Experts warn moral injury remains poorly understood and gaps in how work is organized, supervised and supported are leaving workers quietly harmed
The Canadian Armed Forces (CAF) has been one of the first major Canadian institutions to formally define moral injury and issue guidance on it. In its Understanding Moral Injury guide, the CAF notes that members can experience “events of significance” throughout their service and that roles responsible for the health, wellbeing and safety of others face higher exposure. These experiences may become potentially morally injurious events (PMIEs) when they clash with a person’s deeply held values and beliefs.
A Canadian lens on moral stress, distress and injury
The CAF explains that PMIEs typically involve either doing something that feels morally wrong, failing to act in line with one’s values, or feeling betrayed by leaders or institutions that act, fail to act, or compel actions contrary to those values. It also frames moral harm on a continuum: moral stress as a common response to moral challenges; moral distress when stressors are intense, frequent or prolonged and people feel powerless; and moral injury as a severe, enduring reaction marked by guilt, shame, anger, hopelessness, diminished trust and, in some cases, suicidal thoughts. Leaders and organizations, the guide stresses, play a central role in preventing that progression.
Conflict management and psychosocial risk consultant Treena Reilkoff uses similar language, describing moral injury as “the severe stress reaction following the experiences of events or reoccurrence of situations or events that contradict your individual moral beliefs and values.”
How moral injury shows up in everyday workplaces
Although research often highlights military and first responders, Reilkoff says moral injury is already present in ordinary Canadian workplaces.
One case she cites is a robbery at a retail store in the Greater Toronto Area, where armed robberies of drugstores and jewellery stores have become more common. After a holdup, police and victim services respond and the store closes briefly, then reopens. “They shut down the store for three hours,” she notes, but there is no structured debrief, no check‑in a week or two later; workers are simply asked if they want to stay or go home.
On paper, the employer may appear compliant. In practice, Reilkoff calls it “a lack of education, a lack of performance competencies” and a failure to integrate psychological health and safety into critical‑incident response. If robberies recur and nothing changes – no updated procedures, no security enhancements, no systematic debriefing – workers can start to feel the organization is not serious about protecting them. That perceived betrayal, especially after concerns have been raised and ignored, is a classic pathway into moral injury.
Education is another high‑risk environment. Reilkoff points to rising violence toward teachers and the tension they face between protecting students, teaching effectively and working within institutional constraints. When schools fail to turn policy into real protection, “now there’s institutional betrayal happening,” she says, because systems meant to keep staff and students safe are not doing so in practice.
Even familiar psychosocial hazards like workload can become fertile ground. Reilkoff likens workload to “ice” as a hazard: if overload and role conflict are allowed to build, the risk becomes sustained stress, anxiety, depression and eventually burnout or worse. When workers repeatedly raise concerns about impossible demands and nothing changes, they can come to believe that institutions “are not creating the control measures” needed to protect their mental health.
Trauma, moral injury and the role of safety leaders
The concept is also gaining attention in public safety and emergency services, where workers routinely face both trauma and moral challenges. In a recent LinkedIn post aimed at public safety professionals, U.S. clinician Kimberly Ingram pushed back on claims that horrific scenes are not what cause trauma, and that only poor organizational response is to blame.
Citing the DSM‑5, she notes that exposure to actual or threatened death, serious injury or sexual violence – experienced directly, witnessed, learned about in specific circumstances, or encountered repeatedly in professional roles, with intense fear, helplessness or horror – is, by definition, traumatic. The horrific things public safety personnel see “absolutely can be traumatic,” she argues, even when agencies respond well.
Ingram differentiates that from moral injury, which she describes as deep psychological, emotional and spiritual distress from perpetrating, failing to prevent, witnessing or learning about acts that violate fundamental moral beliefs, often co‑occurring with PTSD. Her message to those with platforms is blunt: keep raising awareness and fighting stigma, but “when it comes to clinical things… at least get your facts straight,” because inaccurate messaging can do more harm than good.
For occupational health and safety professionals, the common thread is clear: moral injury is not an individual flaw but a systemic, foreseeable risk. That aligns with the CAF’s emphasis on leadership responsibilities and with Canadian standards that already frame psychosocial hazards as OHS issues.
Reilkoff warns against conflating psychological safety – a culture where people can speak up without fear – with psychological health and safety in the legal and standards sense. Organizations may encourage open dialogue yet still fail to assess and control the hazards that are injuring workers.
She urges safety leaders to treat moral stressors with the same discipline as physical risks: map where they are likely to occur (critical incidents, resource‑allocation decisions, patterns of inaction on reported concerns), build in structured debriefs and ethical discussions, train leaders on responding constructively when workers speak up, and make structural changes to workload, staffing and role clarity rather than relying solely on individual coping skills.
As Reilkoff puts it, people come to work expecting that institutions will protect them not only from physical hazards but from psychological harm as well. For Canadian OHS professionals, taking moral injury seriously is fast becoming part of that promise.
This article is part of our Monthly Spotlight series, which in February focuses on Psychological Safety & Mental Health.
