Anti-DEI Policies Fuel Moral Distress Among Physicians

Physicians in the United States are confronting a new source of moral distress as political and institutional efforts dismantle diversity, equity, and inclusion programs in medical schools, hospitals, professional associations, and accreditation systems. A perspective published in the Journal of General Internal Medicine argues that the conflict is especially acute for doctors who believe that supporting equitable care is both a professional responsibility and an obligation to patients, trainees, and communities, yet who must operate within policies that restrict those efforts. The authors describe moral distress as a negative emotional response that occurs when a person recognizes the morally preferable course of action but is prevented from taking it by an institution, other healthcare workers, family members, or society. The concern is not merely that policies are politically contested, but that they may force physicians to act against the values underpinning the Hippocratic Oath and the fairness of their profession.

The concern has intensified since January 2025, when executive orders aimed at reducing or prohibiting DEI programs and preferences began affecting public and private institutions. In April 2025, another order targeted the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education, arguing that medical training standards should focus on quality of care rather than what it described as unlawful discrimination. According to the perspective, the LCME and ACGME subsequently removed accreditation requirements related to diversity. These changes have affected programs intended to address documented disparities in health and education, including the underrepresentation of Black, Latinx, and Indigenous physicians, barriers faced by women in advancing toward leadership, and gaps in care for patients from historically marginalized groups. The authors argue that dismantling such programs can affect both the future workforce and the ability of health systems to understand and respond to the communities they serve.

Moral distress is not a new phenomenon in medicine. The term was introduced in 1984 by Andrew Jameton and Eileen Jackson and was initially connected to nurses’ experiences of being unable to provide what they believed was appropriate care. It later became a broader concept applied during the COVID-19 pandemic and in conflicts over abortion care and gender-affirming care. The authors note that the condition can affect people who experience a conflict between their professional obligations and external constraints, even when the individual has not personally made a morally wrong decision. In health care, this distinction is important because distress may arise not from a personal failure but from the gap between what clinicians know is needed and what institutional structures allow them to do. A physician may be forced to withdraw support for gender-affirming care, discontinue training programs that prepare doctors to serve demographically similar patients, or comply with policies that reduce attention to inequity.

Research cited in the perspective links moral distress with emotional exhaustion, a central component of burnout, and with clinicians’ intention to leave their jobs. A 2025 systematic review and meta-analysis found a statistically significant, moderate relationship between moral distress and emotional exhaustion among healthcare professionals. Another study, using a validated moral-distress assessment tool, found that institutional leaders—including clinical supervisors, managers, educators, directors, and administrators—reported the greatest distress compared with other healthcare workers. That pattern is consequential because leaders shape workplace culture, staffing decisions, educational programs, and the response to policy changes. In the same study, nurses accounted for 42.2% of respondents considering leaving their positions because of moral distress, while workers on mixed-acuity medical-surgical floors represented 22.8% of that group. The authors caution that the findings do not mean every physician experiences the same level of distress, but say that conversations within national professional organizations have revealed a persistent undercurrent of concern among clinicians.

The perspective recommends both individual and organizational responses, while warning that self-reflection alone cannot solve a problem created partly by institutional conditions. At the individual level, the authors describe the American Association of Critical-C Nurses’ “4 A’s” model: ask what emotion is being experienced, affirm one’s professional responsibility, assess the risks and benefits of pursuing the right course, and act. The model asks clinicians to identify moral distress, consider how their professional values apply, analyze patient safety and organizational realities with input from trusted colleagues, and choose an action that can provide some emotional resolution. Suggested professional virtues include integrity, compassion, self-effacement, self-sacrifice, and humility. Another approach is to focus on factors that can be influenced, shifting attention from outcomes outside a clinician’s control to the part of the problem that can be changed. Although these techniques may help people navigate difficult cases, the authors worry that they place a heavy burden on professionals who are already exhausted.

Evidence from physicians in abortion-restricted states suggests that support and peer connection can make a meaningful difference. Qualitative work with obstetrics and gynecology residents after the 2022 Dobbs v. Jackson decision identified several coping strategies: maximizing clinical care within legal constraints, supplementing education, engaging in advocacy, and obtaining support from personal and professional relationships. Residents valued faculty members who modeled going beyond routine expectations for patient care, institutions that were transparent about local limitations, and leaders who created space for discussion. Advocacy had variable effects. Some residents felt empowered, whereas others became burned out when advocacy produced no change. The findings suggest that support networks can help clinicians share concerns, align efforts, and identify resources, but they cannot substitute for institutional action or eliminate the legal and policy barriers that generate distress in the first place.

At the organizational level, the authors call for education about moral distress, stronger connections among workers, and better measurement of the relationship between moral distress and healthcare outcomes. Yet they note that the evidence base remains limited. A systematic review of interventions found 16 studies that met its quality criteria, using approaches such as ethics consultations, multidisciplinary rounds, facilitated discussions, mindfulness, reflective writing, and narrative writing. Most programs focused on nurses, many were conducted at a single site without a clear comparator, and only some produced statistically significant differences between pre- and post-intervention surveys. This absence of strong comparative evidence does not mean the interventions are ineffective, but it highlights the need for multi-site studies with standardized outcome measures. The authors argue that institutions should identify where moral distress is occurring, learn which interventions improve working conditions, and protect the clinical values that are difficult to measure through conventional performance metrics.

Despite restrictions, the perspective urges physicians to continue advocating for patients and learners, although the form that advocacy takes may have to change. One priority is to remain grounded in the evidence that a diverse and inclusive healthcare workforce contributes to better patient outcomes. Another is mentorship: students and trainees watch how senior physicians respond when policies conflict with professional values, and they may rely on mentors to interpret difficult situations. Physicians are also encouraged to align with professional organizations that resist overcompliance and to make their own views known when institutional silence or superficial renaming obscures the loss of substantive programs. The authors suggest that advocacy can include speaking with elected representatives, participating in advocacy days, and writing opinion pieces, with clear disclosure when personal views do not represent an institution. Seeking leadership positions may also prepare the profession to rebuild programs when the regulatory climate permits.

The authors reject the idea that improving conditions for one group necessarily requires worsening conditions for another. What they call a scarcity mindset can intensify conflict, undermine long-term goals, and deepen moral distress. In their view, a healthy healthcare system and workforce cannot be sustained without efforts to make the workplace more equitable and allow more people to thrive. They are optimistic that anti-DEI rhetoric may be temporary, but they acknowledge that work in this area is already being delayed or reversed. A recent analysis linked the post-Dobbs reduction in residency applications in abortion-restricted states with a potentially shrinking future workforce in those regions; the authors note that approximately 56% of trainees remain where they complete residency, so recruitment effects can have long-term consequences. The central message is that moral distress should not be treated as a private emotional failure. It is a warning sign of conflict between professional ethics and institutional policy, and responding to it requires both individual resilience and organized efforts to preserve equitable, accessible care.

Subject of Research: Physician moral distress caused by anti-DEI healthcare policies and proposed coping strategies

Article Title: First Do No Harm: Moral Distress and the Attack on DEI Initiatives

Article References: Chisty, A., McNamara, M., Farkas, A. H., Cioletti, A., Bhayani, R., & Koch, J. (2026). First Do No Harm: Moral Distress and the Attack on DEI Initiatives. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10938-x

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10938-x

Keywords: moral distress, physicians, DEI, healthcare equity, medical education, burnout, patient care, organizational ethics, health policy, advocacy, First, Harm