Understanding Moral Injury in Physicians

Moral injury refers to the psychological, emotional, and spiritual distress that arises when individuals are forced to act—or are unable to act—in ways that conflict with their deeply held moral beliefs.

Moral injury originally was conceptualized in a military context. In the health care setting, moral injury was highlighted especially during the covid pandemic where physicians often had to make very difficult decisions around determining who would receive life-saving interventions, such as ICU bed and ventilators, because of resource shortages.

These ethically challenging decisions resulted in many physicians and health care providers, who were at the forefront of resource management, to experience moral distress - and repeated moral distress resulted in moral injury. Clinically, this can manifest with symptoms similar to depression, PTSD, often going on to result in emotional detachment, decreased job satisfaction and burnout. Moral injury is also closely associated with empathic stress and secondary traumatic stress, further worsening the psychological burden experienced by physicians and other health care professionals.

Dr. Muna Chowdhury is an Assistant Professor at the Department of Family Medicine, Dalhousie University and current Member of the Board of Directors at Doctors Nova Scotia (DNS).  Active in the community, Dr. Chowdhury is the Founder of ‘Thrive Youth Clinic, a Physician Professional Peer Counselor with DNS’ Professional Support Program, active with Direction 180 Opioid Agonist Treatment Centre, and a consultation physician with Gender Affirming Care for Youth, K'jipuktuk-Halifax.