Staff Perspective: When the Doctor Becomes the Patient - Recent Publications and a Selection of Resources for Moral Injury in Military Health Care Workers
As noted by the VA’s National Center for PTSD, the majority of research into defining and understanding moral injury (MI) has been conducted with military service members and veterans, given that military-related experience tend to put people at greater risk for encountering potentially morally injurious events (PMIEs). Military PMIEs include many aspects of military service and combat, including killing or harming others, developing strategies or decisions that put others at risk, experiencing conflicting emotions when harming or killing others, and having to select or triage injured comrades with limited medical resources.
With the relatively high prevalence of MI in the general military having been established, a significant emphasis of research on MI in the military has been on identifying methods/tools for assessment and developing interventions for effective treatment. One critical aspect that is often overlooked though, is the consideration of situations where the doctor becomes the patient, or when health care providers experience MI themselves. This topic has become a bit better understood with the publication of two papers, one narrative review and one qualitative study, both examining MI in military medical personnel.
The first of these two publications is a review of MI across studies that included medical personnel and first responders from a diverse sampling of health care and emergency response professions (Rimon & Shetlef, 2025). The authors sought to better understand aspects of MI prevalence, risk, and outcomes within these populations. Although studies that focused exclusively on military populations were excluded, papers that included populations with military backgrounds, health care settings within military institutions, and outcomes relevant to military personnel were represented in the review and discussed by the authors. They noted that the reviewed studies identified unique challenges faced by military health care providers, including hierarchical decision making and dual obligations to mission and patients as contributing to elevated risk for MI in this group (Rimon & Shetlef, 2025). Several also discussed the frequent exposure of military clinicians to PMIEs in combat zones and operational environments. The authors note that military providers may experience conflict between their roles as a caregiver and as a service member, potentially forcing them to put mission over individual moral judgement and to follow orders that may conflict with professional and medical ethical standards. As a result, MI in military providers is frequently associated with symptoms such as sleep disturbances, anger, guilt, and long-term emotional distress (Rimon & Shetlef, 2025).
While the Rimon & Shetlef review takes a high-level approach to characterizing and understanding MI in military providers, a smaller qualitative study by Cole and colleagues (2025) examined MI on a much more personal level. A dozen military medical providers participated in semi-structured interviews about their experiences as military medical officers and their perceptions of moral injury. Through analysis of participant responses, the authors identified three primary themes regarding how military physicians experience moral injury (Cole, Shumaker, & Rudinsky, 2025). The first was an inability to provide standard of care that hindered their ability to fulfill the Hippocratic Oath. Within this theme, providers identified their position under their commander within the command hierarchy and a lack of resources in austere operational environments as contributing to an inability to provide adequate care. The second theme revolved around the ambiguity of caring for foreign nationals in both humanitarian and combat missions. When rendering humanitarian aid, some participants noted distress around leaving the situation without providing adequate follow-up care or feelings that the effort was primarily for show or diplomacy, not true impact. In combat situations, providers cited MI from conflicting thoughts and emotions around providing medical aid to enemy combatants and detainees. The final theme was personal impact, focused primarily on reconciling their own sense of morality with their military mission, resulting in cognitive dissonance, a loss of personal identity, and often MI (Cole, Shumaker, & Rudinsky, 2025). The authors go on to provider recommendations for better supporting and preparing military medical providers to cope when faced with these issues and dilemmas.
Fortunately, there are resources for health care providers, whether military or civilian, who are experiencing MI. While not military-specific, one helpful source for thinking about MI in medical providers is the Moral Injury in Health Care Workers website from the VA’s National Center for PTSD. Here you can find more information about potential sources and impacts of MI in health care workers, as well as self-care recommendations and support strategies for co-workers and leaders. The Consortium for Defense Psychology (CDP) also has links to recorded webinars on Adaptive Disclosure-Enhanced (AD-E) and Acceptance and Commitment Therapy for Moral Injury (ACT-MI), both strategies for addressing MI that can be used with affected health care workers.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jenny Phillips, Ph.D., is the Associate Director of Program Evaluation for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, MD.
References:
Cole, R., Shumaker, J. T., & Rudinsky, S. L. (2025). “It’s there and you’re changed forever”: military
physicians’ perceptions of moral injury. Journal of Military Ethics, 1-13.
Rimon, A., & Shelef, L. (2025). Moral Injury Among Medical Personnel and First Responders Across
Different Healthcare and Emergency Response Settings: A Narrative Review. International Journal of
Environmental Research and Public Health, 22(7), 1055.
