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Though anxious to avoid harming their patients, clinicians are disempowered by hierarchical systems of medical decision-making, which hinder their ability to always act in what they feel are the patient's best interests. This paper highlights the emotional/affective distress and ambivalence experienced by physicians when making decisions about whether to administer or prescribe opioids. Ultimately, the paper demonstrates how iatrogenesis and moral injury are concomitantly produced through cascades of decision-making and local health syst