Moral Injury, the Clinician and Occupational Therapy

As an occupational therapist, the celebrations of OT Month have brought an opportunity to reflect on the discipline and its potential to serve a pivotal role at this time in human history. The impetus of occupational therapy discipline more than a century ago was an identification of the void in human performance created by the violence of war. The physical, emotional and psychological wounds suffered by shell-shocked soldiers required a novel approach to healing beyond topical bandages and iodine. 100 years on, front-line clinicians are struggling to cope with the occupational deprivation wrought by the stresses of relentless death and disability while virtually holding the hands of distraught, heartbroken families. A more contemporary void emerges. Front line: a militaristic term that has become an integral part of public pandemic discourse in 2020 provides a framework to comprehend the nature of battling a viral scourge when your duty is to charge the enemy within a patient’s corporeal landscape. 

The online resource “Moral Injury of Healthcare” states that such injury “occurs when clinicians are repeatedly expected, in the course of providing care, to make choices that transgress their long-standing, deeply held commitment to healing”. The dual phenomena of burnout and moral injury have been exacerbated by the rigors of providing clinical care amidst the persistent roar of the pandemic within a landscape of resource-scarcity. Where burn out is often framed as a deficit in individual resilience when environmental press increases, moral injury begins to acknowledge the concrete challenges of care provision when a dearth of resources such as ventilators, personal protective equipment (PPE), and intensive care unit (ICU) beds force a choice of who might live or die. 

As the euphoria of efficacious vaccine distribution begins to pervade the collective consciousness and the hospital beds begin to empty, it is imperative that we establish and maintain a focus on the mental, physical and emotional wellbeing of those on the frontline. The unique ability of occupational therapy to assess and address the musculoskeletal, mental, spiritual, and social makes it a potent tool in the quest to center clinician-health. The past year has been horrendous for many; let us ensure that unlike so many soldiers returning from war, the wellbeing of those who held the hands of our dying is not an afterthought. 

By Fatima Adamu-Good BA MS OTR/L

April 3rd, 2021