As noted by the VA’s National Center for PTSD, the majority of research into defining and understanding moral injury (MI) has been conducted with military service members and veterans, given that military-related experience tend to put people at greater risk for encountering potentially morally injurious events (PMIEs). Military PMIEs include many aspects of military service and combat, including killing or harming others, developing strategies or decisions that put others at risk, experiencing conflicting emotions when harming or killing others, and having to select or triage injured comrades with limited medical resources.
With the relatively high prevalence of MI in the general military having been established, a significant emphasis of research on MI in the military has been on identifying methods/tools for assessment and developing interventions for effective treatment. One critical aspect that is often overlooked though, is the consideration of situations where the doctor becomes the patient, or when health care providers experience MI themselves. This topic has become a bit better understood with the publication of two papers, one narrative review and one qualitative study, both examining MI in military medical personnel.
The first of these two publications is a review of MI across studies that included medical personnel and first responders from a diverse sampling of health care and emergency response professions (Rimon & Shetlef, 2025). The authors sought to better understand aspects of MI prevalence, risk, and outcomes within these populations. Although studies that focused exclusively on military populations were excluded, papers that included populations with military backgrounds, health care settings within military institutions, and outcomes relevant to military personnel were represented in the review and discussed by the authors. They noted that the reviewed studies identified unique challenges faced by military health care providers, including hierarchical decision making and dual obligations to mission and patients as contributing to elevated risk for MI in this group (Rimon & Shetlef, 2025). Several also discussed the frequent exposure of military clinicians to PMIEs in combat zones and operational environments. The authors note that military providers may experience conflict between their roles as a caregiver and as a service member, potentially forcing them to put mission over individual moral judgement and to follow orders that may conflict with professional and medical ethical standards. As a result, MI in military providers is frequently associated with symptoms such as sleep disturbances, anger, guilt, and long-term emotional distress (Rimon & Shetlef, 2025).
While the Rimon & Shetlef review takes a high-level approach to characterizing and understanding MI in military providers, a smaller qualitative study by Cole and colleagues (2025) examined MI on a much more personal level. A dozen military medical providers participated in semi-structured interviews about their experiences as military medical officers and their perceptions of moral injury. Through analysis of participant responses, the authors identified three primary themes regarding how military physicians experience moral injury (Cole, Shumaker, & Rudinsky, 2025). The first was an inability to provide standard of care that hindered their ability to fulfill the Hippocratic Oath. Within this theme, providers identified their position under their commander within the command hierarchy and a lack of resources in austere operational environments as contributing to an inability to provide adequate care. The second theme revolved around the ambiguity of caring for foreign nationals in both humanitarian and combat missions. When rendering humanitarian aid, some participants noted distress around leaving the situation without providing adequate follow-up care or feelings that the effort was primarily for show or diplomacy, not true impact. In combat situations, providers cited MI from conflicting thoughts and emotions around providing medical aid to enemy combatants and detainees. The final theme was personal impact, focused primarily on reconciling their own sense of morality with their military mission, resulting in cognitive dissonance, a loss of personal identity, and often MI (Cole, Shumaker, & Rudinsky, 2025). The authors go on to provider recommendations for better supporting and preparing military medical providers to cope when faced with these issues and dilemmas.
Fortunately, there are resources for health care providers, whether military or civilian, who are experiencing MI. While not military-specific, one helpful source for thinking about MI in medical providers is the Moral Injury in Health Care Workers website from the VA’s National Center for PTSD. Here you can find more information about potential sources and impacts of MI in health care workers, as well as self-care recommendations and support strategies for co-workers and leaders. The Consortium for Defense Psychology (CDP) also has links to recorded webinars on Adaptive Disclosure-Enhanced (AD-E) and Acceptance and Commitment Therapy for Moral Injury (ACT-MI), both strategies for addressing MI that can be used with affected health care workers.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jenny Phillips, Ph.D., is the Associate Director of Program Evaluation for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, MD.
References:
Cole, R., Shumaker, J. T., & Rudinsky, S. L. (2025). “It’s there and you’re changed forever”: military
physicians’ perceptions of moral injury. Journal of Military Ethics, 1-13.
Rimon, A., & Shelef, L. (2025). Moral Injury Among Medical Personnel and First Responders Across
Different Healthcare and Emergency Response Settings: A Narrative Review. International Journal of
Environmental Research and Public Health, 22(7), 1055.