본문 바로가기
KERD
논문KCI 등재

Moral Injury: Clinician Burnout as a Consequence of Degraded Values, Virtues, and Professionalism in Medicine

0

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류학제간연구

초록

Recently, the concept of “moral injury” has been attracting greater attention from researchers and practitioners in medicine. It has been argued that the concept of moral injury is the most appropriate portrayal of a unique kind of human anguish ─ clinician burnout. Placing more emphasis on clinician burnout as a form of suffering associated with deeply held moral beliefs, rather than focusing on individuals experiencing emotional distress, is taken to be essential to prevent clinicians from internalizing the cause and harms of clinician burnout. Critics are now advocating for a definitional shift to the notion of moral injury because of its potential to function as a criticism of causes that are external to individuals. However, the notion of moral injury has not been widely recognized by either medical society or medical ethics in general, due to the lack of definitional specificity required for reliable communication within and among related disciplines. This paper aims to present a clear description of the form of moral injury that occurs in medical practice and reveal the causal relationship between degraded values and virtues internal to the discipline of medicine, and the moral injury that leads clinicians toward burnout. First, it will provide the most recent theory of moral injury. Second, it will describe a comprehensive analysis of Pellegrino’s medical ethics regarding values and virtues internal to medicine. Lastly, it will propose moral injury as constituting the consequence of degraded professionalism and professional identity upheld by clinicians, then suggest the usefulness of Pellegrino’s work in preventing ─ or reducing the harm caused by ─ moral injury.

Abstract

Recently, the concept of “moral injury” has been attracting greater attention from researchers and practitioners in medicine. It has been argued that the concept of moral injury is the most appropriate portrayal of a unique kind of human anguish ─ clinician burnout. Placing more emphasis on clinician burnout as a form of suffering associated with deeply held moral beliefs, rather than focusing on individuals experiencing emotional distress, is taken to be essential to prevent clinicians from internalizing the cause and harms of clinician burnout. Critics are now advocating for a definitional shift to the notion of moral injury because of its potential to function as a criticism of causes that are external to individuals. However, the notion of moral injury has not been widely recognized by either medical society or medical ethics in general, due to the lack of definitional specificity required for reliable communication within and among related disciplines. This paper aims to present a clear description of the form of moral injury that occurs in medical practice and reveal the causal relationship between degraded values and virtues internal to the discipline of medicine, and the moral injury that leads clinicians toward burnout. First, it will provide the most recent theory of moral injury. Second, it will describe a comprehensive analysis of Pellegrino’s medical ethics regarding values and virtues internal to medicine. Lastly, it will propose moral injury as constituting the consequence of degraded professionalism and professional identity upheld by clinicians, then suggest the usefulness of Pellegrino’s work in preventing ─ or reducing the harm caused by ─ moral injury.

참고문헌 (88)

