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Moral Injury in U.S. Health Care: The Ethical Wounds Behind Burnout Understanding How Systemic Pressures and the COVID-19 Pandemic Deepen Clinicians’ Moral Distress In recent years, doctors and nurses have reported high levels of exhaustion and cynicism – traditionally labeled “burnout” statnews.com – but many experts now argue that this misses the core problem. Instead, a deeper moral injury is at work. Moral injury occurs when clinicians are repeatedly forced to act against their professional and personal values, leaving them with guilt, shame, and a sense of betrayal  statnews.com   pmc.ncbi.nlm.nih.gov . This article explores moral injury – a term borrowed from military psychology – and explains how business pressures, staffing shortages, electronic bureaucracy, and especially the COVID-19 crisis have created ethical conflicts in U.S. medicine. We contrast moral injury with burnout, review evidence of its prevalence and harm, and examine proposed responses to heal...