{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T17:35:33Z","timestamp":1786556133189,"version":"build-2736575974"},"reference-count":90,"publisher":"University of Chicago Press","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Clinical Ethics"],"published-print":{"date-parts":[[2026,9,1]]},"DOI":"10.1086\/741885","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T16:44:41Z","timestamp":1786553081000},"page":"222-230","source":"Crossref","is-referenced-by-count":0,"title":["Slow Trauma: Reframing Concepts of Moral Injury in Trauma-Informed Ethics Consultation"],"prefix":"10.1086","volume":"37","author":[{"given":"Charles S.","family":"Love","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"200","reference":[{"key":"p_n_1","volume-title":"Trauma-Informed Care in Behavioral Health Services (Substance Abuse and Mental Health Services Administration","author":"Substance Abuse and Mental Health Services Administration","year":"2014","unstructured":"Substance Abuse and Mental Health Services Administration , Trauma-Informed Care in Behavioral Health Services (Substance Abuse and Mental Health Services Administration , 2014 )."},{"key":"p_n_2","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2021.1887963"},{"key":"p_n_3","doi-asserted-by":"publisher","DOI":"10.1086\/733392"},{"key":"p_n_4","volume-title":"moral injury","unstructured":"This article uses \" moral injury \" as a collective definition for harm to or unwelcome incursion into one's moral space. Lanphier and Anani signify harm as an incursion into one's moral space. Fiester is more expansive in her definitions and refers to moral harm as the overriding of moral principles. These definitions are in line with Litz and colleagues, who identify moral injury as \"morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations\" and \"may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially.\" See"},{"key":"p_n_5","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2009.07.003"},{"key":"p_n_6","unstructured":"Fiester \"TIEC Trauma Capacity \" see"},{"key":"p_n_7","unstructured":"note 2 above."},{"key":"p_n_8","unstructured":"Lanphier and Anani \"Trauma Informed Ethics Consultation \" see"},{"key":"p_n_9","unstructured":"note 2 above pp. 50-1."},{"key":"p_n_10","unstructured":"Ibid. 47."},{"key":"p_n_11","unstructured":"Fiester \"TIEC Trauma Capacity \" see"},{"key":"p_n_12","unstructured":"note 2 above p. 40."},{"key":"p_n_13","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2022.2055220"},{"key":"p_n_14","unstructured":"Fiester \"TIEC Trauma Capacity \" see"},{"key":"p_n_15","unstructured":"note 2 above p. 45."},{"key":"p_n_16","unstructured":"Ibid. 42."},{"key":"p_n_17","unstructured":"Ibid."},{"key":"p_n_18","unstructured":"Ibid. 43."},{"key":"p_n_19","unstructured":"Ibid. 46."},{"key":"p_n_20","doi-asserted-by":"publisher","DOI":"10.1037\/tra0000326"},{"key":"p_n_21","doi-asserted-by":"publisher","DOI":"10.1159\/000070783"},{"key":"p_n_22","unstructured":"Substance Abuse and Mental Health Services Administration Trauma-Informed Care see"},{"key":"p_n_23","unstructured":"note 1 above."},{"key":"p_n_24","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425787"},{"key":"p_n_25","volume-title":"Psychology Today","author":"Lobel D.","year":"2022","unstructured":"D. Lobel , \" Responding to Fast Trauma and Slow Trauma ,\" Psychology Today , 15 January 2022 , https:\/\/www.psychologytoday.com\/us\/blog\/my-side -the-couch\/202201\/responding-fast-trauma-and-slow -trauma."