If you were asked to dismiss an employee but disagreed with the decision on ethical grounds, how would you respond? Handling difficult workplace decisions could put you at risk of moral burnout. 

In the 1990s, Jonathan Shay, a psychiatrist at a Department of Veterans Affairs clinic in Boston, was working with veterans and helping them come to terms with the atrocities they’d witnessed on deployments.

Many felt their morals had been violated and had lost their faith in humanity, leading Shay to coin the term ‘moral injury’. 

When these soldiers returned home, they tried to “make some sense of the moral transgressions, such as war crimes or immoral behaviour, that they’d witnessed,” says Rachel Clements, Co-Founder and Director of Psychological Services at the Centre for Corporate Health.

Although moral injury was first coined in the defence force, the term has since been applied to understand workplace stress and trauma in a range of professions.

“Moral injury occurs when someone feels their purpose, sense of meaning or values have been shattered in some way because they’ve been so severely compromised. I use the word ‘shattered’ because it elicits a very strong reaction,” says Clements.

In recent years, moral injury has surfaced in professions including healthcare, media and HR.

As doctors and emergency services personnel responded to the pandemic, some felt the standard of care they could provide was compromised because of staff shortages, for example, or insufficient access to essential equipment.

“When someone feels they were in a situation where they didn’t act or do enough to support a cause, they might feel a sense of shame. People can come out of that experience almost feeling they’ve perpetrated something even though others can see they haven’t.” – Rachel Clements

“Healthcare professionals might even have to make ethical decisions about who receives life-saving treatment and who doesn’t. And if you don’t have enough beds, you might need to turn some people away – how do you decide who to select?” says Clements.

It can also occur in the media industry, she adds.

“Moral injury can occur in producers who work on reality shows. Their moral compass might be stretched because making ‘good’ TV sometimes means they’re requiring people to be sleep deprived or highly emotional. “How far do you push that moral compass as a producer?” 

While moral injury could occur as a one-off incident – for example, if an HR leader is told to dismiss an employee, but they fundamentally disagree with the decision on ethical grounds – it could also occur on an ongoing basis and lead to moral burnout.

“This is an accumulation of witnessing more of the same problematic behaviour. HR might witness ongoing bullying, harassment or aggressive workplace behaviour, and see employees leave or their mental health affected as a result.

“If the organisation wants to turn a blind eye to the bad behaviour because the person is a top performer and brings a lot of value to the business, HR might feel very compromised if they’re trying to put a stop to the behaviour.”

Identifying moral injury

Relative to other psychological issues, such as post-traumatic stress disorder (PTSD), moral injury isn’t as widely understood. In fact, it’s only started gaining more attention in recent years.

“It’s not a diagnosable condition in the Diagnostic and Statistical Manual of Mental Disorders, unlike a condition such as PTSD which is widely known about. It’s almost like moral injury is now where PTSD was 20 years ago. It’s only now emerging as a known psychological risk.’

Although the two conditions can be related, they differ in some fundamental ways.

“The cause of each is quite distinct. PTSD typically involves a real threat to oneself or to someone else,” says Clements. 

“This isn’t necessarily the case for moral injury. Someone can witness a horrific car accident and experience PTSD, but if the accident doesn’t threaten their morals or values, they probably won’t have a moral injury. That’s the key differentiator.”

“Moral injury occurs when someone feels their purpose, sense of meaning or values have been shattered in some way because they’ve been so severely compromised.” – Rachel Clements

There are, however, some similarities between PTSD and moral injury – particularly in terms of symptom presentation and coping styles.

“In both cases, the person may experience guilt or shame, anxiety, and sleeplessness. Nightmares are common as well. 

“In moral injury, we tend to see a loss of faith in people or the world. The world as the person knew it has changed. That can also happen with PTSD. You’re really struggling with your belief systems.

Photo: Marcus Aurelius, Pexels

“There are also often maladaptive coping styles – such as denial, avoidance or blocking out the experience through drug and alcohol misuse. The way that people might cope with PTSD and moral injury can be quite similar.”

“In both instances you’re aiming to reduce symptoms, but how you go about addressing the cause will be quite different.”

Treating moral burnout

Many HR professionals enter the industry because they’re committed to changing organisations for the better. They might see it as their role to help stamp out bullying and sexual harassment, or maybe they’re passionate about moving the needle on diversity, equity and inclusion issues.

It can therefore be disheartening if you come to the realisation that your company may not take a strong stance on these issues. Clements says this clash between personal values and an organisation’s priorities or culture can present a major risk for moral burnout.

