Identifying potentially morally injurious events from the Veteran perspective: A qualitative descriptive study

LAY SUMMARYCurrent conceptualizations of potentially morally injurious events (PMIEs) emphasize war atrocities (e.g., killing of children or civilians, witnessing abuse of prisoners of war). Additional research on PMIEs could inform provision of patient-centred care in pursuit of healing for those experiencing moral injury. The field would benefit from an operationalization of PMIEs that is not only grounded in empirical data and meaningful to clinicians but also accounts for the perspectives of the Veterans who experienced PMIEs. This study sought to gain a more in-depth understanding of and explore Veterans' experiences surrounding PMIEs. Introduction: Current conceptualizations of potentially morally injurious events (PMIEs) emphasize war atrocities. However, additional research on the breadth of PMIEs could inform provision of patient-centred care for those experiencing moral injury. This study sought to gain a more in-depth understanding of Veterans' experiences surrounding PMIEs. Methods: Semi-structured, in-depth individual interviews were conducted with 32 Veterans who agreed or strongly agreed that they witnessed, did not stop (despite believing they could have), did things they felt were morally wrong during their time in a war zone, or all of these. Participants were asked what is important to know about such events and probed to describe the events in whatever level of detail they felt comfortable. Applied thematic analysis was used to code and analyze the data, including structural and content coding. Coding discrepancies were resolved by mutual consensus. Results: In addition to war atrocities, analyses revealed types of events that may be overlooked as potentially morally injurious but that were salient to Veterans: 1) fraud, waste, and abuse, 2) animal cruelty, 3) bullying and reputation smearing, 4) infidelity, 5) racism and sexism, 6) morally abhorrent practices, and 7) events outside the military. Veterans also reported and described multiple events at once or over time given multiple deployments and time in service rather than identifying a single specific PMIE. Discussion: The field would benefit from an operationalization of PMIEs not only grounded in empirical data and meaningful to clinicians but that also accounts for the perspectives of the Veterans who experienced PMIEs.