{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:08:18Z","timestamp":1789477698680,"version":"build-2803163510"},"reference-count":89,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"2021 Social Sciences and Humanities Research Council","award":["435-2022-0959"],"award-info":[{"award-number":["435-2022-0959"]}]},{"name":"New Frontiers in Research Fund","award":["NFRFR-2022-00305"],"award-info":[{"award-number":["NFRFR-2022-00305"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_med-2026-1503_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Although compliance is often interpreted as consensus and dissent as \u201cvaccine hesitancy\u201d, misinformation, or deficient trust, less is known about how healthcare workers experienced Covid-19 vaccine mandates or how their legitimacy was constructed and contested.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1503_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1503_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most respondents (82.5\u202f%) expressed negative sentiments, while a minority (17.5\u202f%) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1503_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/med-2026-1503","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T07:56:45Z","timestamp":1786953405000},"source":"Crossref","is-referenced-by-count":0,"title":["\u2018When I had concerns about my own patients\u2026I was told to keep quiet\u2019: experiences of moral injury among healthcare workers under Covid-19 vaccine mandates in Alberta, Canada"],"prefix":"10.1515","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9208-7630","authenticated-orcid":false,"given":"Claudia","family":"Chaufan","sequence":"first","affiliation":[{"name":"School of Health Policy and Management , York University , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1385-8279","authenticated-orcid":false,"given":"Natalie","family":"Hemsing","sequence":"additional","affiliation":[{"name":"School of Health Policy and Management , York University , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7058-1863","authenticated-orcid":false,"given":"Rachael","family":"Moncrieffe","sequence":"additional","affiliation":[{"name":"School of Health Policy and Management , York University , Toronto , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"2026091512564440315_j_med-2026-1503_ref_001","doi-asserted-by":"crossref","unstructured":"Maneze, D, Salamonson, Y, Grollman, M, Montayre, J, Ramjan, L. Mandatory COVID-19 vaccination for healthcare workers: a systematic review. Int J Nurs Stud 2022;138:14.","DOI":"10.1016\/j.ijnurstu.2022.104389"},{"key":"2026091512564440315_j_med-2026-1503_ref_002","doi-asserted-by":"crossref","unstructured":"Kung, PJ, Chen, CM, Lin, ECL, Shu, BC, Tew, Y, He, J, et al.. Ethical challenges around mandatory vaccination among nurses: a systematic review of qualitative and quantitative evidence. Int J Nurs Stud 2026;175:105313. https:\/\/doi.org\/10.1016\/j.ijnurstu.2025.105313.","DOI":"10.1016\/j.ijnurstu.2025.105313"},{"key":"2026091512564440315_j_med-2026-1503_ref_003","doi-asserted-by":"crossref","unstructured":"McDonald, CI, Parry, P, Rhodes, P. Economic and psychosocial impact of Covid-19 vaccine non-compliance amongst Australian healthcare workers. 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Anti-vaccine protesters harassing health care workers, patients: AHS president [Internet]. Calgary Herald; 2021. Available from: https:\/\/calgaryherald.com\/news\/local-news\/anti-vaccine-protesters-harassing-health-care-workers-patients-ahs-president."},{"key":"2026091512564440315_j_med-2026-1503_ref_010","unstructured":"United Nurses of Alberta. UNA members employed by AHS and covenant health have until October 16 to submit proof of vaccination [Internet]; 2021. Available from: https:\/\/www.una.ca\/1294\/una-members-employed-by-ahs-and-covenant-health-have-until-october-16-to-submit-proof-of-vaccination [Accessed 23 Jan 2026]."},{"key":"2026091512564440315_j_med-2026-1503_ref_011","unstructured":"Wilson, J. Doctors suing Alberta health services over COVID vaccine mandate [Internet]. Canadian Occupational Safety; 2021. 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Eur J Epidemiol 2021;36:1237\u201340. https:\/\/doi.org\/10.1007\/s10654-021-00808-7.","DOI":"10.1007\/s10654-021-00808-7"},{"key":"2026091512564440315_j_med-2026-1503_ref_037","doi-asserted-by":"crossref","unstructured":"Fraiman, J, Erviti, J, Jones, M, Greenland, S, Whelan, P, Kaplan, RM, et al.. Serious adverse events of special interest following mRNA COVID-19 vaccination in randomized trials in adults. Vaccine 2022;40:5798\u2013805. https:\/\/doi.org\/10.1016\/j.vaccine.2022.08.036.","DOI":"10.1016\/j.vaccine.2022.08.036"},{"key":"2026091512564440315_j_med-2026-1503_ref_038","doi-asserted-by":"crossref","unstructured":"Karlstad, \u00d8, Hovi, P, Husby, A, H\u00e4rk\u00e4nen, T, Selmer, RM, Pihlstr\u00f6m, N, et al.. SARS-CoV-2 vaccination and myocarditis in a nordic cohort study of 23 million residents. 