Moral injury, long discussed in military and healthcare circles, is increasingly entering mainstream workplace conversations, and experts warn that employers who fail to address related psychological harms could face mental health claims, regulatory scrutiny and potential legal challenges.
Beata Chami, an organizational psychologist and executive coach at Magnify Consulting in Vancouver, says moral injury is a misunderstood concept in workplace mental health — and one of the most consequential.
“Moral injury is very much about betrayal of my morals, betrayal of my ethics, my ethical code, my values and my conscience,” Chami said in an interview with HR News Canada. “I can’t live with what I’m being asked to do.”
What moral injury is, and what it isn’t
Moral injury is not burnout, Chami said. Burnout stems from depletion — too much work over too long a period with too little recovery. Moral injury is something different: the psychological distress that results when a worker is forced to act against their core values, or witnesses serious wrongdoing they cannot stop.
The concept originated in military psychology in the 1990s and has since spread to healthcare, education, social services and corporate environments.
Chami draws a clear line between ordinary workplace disagreement and moral injury.
“One could disagree that they didn’t like the way their organization handled that layoff,” she said. “But when it’s moral injury, it’s a breach on their own values and their own conscience — and the individual feels like they’re violating their morals and sense of self by continuing to work in their role.”
Workers experiencing moral injury often begin to disengage, lose motivation and feel helpless, she said. “Employees start feeling really distanced from their work, because they’re not really making the difference they signed up for.”
Recognition in the DSM-5-TR
In September 2025, the American Psychiatric Association updated the DSM-5-TR by expanding code Z65.8 to include “Moral, Religious, or Spiritual Problem.” It appears under the section “Other Conditions That May Be a Focus of Clinical Attention,” formerly labelled “Religious or Spiritual Problem,” now expanded to “Moral, Religious, or Spiritual Problem.”
Chami notes this is an important, albeit nuanced, development. Moral injury is not classified as a diagnosable disorder like PTSD or major depressive disorder. Rather, the Z Code designation allows clinicians to formally document moral problems, including experiences described as moral injury, in a patient’s medical record, which may assist documentation and, in some cases, billing or coverage discussions.
“While moral injury has gained recognition within mental health discourse, it does not currently hold the status of a diagnosable disorder,” Chami said.
Still, she said the recognition signals growing acknowledgement of these experiences within the mental health community.
Who is most at risk
Roles that carry high responsibility but offer limited control are especially vulnerable, Chami said. That includes healthcare workers, teachers, social workers, lawyers, HR professionals, public servants, military personnel, paramedics, firefighters and hospitality workers.
She pointed to the COVID-19 pandemic as a defining example, when healthcare workers had to make decisions about rationing ventilators and other scarce resources — directly contradicting their duty of care.
The legal and financial stakes for employers
Chami said employers who dismiss moral injury as a performance issue, rather than a workplace health and safety concern, may increase their legal and financial risk.
When psychological harm or psychologically unsafe conditions are treated purely as performance issues instead of potential workplace-safety risks, employers may increase their exposure to regulatory enforcement, including orders, administrative penalties, or prohibited-action findings if workers are seen as being penalized for raising concerns. In British Columbia, mental health injury claims are often slower to process and more complex than physical injury claims and typically take longer to be approved, she noted, which can leave some workers without income replacement while their claims are being reviewed.
“There’s damage to be done, not only monetary-wise, but also to somebody’s livelihood — when workers are away from their jobs, their routines and sense of stability are disrupted, which can contribute to a decline in mental health and overall well-being,” Chami said.
What leaders should do
Chami said employers need to look beyond individual employee wellness and address the systemic drivers of moral injury. She outlines three tiers: organizational (policies, leadership communication, senior leadership commitment to mental health), team (how colleagues support one another) and individual (what resources and supports are available to workers).
She recommends employers have a clear response protocol when moral distress surfaces:
- Thank and document: Acknowledge the worker’s concern and document it factually without judgment.
- Separate from performance: Distinguish the ethical issue from performance management and make that distinction explicit.
- Provide escalation options: Point workers to internal resources such as HR or equity offices. Use recurring concerns to review and adjust policies and practices that may be contributing to psychological harm.
- Create debriefing opportunities: Build regular spaces for teams to talk through difficult decisions and moral tensions before they escalate.
- Close the loop: Follow up so the worker knows what happened next. “People need to know what happens next — this helps build trust and minimize stress levels,” Chami said.
Chami also cautioned leaders to watch for moral injury following organizational shocks such as layoffs, workplace incidents, PR crises, compliance investigations and rapid policy changes.
She added an important caveat for leaders themselves. “Oftentimes, they are pouring from an empty cup, as they are experiencing it themselves,” she said.
Day-to-day management
Beyond formal protocols, Chami said the fundamentals matter — and often cost nothing. Leaders should check in regularly, allow workers a voice in decisions that affect them, name what is happening rather than ignore it, and recognize where employees are making a difference.
“A lot of this doesn’t cost a lot of money,” she said. “Sometimes it’s as straightforward as being present.”
She also urged leaders not to reward outcomes at any cost, because what reads as a win for the organization can carry a very different meaning for the worker who had to deliver it.
When an employee does raise a moral concern, Chami said the response should start with curiosity, not defensiveness. Acknowledge what happened, apologize for unintended harm and explain how you will support them moving forward.
“When you know better, you do better,” she said, citing Maya Angelou. “Own it. Change your language. That self-compassion is incredibly important.”
