Scenario-Based Ethical Reasoning Among Healthcare Trainees and Practitioners: Evidence from Dental and Medical Cohorts in Romania

Abstract

Background and Objectives: Clinical ethical judgments are often elicited through scenario-based (vignette-based) dilemmas that guide interpretation, reasoning, and moral judgment. Despite its importance, little is known about how healthcare professionals and students respond to such scenario-based dilemmas in Eastern European settings. This study explored differences in ethical decision-making between senior medical/dental students and practicing clinicians in Romania, focusing on how scenarios-based dilemmas influence conditional versus categorical responses. Materials and Methods: A cross-sectional survey was conducted with 244 participants (51 senior students; 193 practitioners). Respondents completed a validated 35-item questionnaire presenting hypothetical ethical scenarios across seven domains: informed consent, confidentiality, medical errors, public health duties, end-of-life decisions, professional boundaries, and crisis ethics. Each scenario used a Yes/No/It depends response structure. Group comparisons were analyzed using chi-square and non-parametric tests (α = 0.05). Results: Scenario-based dilemmas elicited frequent conditional reasoning, with "It depends" emerging as the most common response (47.8%). Strong consensus appeared in rejecting concealment of harmful errors and in treating unvaccinated families, reflecting robust professional norms. Divergences arose in areas where scenario-based dilemmas emphasized system-level duties: students more often supported annual influenza vaccination (52.9% vs. 32.6%, p = 0.028) and organ purchase authorization (76.47% vs. 62. 18%, p = 0.043), while practitioners more frequently endorsed higher insurance contributions for unhealthy lifestyles (48.7% vs. 23.5%, p = 0.003). Conclusions: Scenario-based dilemmas strongly shape moral decision-making in healthcare. While students tended toward principle-driven transparency, practitioners showed pragmatic orientations linked to experience and system stewardship. To promote high-quality clinical work and align decision-making with best practice and health policy, our findings support institutional protocols for transparent error disclosure, continuing professional development in ethical communication, the possible adoption of annual influenza vaccination policies for healthcare personnel as policy options rather than categorical imperatives, and structured triage frameworks during crisis situations. These proposals highlight how scenario-based ethics training can strengthen both individual reasoning and systemic resilience.

Keywords: Romania; decision-making; dentistry; ethical dilemmas; medicine; scenario-based dilemmas.

Figure 1

Distribution of responses for Item 29—Comparative boxplot illustrating variability in responses across participant groups for the ethical scenario related to professional responsibility.

Figure 2

Distribution of responses for Item 31—Comparative boxplot showing the spread and central tendency of responses across cohorts for the ethical scenario addressing confidentiality and professional judgment.