Moral Dilemmas and Moral Injury

Abstract

Psychiatrists working with war veterans have, in recent years, constructed ‘moral injury’ as a separate manifestation of war trauma that is distinct from Post-Traumatic Stress Disorder (PTSD). This paper argues that for moral degradation to occur, it necessarily involves one’s commissions or omissions that transgresses one’s personal morality, and hence, distinguishes sufferers of moral injury from PTSD sufferers who were witnesses to traumatic and morally abhorrent events. To this end, it clarifies how some of the situations surrounding moral injury are misunderstood, by discussing the process of moral reasoning in the context of moral dilemmas, dirty hands, and moral blind alleys. Finally, it concludes that when we conceptualise moral injury as being caused by one’s commissions and omissions in moral dilemmas, we find that shame and guilt are situation-appropriate responses with a role to play in what ethics mean.