I recently had the opportunity to reflect on professional advocacy while preparing a lecture for a genetic counseling (GC) program. As I considered how to help new graduates understand the importance of professional advocacy — through the lens of ethical standards, personal values, workplace expectations, and codes of conduct — I found myself returning to the concept of moral injury.

While moral injury is widely discussed in medicine, we rarely hear it named in the GC field. I find that striking, because moral injury has been at the core of much of the professional advocacy I’ve engaged in throughout my career.

Moral injury in genetic counseling refers to the emotional and psychological distress that arises when you are unable to act in alignment with your professional values — particularly around patient care, autonomy and doing what you believe is right. It is distinct from burnout. Burnout is often driven by workload and exhaustion; moral injury stems from a mismatch between your values (both personal and professional) and the way care is structured or delivered.

Importantly, moral injury is not a personal failing. It is often a response to system-level constraints — policies, productivity pressures, time limitations and access barriers — that conflict with core GC values such as patient-centered care, informed consent and psychosocial support.

If your day-to-day thoughts sound like any of the following phrases:

• “This isn’t the kind of care I want to be giving.”
• “I know what my patients need, and I can’t provide it.”
• “The system is pushing me to work in a way that doesn’t feel right.”

— you may be experiencing moral injury.

With burnout, solutions may include adjusting workload, taking time off or setting clearer boundaries. With moral injury, those same strategies often fall short — because the issue is not just how much you’re doing, but how the work itself is structured.

If you recognize moral injury in your own work, it can actually serve as a valuable signal. It points to what matters most to you professionally. From there, genetic counselors can take several approaches. 

Sometimes, we choose to adapt. We recalibrate expectations, redefine what “good enough” care looks like within constraints, and find ways to cope when change feels out of reach.

Sometimes, we can advocate. A moral injury can ignite a strong drive to improve systems, workflows or policies. In these moments, we become advocates — working to realign practice with our professional and personal values.

And sometimes, we shift roles. When the gap between values and reality feels too wide, GCs may transition into a different role. We may decide to shift to a different GC-related role or leave the field altogether. This is not uncommon, especially when moral injury persists over time without resolution or if advocacy efforts fail.

These responses to moral injury are not linear, nor are they mutually exclusive. Some moral injuries are manageable and perhaps even resolve quickly; others are profound enough to reshape a career. Often, unresolved moral injury can lead to burnout — especially when it is experienced repeatedly without a sense of progress or closure. But when moral injury leads to professional advocacy, it can be a powerful force for change.

I’ve experienced this process firsthand in my own career, where a long-standing moral injury ultimately became a driver for advocacy. Early in my career as a clinical GC, I became acutely aware — especially as a bilingual provider — of how limited resources were for non-English-speaking patients. Whether a diagnosis was rare or common, accessible patient-centered educational materials in other languages were often scarce, inadequate or unreliable. In some cases, patients were even charged to have their own medical records translated.  

Like many colleagues, I accepted a “good enough” approach, relying on existing resources and being told that little could be done to change the system. At every clinical job I had, I spent extra hours translating materials myself or searching for appropriate resources for my patients. I had moments of burnout, but what kept me in my clinical role was the belief that a solution was possible — and that staying might allow me to be part of meaningful change.

Over many years, I gradually built relationships within my institution, which helped me identify opportunities to push further. Eventually, I connected with the head of equity relations, who shared a potential pathway for translating standardized, generalized educational materials for our patients. The process that followed was neither quick nor straightforward, as it required sustained advocacy, multiple meetings, repeated revisions, and considerable patience. With support from leadership and colleagues, what began as a long-standing moral injury slowly evolved into meaningful change. After more than two decades of witnessing this gap, we were able to develop translated handouts in multiple languages for cancer gene syndromes. These resources are now available not only to my patients, but to the broader community online.

This is what it can look like when moral injury leads to professional advocacy. The experience didn’t just address the gap; it gave me purpose. The next time you find yourself facing moral injury, consider it an opportunity to realign your work with your professional values and, potentially, to create meaningful change.

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