'When I had concerns about my own patients…I was told to keep quiet': experiences of moral injury among healthcare workers under Covid-19 vaccine mandates in Alberta, Canada.

Abstract

Objectives: Although compliance is often interpreted as consensus and dissent as "vaccine hesitancy", misinformation, or deficient trust, less is known about how healthcare workers experienced Covid-19 vaccine mandates or how their legitimacy was constructed and contested.

Methods: We analyzed open-ended survey responses from 80 respondents within a convenience sample of 189 healthcare workers in Alberta, Canada. Informed by Weberian ideal types, responses were classified by normative orientation toward mandates and analyzed thematically.

Results: Most respondents (82.5 %) expressed negative sentiments, while a minority (17.5 %) were positive; none were neutral. Negative accounts emphasized coercion, institutional betrayal, silencing, ethical conflict, and moral injury, including among vaccinated respondents. Positive responses emphasized patient care, role expectations, and public safety, often framing dissent as illegitimate.

Conclusions: The findings indicate that mandates were experienced as professionally divisive and, by many respondents, as ethically disruptive; that compliance should not be equated with ethical alignment; and that high vaccination uptake can obscure coercive conditions. Treating dissent as an empirical object reveals how mandate legitimacy was constructed and how institutional practices managed disagreement. Moral injury emerged not merely as an individual psychological response, but as a structurally induced ethical harm with implications for professional judgment, informed consent, patient care, workforce stability, and institutional integrity.