  1. S. Yun, "On blaming the healthcare system : A preliminary study of moral injury in the clinical context, based on Pellegrino’s medical ethics", Master, pp.2024
  2. V. J. Dzau, "To care is human – collectively confronting the clinician-burnout crisis", NEJM, 378(4) (2018)[DOI]
  3. National Academies of Science, Engineering, and Medicine, "Taking action against clinician burnout: A systems approach to professional well-being" (2019), The National Academies Press
  4. T. Hinkley, "Nurse resilience is not enough", Medsurg Nurs, 30(3) (2021)
  5. S. E. Morris, "Burnout in psychosocial oncology clinicians: A systematic review", Palliat Support Care, 19(2) (2021)[DOI]
  6. M.S. Williams, "Misdiagnosis: “Burnout, moral injury, and implications for the electronic health record”", JAMIA, 28(5) (2021)[DOI]
  7. N. C. Greep, "Physician burnout: Fix the doctor or fix the system?", Am J Med, 135(4) (2022)[DOI]
  8. M. DiGiorgio, "Improving health care quality measurement to combat clinician burnout", JAMA, 330(12) (2023)[DOI]
  9. M.C. Gebhardt, "Editorial: It’s more than burnout – the moral injury crisis in orthopaedic surgeons", Clin Orthop Relat Res, 481(11) (2023)[DOI]
  10. J. Shay, "Achilles in Vietnam: Combat trauma and the undoing of character" (1994), Atheneum
  11. J. Shay, "Odysseus in America: Combat trauma and the trials of homecoming" (2002), Scribner
  12. J. Shay, "Moral injury", Psychoanal Psychol, 31(2) (2014)[DOI]
  13. B. T. Litz, "Moral injury and moral repair in war veterans: A preliminary model and intervention strategy", Clin Psychol Rev, 29(8) (2009)[DOI]
  14. J. M. Currier, "Moral injury, meaning making, and mental health in returning veteran", J Clin Psychol, 71(3) (2015)[DOI]
  15. L. B. Carey, "Moral injury, spiritual care and the role of chaplains: An exploratory scoping review of literature and resources", J Relig Health, 55(4) (2016)[DOI]
  16. T. J. Hodgson, "Moral injury and definitional clarity: Betrayal, spirituality and the role of chaplains", J Relig Health, 56(4) (2017)[DOI]
  17. R.K. Papadopoulos, "Moral injury and beyond: Understanding human anguish and healing traumatic wounds" (2020), Routledge
  18. "In memoriam: Andrew Jameton, PhD" (2022)[URL]
  19. A. Jameton, "Nursing practice : The ethical issues" (1984), Prentice-Hall
  20. S. K. Sporrong, "We are white coast whirling round – moral distress in Swedish pharmacies", Pharm World Sci, 27(3) (2005)[DOI]
  21. K. J. Schwenzer, "Assessing moral distress in respiratory care practitioners", Crit Care Med, 34(12) (2006)[DOI]
  22. R. Hillard, "Ethical conflicts and oral distress experienced by paediatricresidents during their training", Paediart Child Health (Oxford), 12(1) (2007)[DOI]
  23. M. Curl, "Commentary – Chronic moral distress among childbirth educators: Is there a cure?", J Perinat Educ, 18(1) (2009)[DOI]
  24. D. Mukherjee, "Moral distress in rehabilitation professionals: Results from a hospital ethics survey", PM R, 1(5) (2009)[DOI]
  25. M. Weinberg, "Moral distress", Can Soc Work Rev, 26(2) (2009)
  26. L. Sasso, "Moral distress in undergraduate nursing students: A systematic review", Nurs Ethics, 23(5) (2016)[DOI]
  27. "Physicians aren’t ‘burning out.’ They’re suffering from moral injury" (2018)[URL]
  28. R. Raso., "Burnout: Is resilience enough?", Nurs Manag, 51(4) (2020)[DOI]
  29. S. Mantri, "Reframing the conversation around physician burnout and moral injury: “We are not suffering from a yoga deficiency”", Perm J, 25(4) (2021)[DOI]
  30. W. Dean, "Reframing clinician distress : Moral injury not burnout", Fed Pract, 36(9) (2019)
  31. B.S. Powers, "Moral injury and original sin: The applicability of Augustinian moral psychology in light of combat trauma", Theol Today, 73(4) (2017)[DOI]
  32. J. Snyder, "Blood, guts, and gore galore: Bodies, moral pollution and combat trauma", Symb Interact, 37(4) (2014)[DOI]
  33. R.N. Brock, "Moral injury and beyond Understanding human anguish and healing traumatic wounds" (2020), Routledge
  34. W. P. Nash, "Psychometric evaluation of the moral injury events scale", Mil Med, 178(6) (2013)[DOI]
  35. C. Center, "Confronting depression and suicide in physicians : A consensus statement", JAMA, 289(23) (2003)[DOI]
  36. D.W. Alexander, "Moral injury and beyond: Understanding human anguish and healing traumatic wounds" (2020), Routledge
  37. J. M. Currier, "Addressing moral injury in clinical practice" (2021), American Psychological Association
  38. M. Timmons, "Moral theory : An introduction" (2022), Rowman & Littlefield
  39. "Intrinsic vs. extrinsic value" (2019)[URL]
  40. "Value theory" (2021)[URL]
  41. "Metaphysics" (2023)[URL]
  42. G. Khushf., "Why bioethics needs the philosophy of medicine: Some implications of reflection on concepts of health and disease", Theor Med, 18(1-2) (1997)[DOI]
  43. C. Boorse, "On the Distinction between disease and illness", Philos Public Aff, 5(1) (1975)
  44. C. Boorse, "Health as a theoretical concept", Philos Sci, 44(4) (1977)[DOI]
  45. G. Hesslow, "Do we need a concept of disease?", Theor Med, 14(1) (1993)[DOI]
