For those who have found themselves on the frontline of a different kind of battle, the war against Covid, moral injury has been all too common. Dr Emma Hepburn, the clinical psychologist known to her 136,000 Instagram followers as @thepsychologymum, has recently worked in staff support. “Anecdotally I’ve heard more people speak about moral distress and injury,” she tells me. “A clear example of this was patients being unable to see their loved ones face-to-face when unwell or dying, which was very distressing for families and the healthcare workers supporting them.”

Moral injury can also be mistaken for burnout, which is caused by chronic stress in the workplace, but, says Dr Hepburn, it is more specific. “It’s about experiencing situations which violate a person’s values, beliefs or ethics, which can include witnessing, engaging in and failing to stop a situation, or betrayal by a trusted person, which can include their organisation.”

While it is not a diagnosis in itself, the effects of moral injury can include feelings of guilt, shame, betrayal and anger, she says. “And because the experiences have challenged [a sufferer’s] beliefs or assumptions, this may impact on their thoughts and beliefs about themselves, other people and the world. They may turn to unhelpful coping strategies such as drinking or withdrawing from social situations, and as moral injury is linked to mental health difficulties, it is important to look out for signs of depression, which can include low mood and suicidal thoughts, and also PTSD, which may include flashbacks and hypervigilance.”

A British Medical Association survey of 1,900 doctors in early 2021 found that while less than half had heard of the terms, 78 per cent said that moral distress resonated with their experiences at work and 51 per cent said the same about moral injury. Other research has shown that those with a strong ethical code, such as the very religious, are more likely to experience moral distress.

The BMA survey also indicated that female doctors were roughly 50 per cent more likely to highlight a “lack of time to give sufficient emotional support to patients” as a factor.

“My lowest point was at the height of the pandemic, having a phone call with an elderly lady whose husband had died four weeks before,” recalls Dr Helen Fidler, a London-based consultant gastroenterologist and member of the BMA consultant committee. “She didn’t have any relatives [sitting in] on the phone call and I had to explain to her that we needed to get her in because she may have colon cancer, but that I couldn’t give her a date when we’d see her. She was in tears and I just felt so helpless. I wasn’t able to give her any certainty. It was really upsetting and at the end of the phone call, I was pretty distressed.

“I’m 59 and I’ve been a consultant for 24 years, so I am fairly experienced, and it’s always been the case that one gets upset if a patient has a bad diagnosis and you have to explain that to them. That comes with the job. It’s an onerous responsibility, and it’s one we take on happily, but things have changed. I think people must be sick of hearing that the NHS needs more money, but what we’re seeing now is the impact of that underfunding.

“Of course, my husband says, ‘You need to leave, don’t work there any more.’ And that’s what’s happening: loads of people are leaving. I’ve stuck with it so far, but I always planned to stay way after retirement age and I don’t think I will now. I’m a bit old and tired, and it’s a little bit too upsetting at times.

“When I applied to medical school, they said, ‘Don’t, whatever you do, say at interview that you want to help people, because they’re sick of hearing that.’ But that is why I want to do it – that’s what makes the job so joyful and such a privilege. But if you’re working in a situation where there are constraints that prevent you from doing that to the standard you know people are entitled to, it becomes a nightmare. Every single working moment you can find yourself faced with guilt and blame, and anxiety that things are about to go wrong. So rather than it being a positive thing, this responsibility becomes a two-edged sword.”

Of course, it’s not just in life-or-death situations where you can find yourself questioning whether a job aligns with your personal moral compass. And more and more of us are deciding, when faced with those dilemmas, that we just won’t put up with it any more. Brits are quitting their jobs at the highest rate since 2009 – a trend economists have called the Great Resignation.

But interestingly, while you might assume that it is about work-life balance or the pursuit of a higher salary, it is our principles and values that are the biggest driving factor. According to a new study by US company Revelio Labs, which analysed employees’ reports on the jobs site Glassdoor, toxic workplace culture is more than 10 times likely than low pay to predict a high attrition rate within a company.

So how can you work out if the culture of a workplace aligns with your own moral compass when you’re looking for a new job? Reviews from current and former employees on sites like Glassdoor are a good place to start, and while interviewing, look for positive signs like an open culture – and red flags like a high staff turnover.

It is seven years since Sonia left her job at the charity, which has since closed. She now works for an organisation that, while not perfect, is “much more straight down the line”. But the experience has left a mark and she is far more cautious. “In interviews, I ask a lot more questions that unpick the culture of the organisation – and I try to avoid roles where I have to play any part in the financial claims – keep me away from that!”