Moral Injury
Moral injury refers to the psychological, emotional, or spiritual distress that occurs when a person perpetrates, witnesses, or fails to prevent actions that violate their deeply held moral beliefs or professional values.
🩺 In healthcare (especially surgery and residency training):
Moral injury happens when clinicians are forced to act against their conscience—often due to systemic pressures, institutional policies, or conflicting demands—leading to feelings of:
Guilt
Shame
Anger
Loss of professional identity
⚠️ Common scenarios of moral injury in medicine:
Being unable to provide appropriate care due to administrative or financial constraints
Participating in unjust decisions (e.g., performing futile interventions under pressure)
Witnessing patient suffering without being allowed to intervene
Teaching practices residents believe are harmful, but which are enforced by the system
Feeling like a technician serving metrics, rather than a physician serving patients
🧠 In short:
Moral injury is not burnout.
Burnout is about exhaustion.
Moral injury is about betrayal—by the system, by leadership, or by one’s own actions under coercion.