@Article{info:doi/10.2196/52711,
author="Hsieh, Hsing-yen
and Lin, Chyi-her
and Huang, Ruyi
and Lin, Guan-chun
and Lin, Jhen-Yu
and Aldana, Clydie",
title="Challenges for Medical Students in Applying Ethical Principles to Allocate Life-Saving Medical Devices During the COVID-19 Pandemic: Content Analysis",
journal="JMIR Med Educ",
year="2024",
month="Jan",
day="5",
volume="10",
pages="e52711",
keywords="virtual patient; virtual patients; medical resources distribution; medical ethical education; COVID-19 pandemic; ethics; medical student; medical students; medical ethics; decision-making; ethical dilemna; simulation; reasoning; decision support; medical guideline; medical guidelines; medical devices; medical device; life-saving; thematic analysis; virtual platform",
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: This study aimed to assess the ability and confidence of medical students to apply principles of medical ethics in allocating critical medical devices through the scenario of virtual patients. Methods: The study recruited third- and fourth-year medical students during clinical rotation. We 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 out of 71 medical students with a mean age of 34 (SD 4.7) years, 60{\%} (n=40) of whom were female students. The principle of justice was cited by 73{\%} (n=49) of students while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46{\%} (n=31) citing the principle of nonmaleficence, 31{\%} (n=21) advocating for a first-come-first-served approach, and 25{\%} (n=17) 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{\%} (n=8), proposed the exploration of legal alternatives, while 4{\%} (n=3) suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making. Conclusions: This study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. More than 70{\%} of 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 nonmaleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions. ",
issn="2369-3762",
doi="10.2196/52711",
url="https://mededu.jmir.org/2024/1/e52711",
url="https://doi.org/10.2196/52711",
url="http://www.ncbi.nlm.nih.gov/pubmed/38050366"
}