NHS were 'forced to violate ethical principles'

One doctor's account of working under the Government's Covid response

By Sally Beck

A BRITISH doctor has given his first-hand account of working under the Government’s Covid response saying he is a victim of “moral injury” – describing the emotional impact on those forced to violate ethical principles in their day to day work.

The doctor discusses the “inhumane infection control measures” in NHS hospitals, the difficulties of working while constantly masked and how patients “did not receive the care they would ordinarily have had”.

The doctor has requested to remain anonymous.

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I am a hospital doctor, trained at a UK university, working in a central teaching hospital, and now — aged only 40 —  wondering how I can retire and leave my vocation behind.

For 20 of those 40 years I have worked within hospitals but am now doing so while subjected to ‘moral injury’, a term used to describe the emotional impact on those forced to violate ethical principles in their employment.

This definition by Dr Nathan Smith of the University of Manchester sums it up: ‘...the psychological distress which results from actions, or lack of them, which violates your moral and ethical code’.

Elaborating, Dr Smith says in his Moral Injury briefing paper*: ‘When preventable loss of life occurs due to these reasons, healthcare workers may be at risk of moral injury.’

Moral injury influences mental health and predisposes towards post-traumatic stress disorder, he says, adding that ‘those who experience moral injury may negatively self-appraise and maintain distress in a recursive cycle’. This in turn can lead to difficulties in coping with occupational stress and manifest as social withdrawal and personal relationship breakdown.

All of this applies directly to NHS workers placed under the excess pressure of the Coronavirus response and to me personally it represents the huge toll taken by the inhumane infection control security measures introduced in NHS hospitals in 2020 and still pursued nearly three years on.

Plastic screens at reception and cafe counters, piles of masks left on makeshift self-service areas, scuffed-up heavy duty stickerage still chevroning the halls, talking wall adornments, giant posters with the words ‘DO NOT HUG’, the desolate yellowness of it all.

It is so hard to talk to someone while wearing a mask. Yet our work conversations are laden with important content that is supposed to be accurately communicated. What was once sensory impairment for some individuals must now be an unimaginable supra-torturous ordeal.

I also notice a strange cerebral consequence of chronic exposure to half-faces. Seeing colleagues for a moment when they remove PPE for a breath of unimpeded air, I realise that I no longer have a working memory of the precious faces I previously took for granted. It hurts me in my soul and in my occipital cortex — as if suffering prosopagnosia, the symptom of failure-of-face-recognition after brain injury or stroke.

The cost of hospital biological waste is another source of moral injury for me. This I hold in conjunction with the question: ‘Where are the biohazard bins in towns and shops all over the world?’ There should have been dedicated bins where we could dispose of PPE bio-litter, but they would have cost so much. It would be highly informative to submit a Freedom of Information request enquiring how much hospitals have spent disposing of clinical ward waste relative to pre-Covid response levels.

And at the very sharpest end of what is not being measured there is isolating ourselves from our patients. We have not physically touched a single patient for nearly three years and this is one of many factors that have contributed to some of them not receiving the care they would ordinarily have had, their suffering in turn inflicting moral injury on us.

Add to that telling them they will die from a virus and we must consider the ‘nocebo’ effect of all this. Think about ‘white-coat hypertension’ for instance, the phenomenon of elevated blood pressure in the context of a medical setting. Then there are Do Not Resuscitate (DNAR) instructions, early treatment option obfuscation, confused and stressed bed management, a pharmaceutical lobby agenda and government-incentivised media content.

Sadly, I am now exploring how I can move on but would any medical union even engage over complaints about moral injury relating to the iatrogenic harms of these measures? The General Medical Council appraisal machinery would in turn likely weed out any residual resistance among registered practitioners and do so without due reference to human rights.

But we must nonetheless remember that the worst atrocities are precedents to guide us. Let us not be scared of our uncertainties, though they may confound our judgment: we have the skills and the capability to share information in ways we never could before.

*Moral Injury. The original document by Dr Nathan Smith, University of Manchester, distributed by the NHS to their staff