The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
At a more recognisable level for us, there is I suggest another arena in which moral injury is a growing concern – the provision of health care. Moral injury of health care is not the offense of killing another human in the context of war. It is about being unable to provide high-quality care and healing in the context of health care expectation.
Our current NHS health care system and allied private health practitioners as well, find themselves unable to meet patients or clients needs and this failing has a profound impact on the clinicians and practitioner’s wellbeing especially if the reason for being unable to meet these needs is out of your control. It is this developing and expanding gap between the initial ‘calling’ of your professional life and its related desire to promote health and recovery that creates so much problem.
The matching of ethical care, moral pathways and delivery of focussed and personalised medicine or therapy is very hard in the existing structure of the dominant health care system in the UK, but also elsewhere. The resulting disconnect between intent and execution can lead to a slow degradation of joy and contentment by a series of a thousand small wounds – which overtime coalesce into the ‘moral injury’ of health care.
Whilst in the NHS a top down appreciation of the need to reassign some higher level of autonomy to primary care physicians and an allied process that permits appropriate allocation of time and other resources is a long-term solution – what could be done now, what could help you regain the feelings related to that joyful moment when you finally qualified and saw your rosy future in the delivery of health generation!
Well having a sense of purpose, a vision of a reachable and attainable state of function appears to confer health benefits and reduces stress. How to summarise this:
“it’s basically the idea that your life makes sense, you’re here for a reason, and you’re significant in the world.”
One of the significant observations we have had reported back to us over the years of training practitioners and clinicians in functional and lifestyle medicine has been the sense of re-engaged enthusiasm for their chosen profession – stress is reduced, joy is revitalised when the skills recently learned allows them to re-engage with their inherent purpose.
In turn, these re-invigorated professionals also re-engage in self-promoting behaviours, change eating, exercise and resting profiles and take their new enthusiasm to their patient groups catching many new converts and completing the circle of purpose discovery.
As Nietzsche once wrote, “He who has a why to live for can bear almost any how”.
If you are already on the path of a clear purpose, then well done, your life span is anticipated to be longer and healthier, your tolerance of challenge better and emotional stability more assured. Look out for colleagues for whom moral injury is taking a powerful place in their life, see if a retraining may offer them a way forward and help them rediscover purpose – it’s a gift of immense opportunity.