#135: I Want To, But I Can’t: 3 Ways Moral Injury Differs From Burnout (And Why It Matters). With Dr Shannon Bass

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Do you ever feel just... flat? Not inspired, not excited, and certainly not energised. It might feel like burnout. Or is it compassion fatigue? Maybe it's neither.

You know those moments in veterinary medicine when you know the right thing to do, but external circumstances prevent you from doing it? That dissonance, that discomfort deep in your core: that’s moral injury.

In this episode, we unravel the complexities of moral injury with Dr. Shannon Bass, a leader in veterinary medicine and a passionate advocate for supporting veterinarians through the psychological challenges they face. Moral injury, often confused with burnout or compassion fatigue, is an under-discussed but critical issue in our profession. Together with Dr. Bass, we explore the distinctions between these terms, their impact on veterinary professionals, and how to address them effectively.

Dr. Bass brings over 20 years of experience in general practice, emergency veterinary medicine, and leadership to this conversation, where you’ll learn

• How moral injury manifests in daily practice
• The importance of differentiating it from burnout and compassion fatigue
• Why 'client bashing' can be a symptom of moral distress, and
• Practical steps to create healthier and more supportive veterinary work environments.

Topics and Time Stamps

1. Defining Moral Injury - 02:58

2. Differentiating Trauma, Moral Injury, and Burnout - 07:04

3. Moral Injury in Veterinary Practice: Subtle and Irresolvable Cases - 10:03

4. What’s New for the Vet Vault in 2025 - 16:33

5. Moral Injury vs Moral Distress - 21:18

6. Moral Injury vs Compassion Fatigue - 24:01

7. How Does Moral Injury Manifest? - 27:01

8. How to Address Moral Injury: Recognising and Implementing Solutions - 29:44

9. The Role of Vulnerability and Shared Experiences - 33:25

10. Communication, Community, and Support - 38:59

11. Shannon’s Podcast Choices - 46:29

12. Pass-Along Question - 49:30

Get in Touch

Email us at info@thevetvault.com if you want to find out more about Vet Vault/Vets on Tour 2025 in Wanaka, NZ, or about the Essential Consequence Management series for practice leaders with Rhonda Andrews.

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“What is Moral Injury? Understanding the Hidden Stress in Veterinary Medicine”

Defining Moral Injury in Veterinary Practice
Moral injury is the emotional and psychological distress that occurs when someone is unable to act according to their ethical or moral beliefs due to external constraints. In veterinary medicine, these constraints often arise from systemic barriers, financial limitations, or decisions imposed by clients, colleagues, or leadership. Unlike burnout or compassion fatigue, moral injury involves a deep sense of betrayal of one’s core values, leaving lasting emotional scars.

The concept of moral injury was first articulated in the military context by Dr. Jonathan Shay, an MD psychiatrist, who defined it as the psychological consequence of a betrayal of what is right by someone in a position of legitimate authority during a high-stakes situation. This betrayal factor is a critical component that differentiates moral injury from other stress-related conditions.

The Core Elements of Moral Injury

1. Ethical Betrayal: Feeling unable to uphold personal or professional values due to external factors.
2. High-Stakes Situations: Often arises in critical or emotionally charged scenarios, such as euthanizing savable animals.
3. Lasting Emotional Impact: Leaves a lasting sense of guilt, shame, or anger that can affect mental health and professional satisfaction.

Real-World Examples in Veterinary Medicine
Moral injury in veterinary medicine is not confined to extreme or rare cases; it manifests in everyday practice through situations like:

• Economic Euthanasia: Being forced to euthanize an animal because the client cannot afford treatment, even when viable medical options exist.
• Noncompliance from Clients: Sending a critically ill pet home against medical advice because the owner refuses hospitalization, often out of misguided attachment or misunderstanding.
• Animal Abuse or Neglect: Witnessing cases of abuse or neglect and being unable to intervene effectively, such as when a neglected animal is returned to the same abusive environment due to legal constraints.
• Systemic Constraints: Feeling powerless due to corporate policies or economic pressures that prevent delivering the best care, such as restrictive referral guidelines or inadequate staffing.
• Mass Depopulation Events: Participating in large-scale euthanasia during disease outbreaks, like foot-and-mouth disease, which leaves lasting emotional and moral scars.

How Moral Injury Differs from Burnout and Compassion Fatigue
While moral injury shares overlapping symptoms with burnout and compassion fatigue, it is distinct in its origins and emotional consequences:

• Burnout is characterized by exhaustion, reduced productivity, and feelings of being overwhelmed due to prolonged stress. Rest and workload adjustments often help alleviate it.
• Compassion Fatigue arises from the emotional toll of empathizing with clients and animals in distress, leading to emotional exhaustion.
• Moral Injury stems from ethical conflicts where veterinarians are unable to align their actions with their values, leaving a profound sense of betrayal and guilt that rest alone cannot resolve.

Symptoms of Moral Injury
Moral injury often presents with psychological and behavioral symptoms, including:

• Guilt and shame about past decisions.
• Depression, anger, or emotional withdrawal.
• Reluctance to share difficult experiences due to fear of judgment.
• Isolation and a growing sense of professional dissatisfaction.
• Dreading work or experiencing recurring intrusive thoughts about unresolved cases.

