When health professions students face a case where both answers are defensible, ethical principles are not the only thing deciding

Ethics teaching tends to present four principles, but what settles a decision when those principles collide? This study watched students reasoning in real time rather than asking them afterwards what they thought.

An inductive qualitative analysis of six recorded breakout-group discussions from a one-hour online ethics workshop, with medicine, dental medicine and pharmacy students from two universities in the United Arab Emirates. Recordings were transcribed verbatim, imported into MAXQDA 2022 and coded inductively through four stages of review, reflect, reduce and retrieve, with two coders triangulating the findings. Six cases were used, from a patient with mental illness refusing treatment and a teenager with a suspected sexually transmitted infection asking that his parents not be told, through antibiotic prescribing on request and a patient unable to pay, to premarital screening and research ethics during COVID-19.

• Six things shaped the decisions: emotions, personal experience, law and the legal system, professional background, knowledge of medical research, and exposure to inter-professional education.
• Students did apply the four principles in their reasoning — autonomy, beneficence, non-maleficence and justice — rather than deciding on feeling alone.
• The single most frequent word in the discussions was “harm”, and the commonest move was weighing which option caused the lesser harm, or whether harm could be avoided altogether.
• On the same case, students split sharply. For the teenager who asked that his parents not be told, some insisted his wishes be respected because disclosure risked punishment or abuse; others held that a minor's parents must be informed, and saw empathy as interfering with how the law is meant to work.
• The authors note that female and male students leaned differently on the premarital screening case, with female students expressing more concern for the woman in the scenario — an observation drawn from reading the discussions, not a statistical test.

For curriculum designers, teaching the four principles is not sufficient, because what competes with them — feeling, prior experience, an understanding of the law — is already present in the learner whether or not it is taught. Small-group discussion of real cases brings those influences into the open where they can be examined, and having several professions in the same room emerged as one of the six factors on its own rather than being built into the study's design.