Recognizing and Supporting Morally Injured ICU Professionals during the COVID‑19 Pandemic

The COVID-19 pandemic is producing a maelstrom of morally distressing and potentially morally injurious events (pMIEs). PMIEs are defined as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations”. Moral distress, which occurs when intensive care unit (ICU) professionals cannot fulfill their moral requirements due to internal or contextual constraints, can fade over time. However, moral injury, a concept originating in military psychology, signifies a durable mental wound characterized by symptoms such as guilt, shame, existential or moral conflict, a loss of trust in goodness, moral detachment and/or moral disorientation. A person becomes morally injured if exposed to repeated incidents of moral distress or due to a single egregious violation of morality.