“A person’s value system gives them meaning and purpose. If they’re suddenly in an organisation where it’s not practiced, or transgressed, that can be really challenging.

“When someone feels they were in a situation where they didn’t act or do enough to support a cause, they might feel a sense of shame. People can come out of that experience almost feeling they’ve perpetrated something, even though others can see they haven’t.”

If HR professionals feel their moral code has been crossed, Clements advises some key steps to navigate the issue:

• Connect with a bigger purpose: “Look at how your work might be contributing to a bigger sense of meaning or purpose. While the day-to-day might be ethically challenging, think about what change your work might be contributing towards.The Centre for Corporate Health has helped lawyers who are working on challenging legal matters that might not align with their morals.

  “Often they can still see the bigger picture. They might think they can make some incredible change to case law and help this situation from emerging ever again.”

• Reframe your thinking: Being an agile thinker is key, says Clements.
  
  While an HR professional may experience moral burnout if they feel they didn’t do enough to change a culture of bullying or harassment, an alternative way of viewing this situation could be to recognise that they did all they could with the limited resources and support they had.

Read HRM’s article on reframing negative thoughts.

• See it as a stepping stone: “Try looking at the situation not just as a challenging experience, but as a situation that can teach you something,” says Clements.For example, could it present an opportunity to learn a new skill, acquire fresh knowledge about a particular industry, or potentially offer a deeper, more profound, lesson.“Many people can come out of the experience with more resilience, greater clarity about their values, increased levels of empathy, improved communication skills or they might make a decision to move their career in a different direction because they realise they need to feel they’re contributing to a greater purpose.”

Getting on the front foot

HR plays a critical role in helping to prevent moral burnout in both themselves and their colleagues. Clements shares some steps HR can take to keep it in check: 

• Pre-empt situations when moral injury could occur. This allows employers to get on the front foot by setting up support systems and having conversations early.For example, the Centre for Corporate Health has talked about moral injury and how to prevent it with lawyers before they start work on controversial court matters.“If you have teams that may be exposed to complex situations and you know that there might be potential for moral injury, talk about it,” says Clements.
• Manage people’s workloads: Dealing with an ethical dilemma or moral burnout comes with an emotional load, says Clements.“HR should ensure leaders are on top of the frequency with which morally fraught issues are coming to a team, and how team members are dealing with these challenges.”Perhaps some employees need to have their load lightened or take some time off between handling morally fraught situations at work.

Read HRM’s recent story about a lawyer who sued her employer for failing to protect her from psychological risks after being exposed to emotionally disturbing materials.

• Think about person-job fit: If you’re hiring people or asking employees to work on a project that might be morally challenging, factor this into your selection process, says Clements.“Getting the right people in the right jobs will reduce the risk of moral injury,” she says.“I’d suggest asking questions such as: ‘If you have a certain belief system and you’re asked to work on a particular matter and take a completely different position, how would you feel about that? How would you reconcile the two positions? How would you cope with the situation?'”Someone with lower adaptive resilience might find it more challenging whereas someone with higher adaptive resilience might be able to handle having a moral dilemma because… They manage to find some meaning or purpose in the situation.”
• Establish peer support programs: In the thick of COVID-19, peer-to-peer programs might’ve helped healthcare workers to manage any difficult ethical decisions, says Clements.
  
  “The role of peer-to-peer support in these types of situations is incredible. It helps to prevent more pervasive levels of distress.”
• Provide leadership support: HR should work with leaders to ensure they’re equipped with the skills to try and prevent moral burnout, says Clements.
  
  “If a team might be exposed to moral injury, having a supportive leader is one of the biggest protective factors.”

Until moral burnout becomes a more widely understood and researched issue, we also need to ramp up education efforts.

“I still don’t think there’s that much awareness of moral injury, even though I get asked about it more and more nowadays.”

For this reason, she says raising awareness and putting a name to the experience is key.

“When I explain it to people, they will often say that it makes so much sense. Then they understand why they might be feeling a certain way, why a job or situation is taking an enormous amount of their energy or why they’re feeling so fatigued. 

“Just because moral injury is a relatively new concept and not a diagnosable mental health condition doesn’t mean it doesn’t exist… Being aware of it is such a critical part.”’

Worried moral burnout could affect you or a colleague? AHRI’s short course on Building an Ethical Workplace Culture might be able to help guide decision-making on tricky ethical topics.
Book in for the next course on 15 September.