Figure 1
The Visual Tool.
Table 1
Examples of the Map Scenarios.
| DILEMMA | PARTICIPANTS | SETTING | POTENTIAL SOLUTIONS | THOUGHTS AND EMOTIONS | VALUES |
|---|---|---|---|---|---|
| Presenting a 97-year-old man with a huge incidental liver tumor, knowing that he has an obsession with unlimited medical investigations (Figure 1) | Me- the doctor, the patient | Last stage of residency | Not to tell Tell partially and offer not to treat To objectively present the finding and prognosis, the clarification options | Cheating and distorting reality. I care for him and want to protect him. ‘What you do not know does not hurt you.’ Afraid of the future impact in other cases. | Paternalism, integrity, moral degradation Do not harm |
| During gynecology rotation, our tutor had us observe a speculum exam on an anesthetized patient (Figure 1) | Tutor, students, patient. | Gynecology clerkship | Collaboration refuse and do not report Report the tutor Talk to the tutor | Regret, shame, shock, helplessness, anger, responsibility, fear, embarrassment. Respect the patient. | Helplessness, remorse for reliability and professional integrity. Values at the center: reliability, professionalism, integrity |
| Discussing the euthanasia of a hospice patient with the patient and his family | Me- the doctor The patient The patient’s wife (primary caregiver), his children | At his home, near his bed. Three days after treatment ended | Give optimal palliative care, including sedation; Give life-ending care. Consult with a senior | The ‘right’ legal action; I am not ‘appreciated’ enough. Hospice values are ‘sacred’; Did he have time to say goodbye? Do not cause death to a conscious person. Patient suffering | Integrity Law vs. Ethics Autonomy Patient-centered Human dignity Do good, not harm; Sanctity of life |
| A dialysis patient is not cooperating and insults the staff, who feel threatened. The staff requests to stop treating him. | Patient, dialysis institute staff, Head of the department | Dialysis institute, during COVID-19 | Support and back up the team and continue care. Terminate treatment at the institute. Continue with the routine without taking a stand. | The staff is entitled to respect and security. Who has priority? It is better to avoid decisions until things get better. | Patient-centered Teamwork Respect Responsibility for employees Object to violence Team security |
| Gynecological surgery, a woman in a lithotomy position. A janitor inappropriately touches the patient. I reported the incident to my supervisor, who warned me about the potential repercussions. | The patient, me, the janitor, and the operating room staff | Fifth-year student. Potential for residency in this ward. Operating room. | Tell the patient. Report to the department head/hospital manager/dean of clinical studies. Keep quiet. Confront the janitor. Contact the media. | Fear Not to report- What does that say about me? Feeling exposed, righteous I bypassed my superiors Fear of the janitor’s reaction I will not be able to specialize in the ward. Colleague hostility | Responsibility, Patient respect and dignity. Loyalty to patient vs. the staff. Integrity Do no harm Prevent sexual abuse (in the future) |
Table 2
Themes and Quotes.
| THEME | QUOTE |
|---|---|
| Tool’s effectivity | The workshop provided closure and facilitated personal growth. |
| The experience was insightful. I observed my fellow participants’ moral challenges and motivations, underscoring the horror and entrapment. However, I was able to process the situation effectively. | |
| The opportunity to document my ordeal in a protected environment was challenging yet crucial and insightful. | |
| It made me reconsider the options and revealed additional choices I hadn’t initially recognized. | |
| I felt I had processed the case more effectively and could draw significant insights from the challenging experience for the future. Additionally, I felt more self-compassion. | |
| Reflective thoughts on personal growth and professional identity | It highlighted the workshop’s pivotal role in fostering ethical reflection and self-awareness, which are crucial for making sound moral decisions. |
| The workshop highlighted the parallel between my past feelings of distress and their reemergence years later, underscoring its importance in processing and understanding my experiences. | |
| I realized there’s no absolute truth; everything is a matter of perspective. It affects how I think and feel about my personal and professional life. | |
| What does this mean about me? | |
| How will this affect my work in the future? | |
| Reflecting on the workshop, I realized my decisions were often fear-driven, overlooking the potential benefits for myself and others. This self-awareness prompted me to question my motivation. | |
| Avoidance | The easiest way is to approach my supervisor, ask her to confront the conflict. |
| Let it go… Not to think about it. | |
| Emotions | Feeling exposed, righteous, fear |
| Fear of the janitor’s reaction | |
| I am not ‘appreciated’ enough. | |
| I was angry about the patient’s family; why did they put me in this situation? | |
| I was afraid of my colleague’s hostility. | |
| When unsure about the right choice, I consult a colleague; I try to avoid involving feelings in the decision. | |
| Values | I’ve realized that values evolve, and flexibility is necessary. Life isn’t black and white. I’ve consciously acted against my moral code, recognizing the importance of awareness. I may cross the line, but it’s a conscious choice. |
| Witness reliability and professional integrity values: reliability, professionalism, integrity. | |
| The patient’s benefit often takes precedence over an absolute value like integrity. | |
| We are dealing with unacceptable conduct, including unreliability/transparency/manipulations- a clash of values. | |
| Act against my beliefs and values – how will this affect my work in the future – maybe I will do it again? Moral deterioration. | |
| Integrity | Values of reliability and professional integrity at the center. |
| On the spectrum: ambitions – courage and integrity, standing by my principles until giving up and moving on. | |
| Patient’s autonomy | He [the patient] has a right to his body. |
| The patient’s dignity, the patient’s right to his life. | |
| Avoiding harm | I will not expedite the death of a person. |
| Can I let them starve? | |
| My values are against causing passive/active death. | |
| Doing good | Give optimal palliative pain relief treatment (including sedation). |
| What is in the patient’s best interest? | |
| How does the patient feel? Is he suffering? | |
| Teamwork | Unpleasant, a fight, fear of harassment, feeling exposed, righteous, I am bypassing my superiors |
| Anger towards the patient and [operating room] staff. | |
| The care team is entitled to respect and security. Who has priority? |