Moral Injury: When Compassion and Compliance Collide

Dr Kate Owen
May 24
5 min read

Written by Dr Kate Owen

Clinical Psychologist & Clinical Family Therapist

In helping professions, we are trained to care, advocate, and do no harm. But what happens when circumstances prevent us from doing what we know is right? What if our values clash with what’s required in the system we work within? This is where moral injury can quietly and powerfully take hold.

What Is Moral Injury?

Moral injury occurs when we witness, fail to prevent, or feel forced to participate in actions that violate our deeply held moral beliefs. It's not simply burnout, stress, or compassion fatigue - it's a wound to the conscience and our sense of integrity. A sense that we’ve betrayed ourselves, or have been complicit in harm.

Originally used to describe the experiences of military personnel in war zones, the concept of moral injury is now increasingly applied to health and mental health workers, especially those working in under-resourced or ethically complex environments.

What Does Moral Injury Look Like?

You might have experienced moral injury if you have ever had to say: “This isn’t what’s best for them, but I have no choice.”

In a clinical or community setting, moral injury might arise when:

A therapist is pressured to discharge a client early due to funding restrictions.
A clinician can’t provide the care they know someone needs because of long waitlists or bureaucracy.
A nurse is ordered to discharge a patient earlier than is safe because of bed shortages.
A mental health worker must follow a policy they feel harms the family they're trying to support.
A therapist working with children in foster care must return them to a placement they know is unsafe because no alternative exists.
Witnessing repeated systemic failures that lead to client harm.

Unlike burnout, which often results from too much work, moral injury stems from being unable to do what feels right and being left to carry the weight of that knowledge.

Common Signs of Moral Injury

Persistent guilt or shame about actions taken or not taken – especially over decisions that were out of your control.
Loss of trust in your workplace, profession, or leadership.
Emotional numbing or detachment.
Conflict between your personal values and what the system demands.
Ethical fatigue - the sense of being morally compromised, over and over.
A deep, often private grief over what could not be done.

Why It Hurts So Deeply

Most people drawn to the health and mental health fields come with a strong sense of ethics, empathy, and care. When those core values are compromised by systemic limitations - such as funding cuts, risk-averse cultures, overwhelming caseloads, or policies that feel dehumanising - we absorb the consequences, even when the choices weren’t ours to make.

It can feel like a quiet betrayal of everything you entered the field to uphold.

What Helps?

Moral injury can’t be resolved by individual self-care alone. While rest and support are important, this is a systemic injury that requires acknowledgement, validation, and systemic responses.

Here are some starting points:

Acknowledge the harm
Give language to what happened. Moral injury thrives in silence and isolation.
Talk it through with trusted peers
Reflective practice groups, supervision, and debriefing spaces can help validate the reality of what you’ve experienced.
Reconnect with your values
What matters most to you as a practitioner? Reconnect to your “why”. How can you live out those values, even in small ways, in your current role?
Advocate for change
Your voice matters. Advocate for policy or practice improvements, support ethical leadership, or speak up when safe to do so. Moral injury is often a signal that the system - not you - needs healing.
Seek spaces where ethical alignment is possible
If your current environment constantly violates your sense of integrity, it may be time to consider roles that better align with your professional values.

Reflective Practice Activity: Moral Injury & Reconnection

Use this reflective practice activity after a difficult event, at the end of a challenging week, or during reflective supervision. You can write, speak aloud, or discuss with a trusted colleague.

Step 1: Describe the Situation (What Happened?)

What was the situation? Who was involved?
What actions were taken, or not taken?
What made this moment ethically or emotionally challenging?

Write for 5–10 minutes. Don’t worry about structure - just get the story out.

Step 2: What Was Morally Injuring About This?

What did I believe was the right thing to do?
What prevented me from doing that?
What values or principles of mine felt compromised?

Pause and notice any emotions or sensations in the body.

Step 3: Emotional and Ethical Check-In

What emotions am I still carrying from this event?
Where do I feel them physically?
What story am I telling myself about my role in this situation?

Optional journal sentence starter:

“The part of me that is hurting right now is the part that values __________.”

Step 4: Reconnect with Your Professional Identity

What values matter most to me as a practitioner?
How do I usually try to honour those values?
What would alignment look like for me, even in small ways?

Use this moment to remember who you are beneath the work system.

Step 5: Identify One Act of Repair or Reconnection

Choose one or more:

Debrief with a supervisor or peer.
Rest or pause before taking further action.
Recommit to a small value-aligned action in my work.
Raise a systemic concern or propose a change.
Journal again tomorrow.
Other: _________________________

Final reflection:

“What I want to carry forward from this experience is…”

Suggestions for Use

Pair this with a quiet moment, cup of tea, or a walk.
Use in monthly reflective groups or team check-ins.
Keep a printed version near your desk or in your supervision folder.

Moving Forward

Moral injury is not a sign of weakness, it’s a sign that your moral compass still works. It means you care deeply. That you’re still paying attention to what matters.

Healing doesn’t mean pretending nothing happened. It means honouring the hurt, understanding the forces at play, and finding your way back to your values - in ways that are sustainable for you.

You are not alone in this. And your integrity still matters.

Additional Resources:

Please note that this article is educational in nature and does not constitute therapeutic advice.

Please seek professional support of required.

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