Addressing Moral Injury in Veterinary Medicine
Moral injury is a pervasive issue that requires intentional strategies to address its root causes and mitigate its effects on veterinary professionals.

1. Awareness and Education:
• Educate veterinary teams about moral injury and its distinct characteristics.
• Provide resources and training to recognize the signs of moral injury in themselves and others.
2. Fostering Open Communication:
• Create safe spaces for team members to discuss emotionally challenging cases.
• Promote vulnerability and emotional sharing among staff to reduce feelings of isolation.
3. Building Peer Support Systems:
• Establish small peer groups for discussing moral injury and other stressors in practice.
• Encourage participation in professional organizations like the Veterinary Hope Foundation, which offers structured programs for veterinarians to share their experiences.
4. Addressing Systemic Issues:
• Advocate for better staffing, realistic scheduling, and supportive policies that allow veterinarians to practice in alignment with their values.
• Train practice leaders to recognize the signs of moral injury and take proactive steps to reduce its prevalence.
5. Promoting Emotional Resilience:
• Encourage mindfulness practices and resilience training tailored for veterinary professionals.
• Offer access to counseling services or veterinary-specific mental health resources.
6. Recognizing the Role of Leadership:
• Empower leaders to model empathetic communication and decision-making.
• Equip management with tools to address systemic issues contributing to moral injury, such as overwork or financial pressures.

The Importance of Recognizing Moral Injury
By acknowledging moral injury and distinguishing it from other stress-related conditions, the veterinary profession can take steps to mitigate its impact. Understanding the hidden stress of moral injury is not just about improving individual well-being; it’s also about fostering a healthier, more sustainable practice environment. Recognizing and addressing moral injury allows veterinarians to align their professional actions with their ethical values, leading to greater satisfaction, reduced emotional burden, and improved patient care.

“5 Common Causes of Moral Injury in Veterinary Medicine”

Moral injury is a pervasive and often misunderstood issue in veterinary medicine, stemming from situations where veterinarians and their teams are forced to act in ways that conflict with their ethical values. Below are five common causes of moral injury in veterinary practice, highlighting the systemic and situational pressures that contribute to this hidden stress.

1. Economic Euthanasia

One of the most emotionally challenging aspects of veterinary medicine is euthanizing animals due to financial constraints rather than medical necessity.

• What it Looks Like: A pet with a treatable condition is euthanized because the owner cannot afford care.
• Impact: Veterinarians feel a profound sense of guilt and helplessness, knowing they have the skills and knowledge to save the animal but are prevented by financial barriers.
• Example: A young, healthy animal is euthanized because its owner cannot afford a relatively simple surgical procedure.

2. Client Noncompliance or Misguided Decisions

Veterinarians often encounter clients who refuse recommended treatment plans, even when cost is not an issue.

• What it Looks Like: Owners decline hospitalization or life-saving treatments due to personal beliefs, attachment issues, or misinformation.
• Impact: This creates moral distress as veterinarians watch animals suffer unnecessarily while feeling powerless to intervene.
• Example: A client refuses to leave their pet with severe respiratory distress in the hospital, insisting the pet "can’t be without them," despite medical advice.

3. Systemic Constraints in Veterinary Practices

Corporate policies, inadequate staffing, and time pressures often limit veterinarians’ ability to provide optimal care.

• What it Looks Like: Practitioners are forced to prioritize tasks, resulting in less time or resources for critically ill patients.
• Impact: These constraints lead to feelings of inadequacy, guilt, and frustration, especially when decisions are influenced by business models rather than patient care.
• Example: A clinic denies hiring additional ICU staff despite repeated requests, leaving the existing team overwhelmed and unable to meet the standard of care.

4. Encountering Animal Abuse or Neglect

Witnessing cases of abuse or neglect is an all-too-common experience for veterinarians.

• What it Looks Like: A neglected animal is brought in for treatment, but the veterinarian is unable to ensure its safety after discharge.
• Impact: Veterinarians feel morally compromised when they must return the animal to an abusive or neglectful owner due to legal constraints.
• Example: An animal shows clear signs of abuse, but legal or procedural barriers prevent the veterinarian from intervening.

5. Depopulation of Livestock During Disease Outbreaks

Large-scale culling of animals, while sometimes necessary for public health or disease control, is a significant source of moral injury for veterinarians.

• What it Looks Like: Veterinarians are tasked with euthanizing hundreds or thousands of healthy animals during outbreaks of diseases like foot-and-mouth or avian influenza.
• Impact: These events leave lasting emotional scars, as veterinarians struggle with the conflict between their professional duties and their values.
• Example: During a disease outbreak, a veterinarian spends days euthanizing animals, knowing it is devastating to the animals, the farmers, and themselves.

Addressing the Causes of Moral Injury

Recognizing these common causes is the first step in addressing moral injury within veterinary medicine. By fostering open communication, advocating for systemic changes, and building peer support networks, the profession can work toward mitigating the emotional toll of these situations. Addressing moral injury not only improves the well-being of veterinary professionals but also enhances the quality of care provided to their patients.