First Do No Harm: Moral Distress and the Attack on DEI Initiatives.

Since January 2025, several executive orders have been issued that aim to dismantle diversity, equity, and inclusion (DEI) initiatives in public and private institutions and national medical education accreditation agencies. Many of the DEI initiatives were developed to address existing healthcare inequities, and as a result, the executive orders have had a profound impact on physicians, patients, and medical educators. Physicians may be experiencing moral distress due to the conflict between their ethical responsibility to patients and learners and institutional compliance with anti-DEI directives. In this paper, the authors will explore the concept of moral distress and propose evidence-based strategies for addressing moral distress in healthcare settings. They will share their personal viewpoints and suggest individual and organizational strategies to approach moral distress related to anti-DEI efforts.