Healthcare professionals face ‘avoidable moral conflicts’ at work that are contributing to ill health and leading many to leave the profession, according to a team of international experts.
Dr Deborah Morris, director of the Centre for Developmental and Complex Trauma at St Andrew’s Healthcare, co-authored an article examining the global shortage of doctors and nurses, which has been published in the New England Journal of Medicine.
Morris worked with several global leaders in the field of moral injury, a concept that refers to the trauma experienced by both patients and clinicians when they engage in or witness actions that go against their deeply held moral beliefs.
Moral injury has been linked to feelings of shame, guilt, and anger and can have a detrimental impact on mental health, often leading to suicidal thoughts. Research has shown that this type of trauma can compromise the safety of patient care, with many healthcare professionals in the UK – at all levels, including senior leadership – reporting that they are experiencing moral injury.
Morris said healthcare workforces around the world are shrinking at unsustainable rates, with one in five doctors and one in four nurses stating they may leave the profession in the next three to five years.
According to Morris, ‘burnout’ is typically highlighted as the cause. However, she said 30 years of burnout interventions have failed to make significant impacts on clinician wellbeing, partly because the framework fails to recognise the role of moral and ethical violations in the workplace.
‘Some degree of ethical and moral conflict comes with working in healthcare, but clinicians are increasingly exposed to avoidable moral conflicts by the organisations they represent. Many of these decisions, we believe, are driven by a focus on finances that compromise care in various ways and by the erosion of clinically led health systems and care,’ she said.
‘Healthcare professionals put their trust in the organisations they work for, but we’ve found they often feel betrayed when asked to make decisions which negatively affect patient care and may present for them an ethical dilemma.’
Morris and her co-authors believe there needs to be a significant re-think of the emphasis on individually focused wellbeing interventions and a move to prioritising development of healthy organisational ethics and culture.
They call on healthcare leaders to address the issue of moral injury by focusing on the historical values that healthcare professionals swear to uphold – prioritising patient care. This includes recommending establishing ethical frameworks in Trusts and hospitals to ensure staff can navigate difficult situations without facing criticism.
‘It is vital that changes are made, as failure to address these challenges may lead to further people leaving the healthcare profession, and discourage people from entering it. Ultimately, the failure to address moral injury will lead to further significant impacts to the quality and safety of patient care,’ added Morris.
The authors also advocate for stronger ethical management to prioritise the welfare of both clinicians and patients in decision-making, which they argue will improve patient care and rebuild trust between frontline staff and healthcare organisations.
©2025 All rights reserved LaingBuisson 
