in or witnessing an event, or experiencing betrayal by someone in authority when deeply held principles are violated. It is important to distinguish between a potentially morally injurious event and its consequences. Two people may experience a similar situation differently; the circumstances alone do not establish a diagnosis. The distinction is important because resting and reducing the number of tasks does not always address the heart of the experience. A person may return to the question of whether they acted in accordance with their principles, whom they let down, and whether they could have done something differently. However, not every unpleasant decision should be called a moral injury. Work often requires a choice between imperfect solutions, and the conflict of values alone does not by itself determine the consequences that follow. What's important is the significance of the event, the circumstances and how the person experiences it. This article may help identify the right questions, but it will not replace an individual assessment of the situation. Particular caution should be exercised in transferring concepts developed in contexts involving severe danger to ordinary organizational disappointments or differences of opinion with the supervisor.

What the research actually shows

Williamson, Stevelink and Greenberg carried out a systematic review and meta-analysis of moral injury in professional contexts. The findings suggest an association between these experiences and mental health problems, but the research base and the populations studied need to be taken into account. These findings do not establish that ordinary frustration in the office is equivalent to the experience of people working under extreme risk or responsibility for others' lives. Williamson et al., 2018. Applying the concept to ordinary organizations is a developing area of research. The concept should be used carefully so as not to trivialize severe experiences or medicalize any disagreement with a company's decision. It is reasonable to say that moral conflict deserves special attention. It is not necessary to immediately call it moral injury to acknowledge that the employee needs the opportunity to raise concerns and should not be compelled to do something they believe is seriously harmful.

Why general advice to rest may miss the point

If someone feels that they have betrayed an important principle, a weekend off may restore some energy, but it will not answer the question of responsibility. In our example, the employee also needs clarification as to whether the message to customers will be revised and whether they can refuse to forward it further. The problem is the content of the action, not merely how to manage the emotions it causes. The organizational response should therefore include an assessment of the situation and conditions that led to it. It is important to distinguish between three things: what happened, how much control the person had, and what moral significance they attach to the event. The employee may assume more responsibility than their actual decision-making authority warrants. They may also try to deny it altogether. An honest conversation begins neither with the ready reassurance, 'You have nothing to blame yourself for,' nor with judgment. It requires facts, an understanding of the power dynamics, and space to explore what the person believes was violated. In conversation, it's important to separate the extent of one's influence from the knowledge gained later. After the event, it is easy to judge an earlier decision as if all the information currently known had been available from the beginning. That doesn't mean you're not accountable. It's about faithfully recreating what the person knew, what options they had, and what constraints were imposed on them at the time. Any consequences that require remediation should be considered separately. An organization can help by honestly explaining the process and acknowledging the real difficulties, instead of automatically assuring that everything was fine. Such assurance can close the conversation if the employee needs the organization to take seriously the conflict between the action and the principles that matter to them.

How to discuss a moral objection

It is helpful to state the concern in specific terms: ‘I'm concerned that this message omits information relevant to the customer's decision. I want to explore how we can correct it.’ This helps move the conversation from a general assessment of the company to a specific practice. Depending on the situation, it may be necessary to speak to a supervisor, the relevant compliance or oversight function or an independent specialist. If the case concerns a possible breach of law, legal assessment is a separate task and should not be replaced by a psychological interpretation. A leader receiving such a report should avoid presenting the problem as a lack of resilience or loyalty. They may ask for a specific potential harm, the necessary safeguards and the possibility of limiting further action until the issue is clarified. It is also important to respond after the matter has been investigated. The absence of feedback leaves the employee feeling that the concern was heard only so they could be sent back to follow the same instructions. Organizational accountability requires a visible process, not just an empathetic tone.

When additional support is needed

If the experience involves persistent distress, severe guilt, difficulty sleeping, or daily functioning, it is worth seeking help from an appropriate specialist. The person does not need to decide on their own what label best fits the symptoms. At the same time, it is important to look at working conditions. Individual support should not be used to help a person adapt to an unchanged source of harm. Both personal and organizational levels may require action, although not always at the same time and by the same people. It is also important to determine whether the conditions that led to the incident can be changed. If workers regularly have to choose between impossible requirements, talking about resilience alone is not enough. Changes to a procedure, access to consultation or a clear process for raising concerns before a decision is made may be necessary. It is worth establishing who has the authority to stop the work and on what grounds. At the same time, not every case can be solved at the team level. When the experience has a significant impact on health, relationships or daily functioning, it is important to have access to appropriate specialist support. An employee should not be left with the expectation that they will resolve both the organizational causes and the personal consequences of a difficult event.

Not every difficult experience is a moral injury, but a violation of important principles should not be reduced to mere stress. It is worth clarifying what happened, who was responsible, and whether the conditions can be changed. Help begins with taking seriously what the person experiences as a moral violation.

How Empatyzer supports conversations about conflicting values

Empatyzer can support the preparation of a workplace conversation about an action that raises serious doubts. The Your values feature provides a starting point for identifying the principles that matter to the user, and Talk to Em about yourself helps you organize a description of the situation and the goal of the next conversation. You can ask a question about the basis of the decision, the scope of your responsibility or whether an alternative approach is possible. It is worth separating facts from moral judgments without underestimating the importance of one's own experience. Empatyzer does not diagnose moral injury, determine legal liability or provide therapy. Nor should it replace the appropriate formal report if the case requires a formal explanation. Its role is to help formulate the message and define the conversation needed. The user can thus better prepare a description for their manager or an appropriate support professional, while the assessment of the facts and the choice of further assistance should be based on the actual circumstances and the expertise of the appropriate professionals.