  46. E. J. M. Campbell, "The concept of disease", BMJ, 2(6193) (1979)[DOI]
  47. E.D. Pellegrino, "The goals of medicine: The forgotten issue in health care reform" (1999), Georgetown University Press
  48. D. Callahan, "The troubled dream of life : In search of a peaceful death" (2000), Georgetown University Press
  49. D. Callahan, "What kind of life : The limits of medical progress" (1990), Simon and Schuster
  50. E. D. Pellegrino, "For the patient’s good : The restoration of beneficence in health care" (1988), Oxford University Press
  51. A. J. Greimas, "The interaction of semiotic constraints", Yale French Stud, 41(1) (1968)[DOI]
  52. E. D. Pellegrino, "A philosophical basis of medical practice : Toward a philosophy and ethic of the healing professions" (1981), Oxford University Press
  53. D. C. Thomasma, "Philosophy of medicine as the source for medical ethics", Metamedicine, 2(1) (1981)[DOI]
  54. E.D. Pellegrino, "Toward a reconstruction of medical morality", J Med Humanit Bioeth, 8(1) (1987)[DOI]
  55. E. D. Pellegrino, "The virtues in medical practice" (1993), Oxford University Press
  56. R. J. Levine, "Ethics and regulation of clinical research" (1986), Urban & Schwarzenberg
  57. E. J. Emanuel, "Ethical and regulatory aspects of clinical research : Readings and commentary" (2003), Johns Hopkins University Press
  58. H. Jonas, "Technology and responsibility : Reflections on the new tasks of ethics", Soc Res, 40(1) (1973)
  59. D.P. Sulmasy, "Engaging Pellegrino’s philosophy of medicine: Can one of the founders of the field still help us today?", Theor Med Bioeth, 40(3) (2019)[DOI]
  60. A. MacIntyre, "After Virtue : A study in moral theory" (2007), University of Notre Dame Press
  61. K. Sadegh-Zadeh., "Normative systems and medical metaethics part I: Value kinematics, health, and disease", Metamedicine, 2(1) (1981)[DOI]
  62. E.D. Pellegrino, "Some things ought never be done: Moral absolutes in clinical ethics", Theor Med Bioeth, 26(6) (2005)[DOI]
  63. R.M. Veatch, "The health care professional as friend and healer: Building on the work of Edmund D. Pellegrino" (2000), Georgetown University Press
  64. R. M. Veatch, "Patient, heal thyself : How the new medicine puts the patient in charge" (2009), Oxford University Press
  65. R. M. Veatch, "The patient as partner : A theory of human-experimentation ethics" (1987), Indiana University Press
  66. R. M. Veatch, "The patient-physician relation : The patient as partner, part 2" (1991), Indiana University Press
  67. "The definition of morality" (2020)[URL]
  68. E. D. Pellegrino, "Toward a virtue-based normative ethics for the health professions"", Kennedy Inst Ethics J, 5(3) (1995)[DOI]
  69. E. D. Pellegrino, "Humanism in human experimentation : Some notes of the investigator’s fiduciary role", Tex Rep Biol Med, 32(1) (1974)
  70. S. Johnson, "The prince of Abissinia : A tale", Printed for R. and J. Dodsley, and W. Johnston
  71. K. Jones-Bonofiglio, "Health care ethics through the lens of moral distress" (2020), Springer Nature Switzerland
  72. A.K. Nathaniel, "Moral reckoning in nursing", West J Nurs Res, 28(4) (2006)[DOI]
  73. C.H. Rushton, "Principled moral outrage: An antidote to moral distress?", AACN Adv Crit Care, 24(1) (2013)[DOI]
  74. G. C. Webster, "Margin of error : The ethics of mistakes in the practice of medicine" (2000), University Publishing Group
  75. C. M. Ulrich, "Moral distress : A growing problem in the health professions?", Hastings Cent Rep, 40(1) (2010)[DOI]
  76. C. Varcoe, "Moral distress: Tensions as springboards for action", HEC Forum, 24(1) (2012)[DOI]
  77. C.A. Smith, "Virtue ethics and the physician: Aristotle’s burnout antidote?", South Med J, 113(5) (2020)[DOI]
  78. The Lancet, "Physician burnout: The need to rehumanize health systems", Lancet, 394(10209) (2019)[DOI]
  79. M. R. Ehmann, "Operational recommendations for scarce resources allocation in a public health crisis", Chest, 159(3) (2021)[DOI]
  80. E. J. Emanuel, "Fair allocation of scarce medical resources in the time of Covid-19", N Eng J Med, 382(21) (2020)[DOI]
  81. E. J. Emanuel, "What Covid has taught the world about ethics", N Eng J Med, 387(17) (2022)[DOI]
  82. "AMA Code of ethics: Principles" (2001)[URL]
  83. D. Callahan, "Principlism and communitarianism", J Med Ethics, 29(5) (2003)[DOI]
  84. T. L. Beauchamp, "Principles of biomedical ethics" (2019), Oxford University Press
  85. "AMA Code of ethics: Chapter 11 financing & delivery of health care" (2001)[URL]
  86. L. French, "If I die, they do not care : U.K. National Health Service staff experiences of betrayal-based moral injury during COVID-19", Psychol Trauma, 14(3) (2022)[DOI]
  87. S. Hegarthy, "It hurts your heart : Frontline healthcare worker experiences of moral injury during the COVID-19 pandemic", Eur J Psychotraumatology, 13(2) (2022)[DOI]
  88. K. E. Nelson, "Organizational impact on healthcare workers’ moral injury during COVID-19: A mixed-methods analysis", J Nurs Adm, 52(1) (2022)[DOI]

관련 논문AI추천

이 간행물의 다른 논문 (2건)