Australian workers are at risk of developing a psychological condition first identified in Vietnam veterans. Dr Wendy Bonython warns employers can no longer ignore moral injury.
TIn the 1990s, psychiatrist Jonathan Shay noticed a trend among the Vietnam War veterans he was treating for the US Department of Veterans Affairs. Many of the returned soldiers were suffering deep psychological wounds from the war, but it wasn’t post-traumatic stress disorder (PTSD). Rather than being traumatised by fear or danger, they were haunted by violations of their own moral beliefs.
One veteran described being sent on a mission where the commander’s poor planning led to the deaths of several comrades. Another had been ordered to destroy a village, knowing that civilians would be killed or injured. Their guilt, shame and anger were profound.
Shay coined the term moral injury to describe the psychological harm caused when people are betrayed by authority or compelled to act against their core values.
For many years, moral injury was often dismissed or seen as less serious than PTSD or other combat-related disorders.
But by 2024, when Australia’s Royal Commission into Defence and Veteran Suicide delivered its findings, moral injury was firmly recognised as a key contributor to suicidal behaviour among veterans.
Dr Wendy Bonython first became aware of moral injury through her role as a former member of the Department of Defence and Veterans' Affairs Human Research Ethics Committee.
Now an Associate Professor of Law at Bond University, she recently published a research paper that identifies moral injury as an emerging workplace risk across a range of professions including lawyers, journalists and medical professionals.
“Moral injury typically arises in response to something that fundamentally challenges or conflicts with a person’s personal ethics or organisational values,” Dr Bonython says.
“It may coexist with PTSD, but it can also be a cause of suicidality and suicide independent of any diagnosed psychiatric condition.”
Outside of Defence, moral injury came into the spotlight during the COVID-19 pandemic when healthcare workers faced impossible choices over resource allocation.
“Frontline health workers were faced with really confronting ethical dilemmas on a daily basis – which patient gets the limited supply of ventilators, or how do we decide which patient lives and which one doesn’t,” Dr Bonython says.
"Moral injury typically arises in response to something that fundamentally challenges or conflicts with a person’s personal ethics..."
But despite its potentially deadly impact, moral injury is not yet formally recognised in Australian compensation law.
Dr Bonython gives a hypothetical example that two employees exposed to the same event, with one developing a diagnosable condition and able to claim compensation, while the other copes better or seeks early help and never receives a diagnosis, yet still suffers harm.
“We've got this perverse situation where the law almost encourages people not to be proactive,” she says.
“If they seek early support, they may never get a diagnosis – and without a diagnosis, they can’t claim compensation.”
The message to employers is clear: ignoring moral injury is no longer an option.
“If you’re in a profession where you’ve got people with a very highly developed sense of personal and professional ethics, and you know there are practices that are maybe contrary to that, you should really be starting to think, do I need to address those practices?”
Practical steps for employers include:
- Whistleblower protections backed by genuine organisational support
- Debriefing and counselling for staff exposed to ethically fraught decisions
- Robust complaints and dispute resolution processes that employees trust
- Training for managers to recognise signs of moral distress and respond appropriately
While Australia has been slower to respond, momentum is building internationally, with healthcare and emergency service sectors beginning to explore reforms.
Dr Bonython believes employers should be proactive in preparing for these changes.
“This isn’t just another issue on the employer to-do list,” she says.
“As technology changes work, as AI reshapes professional identities, questions of ethics and values will become even more central.
Machines can’t replicate our morality – and so moral injury will increasingly define how workplaces must care for their people.”
For forward-thinking employers, this challenge also represents an opportunity: to embed genuine ethics into organisational culture, to support workers facing impossible choices, and to prevent harm before it becomes life-threatening.
“Moral injury forces us to ask: are we really walking the talk when it comes to our values?” Dr Bonython says.
“For some of these people it is quite literally going to come down to a life-and-death type approach.”
Published Wednesday, 8 October, 2025.
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