},{"key":"p_n_26","doi-asserted-by":"publisher","DOI":"10.1159\/000511468"},{"key":"p_n_27","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313483663"},{"key":"p_n_28","volume-title":"Patient Safety and Quality: An Evidence-Based Handbook for Nurses, ed","author":"Reinhard S.C.","year":"2008","unstructured":"S.C. Reinhard , \" Supporting Family Caregivers in Providing Care ,\" in Patient Safety and Quality: An Evidence-Based Handbook for Nurses, ed . R.G. Hughes (Agency for Healthcare Research and Quality , 2008 );"},{"key":"p_n_29","doi-asserted-by":"publisher","DOI":"10.1097\/SPC.0b013e328325a5ab"},{"key":"p_n_30","unstructured":"Sanderson etal. \"Signs of Post-Traumatic Stress Disorder \" see"},{"key":"p_n_31","doi-asserted-by":"publisher","DOI":"10.1097\/01376517-199312000-00006"},{"key":"p_n_32","doi-asserted-by":"publisher","DOI":"10.1177\/10499091231198750"},{"key":"p_n_33","unstructured":"Fiester \"TIEC Trauma Capacity \" see"},{"key":"p_n_34","unstructured":"note 2 above p. 42."},{"key":"p_n_35","doi-asserted-by":"publisher","DOI":"10.1002\/jts.2490050305"},{"key":"p_n_36","unstructured":"Lobel \"RespondingtoFastTrauma \"seenote18 above."},{"key":"p_n_37","unstructured":"Chronic stress occurs when stressors persist over an extended period. \"Prolonged exposure to chronic stress can lead to cumulative physiological and psychological effects increasing the risk of health problems such as cardiovascular disease anxiety and depression.\" See"},{"key":"p_n_38","volume-title":"StatPearls (StatPearls","author":"Chu B.","year":"2025","unstructured":"B. Chu , \" Physiology, Stress Reaction ,\" in StatPearls (StatPearls , 2025 )."},{"key":"p_n_39","unstructured":"Herman \"Complex PTSD \" see"},{"key":"p_n_40","unstructured":"note 25 above."},{"key":"p_n_41","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X19666210113152954"},{"key":"p_n_42","volume-title":"America's Forgotten Pandemic: The Influenza of","author":"Crosby A.W.","year":"1918","unstructured":"A.W. Crosby , America's Forgotten Pandemic: The Influenza of 1918 , 2 nd ed. ( Cambridge University Press , 2003).","edition":"2"},{"key":"p_n_43","doi-asserted-by":"publisher","DOI":"10.4236\/psych.2021.1210099"},{"key":"p_n_44","doi-asserted-by":"publisher","DOI":"10.1007\/BF00975140"},{"key":"p_n_45","unstructured":"Substance Abuse and Mental Health Services Administration Trauma-Informed Care see"},{"key":"p_n_46","unstructured":"note 1 above p. 61."},{"key":"p_n_47","unstructured":"American Psychiatric Association and First DSM-5-TR see"},{"key":"p_n_48","unstructured":"note 17 above."},{"key":"p_n_49","doi-asserted-by":"publisher","DOI":"10.1177\/00048674231154206"},{"key":"p_n_50","unstructured":"S.E. Larsen \"Complex PTSD: History and Definitions \" U.S. Department of Veteran's Affairs https:\/\/www.ptsd.va.gov\/professional\/treat\/essen tials\/complex_ptsd.asp."},{"key":"p_n_51","unstructured":"Herman \"Complex PTSD \" see"},{"key":"p_n_52","unstructured":"note 25 above."},{"key":"p_n_53","doi-asserted-by":"publisher","DOI":"10.1037\/tra0001426"},{"key":"p_n_54","unstructured":"Larsen \"Complex PTSD \" see"},{"key":"p_n_55","unstructured":"note 36 above."},{"key":"p_n_56","unstructured":"Eisma \"Prolonged Grief Disorder \" see"},{"key":"p_n_57","unstructured":"note 35 above."},{"key":"p_n_58","unstructured":"Nanni etal. \"Demoralization and Embitterment \" see"},{"key":"p_n_59","unstructured":"note 14 above;"},{"key":"p_n_60","unstructured":"Herman \"Complex PTSD \" see"},{"key":"p_n_61","unstructured":"note 25 above."},{"key":"p_n_62","doi-asserted-by":"publisher","DOI":"10.1037\/tra0000291"},{"key":"p_n_63","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-35574-6_12"},{"key":"p_n_64","unstructured":"Linden and Arnold \"Embitterment and Posttraumatic Embitterment Disorder \" see"},{"key":"p_n_65","unstructured":"note 19 above."