Assessment of physicians' ethical dilemmas and decision-making in emergency departments in resource-limited settings: a study of selected public hospitals in Sidama regional state, Ethiopia, 2024.

backgroundEthical dilemmas are the major issue in emergency departments in hospital settings. The difficulty of choice presents a challenge for doctors, patients, and patient families, and ethical decision-making becomes a problem. Since emergency therapy is different from other departments in that it requires immediate intervention to save lives, the patient’s unknown history, the limited resources available, family culture and/or beliefs, and the congested emergency department, there are also a number of ethical dilemmas. To best of our knowledge, there was no data on physician ethical dilemmas and decision making in the study area.

objectivesTo assess ethical dilemmas and decision-making processes in emergency departments from selected public hospitals in Sidama regional state, Ethiopia.

methodsDescriptive cross-sectional study conducted in public institutions with a standardized, self-administered questionnaire. And the study was done at selected seven public hospitals in Sidama region, Southern Ethiopia from Oct 2023 –May 2024. Self-administered prepared questionnaires were used for data collection from physicians working in emergency departments by convenient sampling. Data was coded, entered, and cleaned using Epi Data version 3.3.1 software. Errors related to inconsistency were verified using the data cleansing method and finally exported into SPSS version 24 software for analysis.

resultThe study included 274 physicians of which 207(75.5%) male and 67(24.5%) female. The majority of participants 164 (59.9%) were general practitioners and 185(81.9%) participants took clinical ethics (medical ethics). 156(56.9%) physicians often encounter limitations of resources that result in difficult choices, 150(54.7%) participants were sometimes encountered significant disagreement among healthcare personnel on continuing the treatment of the patient due to a lack of resource. From a total of 274 physicians 244(89.1%) have paid from their pocket, 77(28.1%) of physicians donated blood for their own patients. Physicians tried to use different strategies to solve ethical dilemmas like, 140(51.1%) of physicians talk with their colleagues and find the solution together. CONCLUSION AND RECOMMENDATION: Throughout their medical careers, physicians frequently encounter ethical dilemmas and struggle with emergency department decision-making. They often encounter limitations of resources, a patient’s (patient’s family) inability to pay that result in difficulty in treating patients at emergency department. As per the study there was no uniform and enough ethical training how to handle different ethical dilemmas. Hospitals should endeavour to tackle hospital resource constraint, which is the primary cause of ethical dilemmas, and develop guidelines to handle ethical issues. CLINICAL TRIAL NUMBER: Not applicable.