Original Articles Ethical Dilemmas and the Moral Reasoning of Medical Students Ethical Dilemmas and the Moral Reasoning of Medical Students

Objectives: To analyze the responses of medical students to ethical dilemmas commonly encountered in the clinical setting. Subjects and Method: A questionnaire based cross sectional survey was conducted on final year medical students from three different medical colleges in Karachi, Pakistan. Results: One hundred and twenty two students participated. Fifty eight percent were willing to withdraw ventilatory support from a terminally ill patient wanting to die, but very few were willing to either prescribe a lethal drug or to administer it themselves. Eighty seven percent students thought that giving false medical certificates was unethical, however 40% (p value: 0.0006) changed their minds and agreed to it if the reason was good. Ninety three percent said it was unethical to give a prescription in the name of a person other than the patient himself but 36% (p value: 0.004) changed their minds and agreed to it and consequently falsely bill a company account if the beneficiary was poor. Eighty three percent of the students regarded breast examination of an un-consenting female patient under anesthesia by male students as unethical. Sixty percent students called human organ trade unethical. However, when a compelling reason was provided for the trade, 41% (p value: 0.00) changed their minds and said it was ethical. Conclusion: Students from different colleges have a similar outlook towards ethical dilemmas and their perceptions are based on their own moral reasoning, strongly influenced by socioeconomic issues. Bioethics education did not influence their responses. It is important that bioethics curricula be devised keeping the local and regional peculiarities in mind (JPMA 53:210;2003).