During the height of the COVID-19 pandemic, a friend of mine who is a physician, told me something that stopped me in my tracks:

“I don’t see how compassion and self-compassion can help me now. This is moral injury.”

This is someone who has dedicated his life to caring for others. Someone who is, at his core, compassionate.

And yet, in that moment, compassion felt impossible.

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When the System Blocks Compassion

My friend was working in a nursing home where patients were isolated, staff were overwhelmed, and death was an almost daily reality. He was exhausted, and his team was shrinking. It felt to him like the needs were endless.

And perhaps most painfully, he couldn’t provide the care he wanted to give.

That’s what we call moral injury, when someone is forced to act (or not act) in ways that go against their deepest values.

In health care, this happens more often than we might think; it’s not just a problem during a pandemic. Moral injury is an everyday occurrence.

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The Misconception About Burnout

We often talk about burnout as an individual issue:

• “You need better boundaries.”
• “Try meditation.”
• “Take care of yourself.”

And while those things matter, they miss something critical. My friend didn’t need a better morning routine. He needed more staff, more time, and more support. He needed a system that allowed him to be the compassionate doctor he already was.

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Compassion Needs Conditions

This is something I keep coming back to:

Compassion isn’t just a personal trait—it’s something that requires the right conditions to exist.

If you’re rushing from patient to patient…
If you’re punished for spending time with someone…
If you’re emotionally and physically depleted…

Compassion doesn’t disappear because you’re a bad person, it disappears because the system doesn’t support it.

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A Different Kind of Question

Instead of asking:
“Why aren’t providers more compassionate?”

What if we asked:
“What conditions would allow compassion to thrive?”

Because when we ask that question, everything shifts. We move from blame to curiosity, from individual responsibility to systemic awareness, and from burnout to possibility.

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This piece is adapted from Chapter 6 of A Case for Compassion: What Happens When We Prioritize People and the Planet—one of the chapters that challenged me to look beyond individuals and toward the systems that shape behavior.