Background Moral Injury is an emerging concept initially studied in the military context, capturing the profound psychological, emotional, and spiritual suffering experienced by individuals who perceive that they have transgressed their deeply held moral or ethical beliefs. In healthcare, Moral Injury occurs when systemic constraints, organizational policies, or professional commitments force healthcare workers (HCWs) to act in ways that dissent from their values. Our study aimed to explore qualitatively the phenomenon of Moral Injury among physicians in healthcare settings in Romania and the Republic of Moldova, focusing on how systemic and organizational factors contribute to their experiences. Methods The study employed a qualitative research design. We collected and analysed 17 interviews with doctors from Romania and Republic of Moldova. Results We identified four central themes and subsequent sub-themes: Perception and Understanding of Moral Injury; Factors contributing to Moral Injury; Impact on Patient Safety and Quality of Care; Coping Strategies and Emotional Survival Mechanisms. Conclusion Our findings suggest that Moral Injury is not the result of isolated events but rather the outcome of persistent exposure to systemic dysfunctions, including coercive hierarchies, politicized leadership, inadequate resources, and the prioritization of economic performance over patient welfare. Physicians described feelings of shame and betrayal when compelled to comply with orders that contradicted their professional ethics.
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Marius‐Ionuț Ungureanu (2025) studied this question.
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