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J\u00a0Trauma Stress 2019;32:341\u20139. https:\/\/doi.org\/10.1002\/jts.22405.","DOI":"10.1002\/jts.22405"},{"key":"2026091512564440315_j_med-2026-1503_ref_043","doi-asserted-by":"crossref","unstructured":"Shay, J. Moral injury [Internet]. Intertexts; 2012, vol 16. 57\u201366, pp. Available from: https:\/\/muse.jhu.edu\/pub\/76\/article\/492650 [Accessed 7 Sep 2024].","DOI":"10.1353\/itx.2012.0000"},{"key":"2026091512564440315_j_med-2026-1503_ref_044","doi-asserted-by":"crossref","unstructured":"Shay, J. Moral injury. Psychoanal Psychol 2014;31:182\u201391. https:\/\/doi.org\/10.1037\/a0036090.","DOI":"10.1037\/a0036090"},{"key":"2026091512564440315_j_med-2026-1503_ref_045","doi-asserted-by":"crossref","unstructured":"Riedel, PL, Kreh, A, Kulcar, V, Lieber, A, Juen, B. A scoping review of moral stressors, moral distress and moral injury in healthcare workers during COVID-19. 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Available from: https:\/\/www.dragnsurvey.com\/blog\/en\/the-crucial-role-of-timing-in-sending-an-online-survey\/ [Accessed 29 Apr 2026]."},{"key":"2026091512564440315_j_med-2026-1503_ref_051","doi-asserted-by":"crossref","unstructured":"Denecke, K, Reichenpfader, D. Sentiment analysis of clinical narratives: a scoping review. J\u00a0Biomed Inf 2023;140:104336. https:\/\/doi.org\/10.1016\/j.jbi.2023.104336.","DOI":"10.1016\/j.jbi.2023.104336"},{"key":"2026091512564440315_j_med-2026-1503_ref_052","unstructured":"Becker, I, Sasse, A. Combining qualitative coding and sentiment analysis: deconstructing perceptions of usable security in organisations [Internet]. Proceedings of the 4th Learning from Authoritative Security Experiment Results (LASER) Workshop: San Jose, CA, USA; 2016. 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Westport, Connecticut: Greenwood Publishing Group; 1998:216 p."},{"key":"2026091512564440315_j_med-2026-1503_ref_074","doi-asserted-by":"crossref","unstructured":"Shir-Raz, Y, Elisha, E, Martin, B, Ronel, N, Guetzkow, J. Censorship and suppression of Covid-19 heterodoxy: tactics and counter-tactics. Minerva 2023:407\u201333. https:\/\/doi.org\/10.1007\/s11024-022-09479-4.","DOI":"10.1007\/s11024-022-09479-4"},{"key":"2026091512564440315_j_med-2026-1503_ref_075","doi-asserted-by":"crossref","unstructured":"Chaufan, C. \u201cYou are not a horse\u201d: medicalization, social control, and academic discourse in the Covid-19 era. In: Controversies in the Pandemic. New Dehli: Jaypee Brothers Medical Publishers; 2024:0\u2013106 pp.","DOI":"10.31235\/osf.io\/fwvem"},{"key":"2026091512564440315_j_med-2026-1503_ref_076","doi-asserted-by":"crossref","unstructured":"Chaufan, C, Hemsing, N, Moncrieffe, R. 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Sociol Health Illness 2026;48:e70119. https:\/\/doi.org\/10.1111\/1467-9566.70119.","DOI":"10.1111\/1467-9566.70119"},{"key":"2026091512564440315_j_med-2026-1503_ref_082","unstructured":"Peterborough Regional Health Centre C. Careers [Internet]. PRHC; 2025. Available from: https:\/\/www.prhc.on.ca\/careers\/ [Accessed 23 May 2025]."},{"key":"2026091512564440315_j_med-2026-1503_ref_083","unstructured":"Ross Memorial Hospital. COVID-19 | Ross Memorial Hospital [Internet]; 2025. Available from: https:\/\/rmh.org\/covid-19 [Accessed 23 May 2025]."},{"key":"2026091512564440315_j_med-2026-1503_ref_084","doi-asserted-by":"crossref","unstructured":"Levin, EG, Lustig, Y, Cohen, C, Fluss, R, Indenbaum, V, Amit, S, et al.. Waning immune humoral response to BNT162b2 Covid-19 vaccine over 6 months. N\u00a0Engl J Med 2021;385:e84. NEJMoa2114583. https:\/\/doi.org\/10.1056\/NEJMoa2114583.","DOI":"10.1056\/NEJMoa2114583"},{"key":"2026091512564440315_j_med-2026-1503_ref_085","doi-asserted-by":"crossref","unstructured":"Menegale, F, Manica, M, Zardini, A, Guzzetta, G, Marziano, V, d\u2019Andrea, V, et al.. Evaluation of waning of SARS-CoV-2 vaccine\u2013induced immunity: a systematic review and meta-analysis. JAMA Netw Open 2023;6:e2310650. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.10650.","DOI":"10.1001\/jamanetworkopen.2023.10650"},{"key":"2026091512564440315_j_med-2026-1503_ref_086","doi-asserted-by":"crossref","unstructured":"\u010cartolovni, A, Stolt, M, Scott, PA, Suhonen, R. Moral injury in healthcare professionals: a scoping review and discussion. Nurs Ethics 2021;28:590\u2013602. https:\/\/doi.org\/10.1177\/0969733020966776.","DOI":"10.1177\/0969733020966776"},{"key":"2026091512564440315_j_med-2026-1503_ref_087","doi-asserted-by":"crossref","unstructured":"Rabin, S, Kika, N, Lamb, D, Murphy, D, Am Stevelink, S, Williamson, V, et al.. Moral injuries in healthcare workers: what causes them and what to Do about them? J\u00a0Healthc Leader 2023;15:153\u201360. https:\/\/doi.org\/10.2147\/JHL.S396659.","DOI":"10.2147\/JHL.S396659"},{"key":"2026091512564440315_j_med-2026-1503_ref_088","doi-asserted-by":"crossref","unstructured":"Shuster, E. Fifty years later: the significance of the Nuremberg code. N\u00a0Engl J Med 1997;337:1436\u201340. https:\/\/doi.org\/10.1056\/NEJM199711133372006.","DOI":"10.1056\/NEJM199711133372006"},{"key":"2026091512564440315_j_med-2026-1503_ref_089","unstructured":"UNESCO. Universal declaration on bioethics and human rights [Internet]. Paris, France: UNESCO; 2005. 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