Moral Injury and Planetary Health in Primary Care Clinicians and Medical Trainees

Climate change is a serious and worsening public health crisis. Primary care clinicians and medical trainees understand the health effects of climate change yet participate in a carbon-intensive industry and often maintain lifestyles linked to high carbon footprints. Moral injury occurs when individuals perpetrate, witness, or fail to prevent acts that transgress deeply held moral beliefs. We hypothesized that primary care clinicians and medical trainees experience morally injurious circumstances in response to climate change.

A cross-sectional survey was sent to University of Wisconsin family medicine clinicians and medical trainees. The survey assessed participant climate change attitudes, levels of moral injury specific to climate change (using an adapted Moral Injury Symptom Scale), and general dysphoria.

A total of 131 surveys were completed (42.5% response rate). The average moral injury score was 45.5 (± 11.8); 80.2% of participants scored at or above the established threshold of 36. A significant, moderate positive correlation was found between climate change attitudes and moral injury (r = 0.561; P < .0001), as well as between moral injury and associated functional impairment and distress (rs =  0.463; P P < .0001).

A high rate of climate change-related moral injury was detected in this sample. The degree of moral injury appears to be associated with climate change attitudes and awareness. Family medicine clinicians and medical trainees may represent motivated agents of change in the global climate health response.