Moral Distress in Ethical Dilemmas: A Comparative Study of Medical Students and Physicians

Abstract

Background: Ethical dilemmas and the moral distress they generate are central challenges in healthcare practice and professional identity formation. While moral reasoning has been widely studied, comparative evidence on how medical students and practicing physicians approach ethical dilemmas remains scarce in Eastern Europe. Methods: A total of 244 participants (51 senior medical students and 193 physicians) completed an adapted version of the Defining Issues Test, version 2 (DIT-2). Three classical dilemmas were assessed: end-of-life decision-making, access to life-saving medication, and the reintegration of a fugitive. Responses were analyzed through descriptive statistics and chi-square tests to identify differences in decision choices and underlying reasoning. Results: Physicians consistently endorsed conventional, law-based reasoning, emphasizing legality and professional codes, while medical students demonstrated greater variability, indecision, and openness to compassion-driven justifications. In the "Jan and the Drug" and "Fugitive" dilemmas, significant between-group differences highlighted tensions between legality, empathy, and justice (p < 0.01). These differences in reasoning indicate differing vulnerabilities to moral distress, especially when legal and compassionate perspectives conflict. Conclusions: The findings reveal distinct patterns of moral reasoning that reflect different levels of vulnerability to moral distress in healthcare contexts. Integrating structured ethics training and reflective dialogue into both undergraduate and continuing medical education could mitigate moral distress by fostering a balance between justice, compassion, and professional responsibility.

Keywords: ethical dilemmas; healthcare education; medical ethics; medical ethics education; medical students; moral distress; moral reasoning; physicians; professional identity.