Abstract

•Define and understand Moral Injury as defined in recent scholarship and how it differs from PTSD.•Discuss examples of moral injury using actual veteran stories.•Understand the impact of moral injury upon veterans at the end of life. Various definitions of moral injury exist. Jonathan Shay describes it as “a betrayal of what’s right, by someone who holds legitimate authority, in a high stakes situation.” Brett Litz defines moral injury as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Moral injury as an entity has only recently been recognized and efforts to address it begun. At the present time, it is not accepted as a diagnosis by the Department of Defense or the Veterans Administration. Moral Injury related to combat is a concept as old as war itself. It is referred to in ancient Greek literature and throughout history. When the noble cause for which one volunteered is compromised a moral injury occurs. Several centers across the country are now conducting research about moral injury and its treatment. Spiritual and faith communities have taken a significant role in addressing and healing moral injury. Outcomes of moral injury include: shame, guilt, anger, isolation, desperation, despair, demoralization, self-handicapping behaviors and self-harming behaviors including suicidality. Unresolved moral injury can complicate the care of Veterans with serious, life limiting, or life-threatening illnesses and have serious effects on their quality of life. Therefore, it is very important that palliative care providers caring for Veterans have a good understanding of the complexities of moral injury. This concurrent session will review the definition of moral injury and how it differs from PTSD. Using stories of combat Veterans, role play and short video presentations, causes of moral injury will be discussed. The effects of moral injury on the care of Veterans in general and Veterans dealing with serious, life limiting, or life-threatening illnesses in particular will be illustrated. This multidisciplinary panel will discuss current treatment options both in the mental health and chaplaincy fields.

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