},{"key":"p_n_66","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.73.4.658"},{"key":"p_n_67","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2003.12.003"},{"key":"p_n_68","doi-asserted-by":"publisher","DOI":"10.1007\/BF02333822"},{"key":"p_n_69","unstructured":"Linden and Arnold \"Embitterment and Posttraumatic Embitterment Disorder \" see"},{"key":"p_n_70","unstructured":"note 19 above p. 74."},{"key":"p_n_71","unstructured":"Ibid."},{"issue":"3","key":"p_n_72","first-page":"209","article-title":"How Accurate Are Physicians' Clinical Predictions of Survival and the Available Prognostic Tools in Estimating Survival Times in Terminally III Cancer Patients? A Systematic Review","volume":"13","author":"Chow E.","year":"2001","unstructured":"E. Chow , \" How Accurate Are Physicians' Clinical Predictions of Survival and the Available Prognostic Tools in Estimating Survival Times in Terminally III Cancer Patients? A Systematic Review ,\" Clinical Oncology 13 , no. 3 ( 2001 ): 209 - 218 .","journal-title":"Clinical Oncology"},{"key":"p_n_73","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.113.000807"},{"key":"p_n_74","unstructured":"Linden and Arnold \"Embitterment and Posttraumatic Embitterment Disorder \" see"},{"key":"p_n_75","unstructured":"note 19 above p. 76."},{"key":"p_n_76","volume-title":"StatPearls (StatPearls","author":"Tyrrell P.","year":"2025","unstructured":"P. Tyrrell , \" Kubler-Ross Stages of Dying and Subsequent Models of Grief ,\" in StatPearls (StatPearls , 2025 )."},{"key":"p_n_77","doi-asserted-by":"publisher","DOI":"10.1007\/s11097-011-9215-1"},{"key":"p_n_78","volume-title":"Mediate.Com","author":"Athens L.","year":"2023","unstructured":"L. Athens , \" Trauma-Informed Care in Mediation ,\" Mediate.Com , 18 July 2023 , https:\/\/mediate .com\/trauma-informed-care-in-mediation\/."},{"key":"p_n_79","unstructured":"Sullivan \"Hope and Hopelessness \" see"},{"key":"p_n_80","unstructured":"note 54 above;"},{"key":"p_n_81","doi-asserted-by":"publisher","DOI":"10.1186\/s13728-016-0048-y"},{"key":"p_n_82","unstructured":"Sullivan \"Hope and Hopelessness \" see"},{"key":"p_n_83","unstructured":"note 54 above;"},{"key":"p_n_84","unstructured":"Leach \"Psychological Factors \" see"},{"key":"p_n_85","unstructured":"note 56 above."},{"key":"p_n_86","unstructured":"Substance Abuse and Mental Health Services Administration Trauma-Informed Care see"},{"key":"p_n_87","unstructured":"note 1 above."},{"key":"p_n_88","volume-title":"Core Competencies for Healthcare Ethics Consultation","author":"American Society for Bioethics and Humanities","year":"2011","unstructured":"American Society for Bioethics and Humanities , Core Competencies for Healthcare Ethics Consultation , 2 nd ed. ( American Society for Bioethics and Humanities , 2011 ).","edition":"2"},{"key":"p_n_89","unstructured":"Lanphier and Anani \"Trauma Informed Ethics Consultation \" see"},{"key":"p_n_90","unstructured":"note 2 above p. 52."}],"container-title":["The Journal of Clinical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.journals.uchicago.edu\/doi\/pdf\/10.1086\/741885","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T16:45:03Z","timestamp":1786553103000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journals.uchicago.edu\/doi\/10.1086\/741885"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":90,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9,1]]}},"alternative-id":["10.1086\/741885"],"URL":"https:\/\/doi.org\/10.1086\/741885","relation":{},"ISSN":["1046-7890","1945-5879"],"issn-type":[{"value":"1046-7890","type":"print"},{"value":"1945-5879","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}