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Abstract
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Uniformed Professionals (UPs), including military members, public safety personnel, and essential service providers, operate in increasingly fast-paced, unpredictable, complex and ambiguous environments. Situations arising in these contexts often require UPs to make prompt decisions and act rapidly to protect themselves and others. While their decision-making is informed by a values-based framework, code of conduct, implicit and explicit duties, and standards of practice, moral dilemmas that arise in the course of service can challenge their values and beliefs. Moral dilemmas are a special class of moral decisions in which (i) there is a conflict between at least two core values/obligations (loyalty, obedience, respect for life); (ii) acting in a way that is consistent with one underlying value means failing to fulfill the other(s); (iii) harm will occur regardless of the option chosen; and (iv) a decision is inescapable and inevitable; some action must be taken (1). In some cases, moral dilemmas can contribute to mental health problems such as PTSD, depression, anxiety, and moral injury (MI).
MI is a psychological and spiritual injury that arises as a result of exposure to a potentially morally injurious event (PMIE), including participating in, witnessing, or failing to prevent an act(s) that transgresses core beliefs (2). Guilt, shame, anger, betrayal, powerlessness, and suicidal ideation are commonly associated with MI. UPs can experience various types of shame and guilt associated with perceived moral transgressions including dishonesty, harm to others, injustice, violation of trust, failure to care, or lack of self-control. They can also experience survivor guilt, guilt over acts of omission or commission, or guilt about thoughts/feelings. Emerging themes in the field of MI include betrayal (e.g., leadership failures, betrayal by peers, failure to live up to one's own moral standards, betrayal by trusted civilians), disproportionate violence (e.g., acts of revenge, mistreatment of combatants), and incidents involving civilians (e.g., harm caused, assault, destruction of property). Moral transgressions associated with violence in service environments (e.g., sexual trauma, friendly fire, “fragging” (i.e., the deliberate or attempted killing of a soldier by a fellow soldier) have also been the focus of significant consideration. These are all difficult to speak about in advance of and following exposure to PMIEs.
Novel approaches and solutions are needed prior to and following exposure to PMIEs to minimize their impact and address PTSD and MI that may result. Such approaches necessitate recognition of moral issues and the development and practice of moral awareness. This requires systematic and continuous interventions focused on enhancing moral reasoning and judgment, and instilling values such as integrity, moral courage, professionalism, and responsibility. We propose that scenario-based supported interventions (SBSIs) that use movie and television references are a novel and promising approach to both stimulate a discourse on PMIEs, PTSD and MI, and support a range of MI interventions including primary prevention, “psychological first aid” training or intervention (3, 4), and individual and group-oriented treatment interventions ...
Language: en |