“Excuse me, I’m Speaking” Combating Moral Injury with Activism

“Excuse me, I’m Speaking”

COMBATING MORAL INJURY WITH ACTIVISM

BY MAURA DUNFEY HWANG, DO

At the start of the COVID-19 pandemic, when healthcare workers were being hailed as heroes, some of our colleagues didn’t fall for it. They knew the accolades were short-sighted and would ultimately ring hollow. As the cheering faded, physicians who were already working within a struggling healthcare system, have seen it breaking further. We are beyond burnout and many of us are struggling with moral injury.

Moral injury occurs when clinicians are repeatedly expected, in the course of providing care, to make choices that transgress their longstanding, deeply held commitment to healing. Moral injury for physicians in 2022 is fueled by sexism, racism, gaslighting*, and white supremacy. We’ve continued doing our jobs while enduring sneers at the grocery store when wearing a mask or wearing scrubs. We’ve been vilified for sharing our expertise as physicians. Our voices as physician parents have been undervalued and/or dismissed by school board members when concerns about COVID mitigation, racial inequities and the children’s mental health crisis, which preceded the pandemic, have been raised.

Physician perspective and input was absent from the Supreme Court majority opinion on abortion in Dobbs v. Jackson Women’s Health Organization. The opinion is not only a clear departure from precedent but goes further by using the derogatory term “abortionist” instead of physician, doctor, or obstetriciangynecologist. It’s demoralizing to see the U.S. Supreme Court engage in this toxic gaslighting, despite expert feedback from physicians. We are now living in a post-Roe America, where the constitutional right to abortion, upheld for nearly a half century, no longer exists.

In the summer of 2022, we are at the convergence of multiple public health crises including child and adolescent mental health, gun violence, and COVID-19 all exacerbated by systemic racism. As physicians, we have put trust in our social infrastructure systems (public health, education, school boards, healthcare). We had hoped that elected officials, appointed officials or administrators would have our backs and share our Hippocratic Oath to do no harm. It has never been more clear that they are failing us.

One of the most ominous examples came late at night on July 8th when the Pennsylvania Senate and House passed a bill that would ask voters to amend the state constitution to declare that there is no right to abortion and no guarantee that taxpayer funding can be used for abortions. Members of the Pennsylvania legislature are not defending or protecting us, they are actively and harmfully impeding our ability to perform our jobs safely and effectively.

At this moment in history, we have the opportunity to use our exhaustion, outrage and moral injury to galvanize ourselves into action. The work can feel overwhelming, but advocacy is empowering and there is a lot we can do in each of our communities. A quote from the Talmud* summarizes it well: “Do not be daunted by the enormity of the world’s grief. Do justly, now. Love mercy, now. Walk humbly, now. You are not obligated to complete the work, but neither are you free to abandon it.”

“Do not be daunted by the enormity of the world’s grief. Do justly, now. Love mercy, now. Walk humbly, now. You are not obligated to complete the work, but neither are you free to abandon it.”

This November we need to elect candidates in Pennsylvania for Governor and the US Senate who are committed to preserving our ability to be the doctors we want and need to be. Just as important, we need to support other candidates for election to the state legislature who will stand up for women’s reproductive rights, protect PA against an abortion ban, and support the health and well-being of PA children and families.

Please consider the following action steps:

1. Encourage patients, colleagues, friends and family to register to vote, in primary and general elections. Look into Vot-ER at your institution. This summer, the AMA declared voting a social determinant of health. Voting is essential to a healthy democracy, healthy patients and healthy families.

2. Raise awareness with colleagues, family and friends — let them know that an abortion ban is on the horizon in PA.

3. Know who your State House and State Senate candidates are and vote accordingly.

Our physician voices will continue to be silenced and sidelined unless we raise them now and use them forcefully. This is our lane, and we will not stop speaking. We have been measured and reasonable, but we are increasingly enraged. We will not stop demanding action. We are literally fighting for our lives, the lives of our patients, and for the lives of our children. References 1. https://www.inquirer.com/politics/pennsylvania/pennsylvaniaabortion-law-bills-constitutional-amendment-20220708.html 2. https://www.fixmoralinjury.org/you 3. https://www.statnews.com/2018/07/26/physicians-not-burningout-they-are-suffering-moral-injury/ 4. https://www.theatlantic.com/health/archive/2022/06/pandemicprotections/661378/ 5. https://www.npr.org/sections/healthshots/2022/07/03/1109483662/doctors-werent-considered-indobbs-but-now-theyre-on-abortions-legal-front-lines 6. https://www.npr.org/2022/06/24/1102305878/supreme-courtabortion-roe-v-wade-decision-overturn

Vot-ER: https://vot-er.org

Physician Support Line: https://www.physiciansupportline.com 1-888-409-0141

Maura Dunfey Hwang, DO, is a double board-certified child, adolescent and adult psychiatrist who is active with many advocacy groups including Physician Women with Democratic Principles (PWDP-PA); Philadelphia Healthcare Invested in Racial Equality (PHIRE) and PA Physicians for Healthy Families. She also serves on the Board of Directors of the Delaware County Medical Society.

*Editor’s Notes: 1. The term gaslighting refers to the manipulation by psychological means into questioning one’s own sanity or attempting to sow self-doubt and confusion. 2. The Talmud (Hebrew for “study”) is one of the central works of the Jewish people. It is the record of rabbinic teachings that spans a period of about six hundred years, beginning in the first century C.E. and continuing through the sixth and seventh centuries C.E.