Physician Moral Injury During the COVID-19 Pandemic

Moral injury is defined as lasting distress due to perpetrating, failing to prevent, or witnessing acts that transgress or deeply violate one's moral or ethical code. Previous research has demonstrated that during the COVID-19 pandemic, healthcare workers were at increased risk of moral injury. However, there is a lack of studies that explore how physician social identity may affect experiences of moral injury.

To identify the main sources of moral injury during the COVID-19 pandemic in a physician cohort, and how moral injury may be experienced differently based on physician social identity.

Participants were 13 physicians who reported caring for COVID-19 patients at a major metropolitan university hospital system during the COVID-19 pandemic (March 2020-May 2023). Physicians were asked about experiences of moral injury and how their social identities affected their experience of caring for COVID-19 patients. Rapid thematic qualitative analysis was used to evaluate interview data.

Four main sources of moral injury were identified in interview analysis, including (1) insufficient resources, (2) conflict between patient autonomy and institutional constraints, (3) balancing patient care and personal/family safety, and (4) witnessing inequality. One prominent theme emerged regarding social identity, with physicians with marginalized identities expressing that self-identification with marginalized patients contributed to their experience of moral injury.

In our sample, physicians who cared for COVID-19 patients during the pandemic experienced various sources of moral injury. Identification of these sources, and the role of social identity, can assist with greater targeted individual and systemic support of physicians.