Accepted for/Published in: JMIR Medical Education
Date Submitted: Sep 13, 2023
Open Peer Review Period: Sep 13, 2023 - Nov 8, 2023
Date Accepted: Dec 3, 2023
Date Submitted to PubMed: Dec 5, 2023
(closed for review but you can still tweet)
Challenges for medical students in applying ethical principles to allocate life-saving medical devices during the COVID-19 pandemic: a qualitative study
ABSTRACT
Background:
The emergence of the COVID-19 pandemic has posed a significant ethical dilemma in the allocation of scarce, life-saving medical equipment to critically ill patients. It remains uncertain whether medical students are equipped to navigate this complex ethical process.
Objective:
To address this, we developed a virtual patient simulation aimed at assessing how medical students apply medical ethics principles when faced with life-or-death decisions.
Methods:
The study recruited third- and fourth-year medical students during clinical rotation. and facilitated interactions between medical students and virtual patients experiencing respiratory failure due to COVID-19 infection. We assessed the students' ability to ethically allocate life-saving resources. Subsequently, we analyzed their written reports using thematic analysis to identify the ethical principles guiding their decision-making.
Results:
We enrolled a cohort of 67 medical students for this study. Seventy-three percent of them cited the principle of justice while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46% citing the principle of non-maleficence, 31% advocating for a first-come-first-serve approach, and 25% emphasizing respect for patient autonomy as key influencers in their decisions. Notably, medical students exhibited a lack of confidence in making ethical decisions concerning the distribution of medical resources. A minority, comprising 12%, proposed the exploration of legal alternatives, while 4% suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making.
Conclusions:
The study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. Most medical students identified justice as the predominant principle in allocating limited medical resources to critically ill patients. However, they exhibited a lack of confidence in making ethical determinations and leaned toward principles such as non-maleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions. Clinical Trial: None
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