Moral Injury, Moral Courage, and the Business of Medicine

What happens when a healthcare system organized around profit repeatedly gets in the way of doing what is right for patients? Physicians for a National Health Program (PNHP) calls one consequence moral injury: the distress physicians experience when the system prevents them from providing the care they believe patients need. PNHP president Diljeet Singh, MD, DrPH, joins Stefan and Saul to discuss the organization's recent report on moral injury and the financialization of American medicine. Saul strongly shares PNHP's commitment to universal health care—but challenges whether the language of moral injury puts too much emphasis on what the system does to physicians and too little on physicians' own agency and responsibility within that system. What follows is a candid and provocative exchange that begins with substantial agreement about what is wrong with American health care and the need for universal coverage, but moves into harder questions about moral distress, physician complicity, professional responsibility—and how much courage we should expect from doctors when doing the right thing comes at a personal cost.