Understanding the Impacts of Moral Transgressions in the Helping Professions: In Search of Conceptual Clarity

Background and Purpose

A vast academic literature exists on the moral dimensions of what are commonly referred to as the ‘helping professions,’ (e.g. social work, medicine, teaching, etc.), with increasing attention being paid to the issue of moral transgressions perpetrated, witnessed, or experienced by these professionals and their accompanying psychological and social outcomes. A variety of constructs have been proposed to guide analyses of moral transgressions and their impacts, including moral distress, demoralization, vicarious trauma, second victim, burnout, and moral injury. This purpose of this paper is to examine to what extent constructs related to moral transgressions and their associated outcomes overlap and diverge to describe similar and/or distinct phenomena.  Understanding the moral dimensions of the helping professions, particularly in terms of the outcomes of violations of moral beliefs, is critical for effective research, just and ethical care, and positive outcomes for recipients.

Methods:

            This conceptual paper begins with a thorough literature review and discussion of each of the identified constructs: moral distress, demoralization, vicarious trauma, second victim, burnout, and moral injury, followed by a comparative analysis.  The paper concludes with recommendations regarding an integrated conceptual framework and needed areas of future research.

Results:

Many similarities exist among the constructs, particularly in terms of the resulting emotional and behavioral outcomes. Distinguishing characteristics can be identified in terms of the role of the individual in the transgression and the nature of the transgressive activities, but it remains difficult to draw clear boundaries among the constructs.  Of all the constructs, moral injury encompasses the broadest range of experiences. One can experience moral injury in the role of the perpetrator, witness, or victim and the transgression can be intentional or accidental.  A social worker could perpetrate a moral transgression by removing a child from a parent despite not feeling the removal is warranted; could witness a moral transgression when they observe an attorney demeaning a parent in court; and could be a victim of a moral transgression when they are assigned a large caseload for whom they will be unable to provide sufficient support.  Social workers’ transgressions could be “intentional,” in that they could choose to enforce their agency’s overly rigid and racially biased policies, or “accidental,” such as when they are overwhelmed with their workload and lose their temper with a parent.  

Conclusions and Implications:

A major limitation for achieving conceptual clarity regarding moral transgressions and their outcomes is the siloed nature of current research.  Most of the constructs have been researched exclusively within one professional field, with very little communication among the researchers of each individual construct. Conceptual clarity cannot be answered with additional theorizing, but rather needs rigorous empirical exploration. Greater conceptual clarification regarding the sources of and impacts of moral transgressions will help to illuminate not just the suffering of individual professionals and clients but also the larger political and social forces that create situations in which moral transgressions occur.