Moral Trauma on the Frontline: See, Prevent and Treat

Competitive Projects

Up to $1.2M in phased development funding to propel technology forward

The Department of National Defence solicited proposals to address challenges that arose as a result of the COVID-19 pandemic. These challenges aimed to strengthen the response to COVID-19, as well as future pandemics, through the development of strategies to re-use protective gear, clean equipment and workspaces, gain real-time insight for decision making, and care for front line workers.


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Challenge Statement

Defence Research and Development Canada (DRDC) in collaboration with Canada’s defence, security and public safety communities are looking for state-of-the-art research on “moral injury” and cutting edge prevention models and treatment strategies, in support of DND/CAF personnel, healthcare workers and First Responders at the front lines of the current pandemic, in order to provide for the long-term mental health of these populations.

Background and Context

Canadian Armed Forces members operate in extremely difficult and dangerous operational contexts and situations, in which they routinely face complex moral and ethical dilemmas. All military members are trained to make quick moral-ethical decisions, at times, with only limited information. Still, some operational experiences can be profoundly distressing. These experiences can give rise to feelings of guilt and shame, which can be morally injurious and result in long-lasting mental health challenges and impairment if left unresolved.

While the risk of “moral injury” is typically associated with warfare and conflict, evidence from the front-line of the COVID-19 pandemic suggests that healthcare workers and First Responders are also suffering extreme psychological, cognitive, and emotional responses, including guilt and shame. This state of anxiety and distress is often described as burnout. However, the cluster of features and symptoms of moral injury is not adequately captured by interventions and treatments associated with burnoutFootnote for Work Cited 1. Nor is moral injury being well captured by existing diagnostic tools.

The psychological trauma associated with moral injuries can lead to insomnia, depression, physical and psychological pain, and maladaptive behaviours, including isolation from friends and family, self-medication with alcohol and drugs, etc. While these symptoms are often ascribed to operational stress injuries, notably, Post-Traumatic Stress Disorder (PTSD), moral injuries produce “scars” that are not well captured by these current conceptualizationsFootnote for Work Cited 2.

The purpose of this challenge is to stimulate empirical research on “moral injury” among healthcare workers and First Responders. It is hoped results will also act as a proxy for understanding the ways military personnel are likely to respond when faced with similar morally injurious circumstances during combat, peacekeeping operations or when responding to a future pandemic. The goal is to understand the circumstances and events that can give rise to “moral injury,” diagnostic criteria, prevention models, and treatment strategies (e.g., psychological, neurological and endocrine interventions for prolonged stress-related response treatment).

Desired Outcomes

Proposals are sought that address, but are not limited, to one or more of these outcomes:

  • Evidence-based methods for the prevention of moral injuries and/or treatment therapies;
  • Research and strategies for helping individuals to make difficult, stressful and emotive decisions in complex moral contexts and emergencies, including but not limited to COVID-19, in order to reduce the potential impact of moral dilemmas on their mental health;
  • Identification of factors that are proven to moderate and mediate the potential for long-term psychological trauma and impairment associated with ethical conflicts and moral violations;
  • Means to identify events and circumstances that have the potential to cause “moral injury,” and to measure its severity, in First Responders and primary healthcare workers;
  • Diagnostic criteria reflecting the cluster of features and symptoms of “moral injury” that may be linked to but separate from PTSD that can be used to accurately identify those affected;
  • Empirical research methods and proposals for measuring stress-related physiological response (e.g., inflammation) that will characterize the effects of population-level prolonged stress exposure on brain structure and function and on patterns of physiological response;
  • Development of models that would assist in predicting and responding to risks associated with “moral injury” during the next Phase of the pandemic or in the future, including, but not limited to development of critical models of disease prevention and psychological, neurological, and endocrine intervention models for responding to risks.

Supplementary Information

Proposals or other solutions that involve prevention or treatment of PTSD will not be considered.

Proposals that consider socio-cultural and gender-based differences are preferred.

Innovators are encouraged to form interdisciplinary teams to address this challenge. Perspectives are encouraged from the following backgrounds and/or disciplines: First Responders, military, biological, philosophical, sociological, psychological, legal, religious, mental health, etc.


Moral Injury: “…[T]he lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations, that is, moral injury”Footnote for Work Cited 3.

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