Djukic Nina A, Ranney Rachel M, Maguen Shira
School of Medicine, University of California - San Francisco, San Francisco, CA, USA.
School of Public Health, University of California - Berkeley, Berkeley, CA, USA.
J Gen Intern Med. 2025 Jul 15. doi: 10.1007/s11606-025-09690-5.
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.
道德伤害被定义为因实施、未能阻止或目睹违背或严重违反个人道德或伦理准则的行为而产生的持久痛苦。先前的研究表明，在新冠疫情期间，医护人员遭受道德伤害的风险增加。然而，缺乏研究探讨医生的社会身份如何影响道德伤害的经历。
确定新冠疫情期间医生群体中道德伤害的主要来源，以及基于医生社会身份道德伤害的体验可能存在的差异。
研究对象为13名医生，他们报告在新冠疫情期间（2020年3月至2023年5月）在一家大型都市大学医院系统照顾新冠患者。医生们被问及道德伤害的经历，以及他们的社会身份如何影响他们照顾新冠患者的体验。采用快速主题定性分析来评估访谈数据。
访谈分析确定了道德伤害的四个主要来源，包括（1）资源不足，（2）患者自主权与机构限制之间的冲突，（3）平衡患者护理与个人/家庭安全，以及（4）目睹不平等。关于社会身份出现了一个突出的主题，具有边缘化身份的医生表示，与边缘化患者的自我认同促成了他们的道德伤害经历。
在我们的样本中，疫情期间照顾新冠患者的医生经历了各种道德伤害来源。识别这些来源以及社会身份的作用，可以有助于为医生提供更有针对性的个人和系统支持。
